Attempting IVF is a big decision due to the enormous investment of time, emotion, and financial resources, and you want to do everything you can to improve your chances of success. While you can’t do anything about your age, you can still control certain conditions to improve your odds of bringing home a baby. Before starting the IVF journey, you should do a check list for factors that can impact your chance of success:
1. Know your egg reserve-
Signs of low egg reserve are short menstrual cycles (26 days or lower), hot flashes when not on menses, low AMH level (<1.5 ng/ml) and low antral follicle count (10 or lower) during the first 3 days of the cycle.
Low egg reserve requires special protocols to optimize egg recruitment. For example, in women with very low ovarian reserve, protocols that use of birth control pill can diminish the response of the ovaries. In contrast, protocols that release of natural store of FSH from the pituitary and use estrogen priming can help to reduce the cost of medications and enhance ovarian response.
2. Watch your weight-
Studies have shown that women with BMI of >32 have a significantly lower chance of pregnancy with IVF and require a higher doses of medications that can rapidly increase cost.
A healthy weight loss plan requires extended time that may not be available for some patients- in these cases, a referral to a nutritionist or a clinic that specializes in medically supervised weight loss may be necessary.
3. Prepare your body-
Stop smoking and avoid second hand smoking- cigarette smoke contains harmful chemicals that can be toxic to your eggs. Women who smoke tend to experience early menopause.
Take natural supplements such as antioxidants, Coenzyme Q10, Omega-3 fatty acid, DHEA (if you have low egg reserve), and vitamin D (if your level is low). Men can also take antioxidants to improve the quality of their sperm.
Reduce stress in your life- Stress can cause constriction of the blood vessels that supply the ovaries and uterus. In addition, emotional stress can reduce the release of natural FSH that helps stimulate the ovaries in special protocols we use to help women with low egg reserve.
Acupuncture, mediation, yoga, and mild exercise can help reduce stress by releasing endorphins, the ‘feel good hormones’, within the brain.
4. Research your clinic-
Success rates for your age group- Clinics can have different success statistics due to the different populations they serve; however, choose clinics that have live birth rates that are better than the national average for your age group.
Check if the IVF clinic is certified by SART (Society for Assisted Reproductive Technology). In order to be a member, a clinic must meet the highest standards for quality, safety, and patient care.
Check if the clinic provides special measures to select optimal sperm for fertilization such as microfluidic technology and PICSI that can be used to eliminate sperm with abnormal DNA fragmentation.
Ask if the clinic has a lot of experience working with patients with fertility issues like yours and if the physicians are flexible in customizing the stimulation protocols to suit your special need. For example, if you have low egg reserve, you should seek someone experienced in working with women low ovarian reserve.
How does the clinic treat its patients? Will you have easy access to your doctor at every visit or just on certain occasions?
5. Plan for a successful embryo transfer-
Remember to use progesterone as instructed. Progesterone is probably the only medication that matters to make the uterine lining receptive to the embryo.
Avoid antihistamine medications as they can impair blood flow to the uterus.
Bromelain, an enzyme found in pineapple juice, can reduce inflammation and may aid implantation. Supplement can be found at health food stores.
For best chance of implantation consider embryo transfer during a frozen cycle. In a fresh IVF cycle high levels of hormones and medications can make the uterus less receptive to the embryo. In a frozen cycle the uterine lining grows under conditions similar to those of a natural cycle and can accept the embryo more readily.
The new flash freeze method (vitrification) has revolutionized embryo freezing. Embryos that are fast frozen using this method can survive thawing and implant as well as a fresh embryo.
A smooth transfer under ultrasound guidance can enhance success. A trial transfer is usually performed during the early phase of the IVF process to make sure that this will be performed easily and with precision. The skill and experience of the physician are important during the embryo transfer.
6. Consider uterine lining scratching-
Finally, for women with a thin or suboptimal uterine lining, an endometrial biopsy or ‘uterine scratching’ prior to the actual frozen transfer cycle may improve the chance of success the next time.
Disrupting the lining of the uterus with a catheter prior to the actual treatment cycle is thought to promote local healing and make the endometrium ‘stickier’ to the embryo. The procedure can be performed without much discomfort by the use of local anesthetics such as the paracervical block.