Office based IVF is the best treatment for a number of fertility problems. In cases of tubal disease or absent fallopian tubes, or when there is extensive scarring of the tubes and ovaries, IVF may allow a woman to achieve a pregnancy. Another group are women who have had surgical sterilizations, where large sections of the fallopian tube have been removed: their chances of a successful microsurgical sterilization reversal may be low. Office based IVF is also used effectively in women with Endometrioses, uterine fibroids and unexplained infertility.
Different protocols are now used in IVF for stimulating the ovaries to produce multiple eggs. One approach is used for patients with very sensitive ovaries, such as young women or women with Polycystic ovary disease (PCO). A different regimen is called for in patients with more resistant ovaries, such as women who are over 35 or 40 or who have not responded well to standard fertility injections in the past.
Another variation on the Office based IVF theme is natural cycle IVF. Natural cycle IVF has the advantage of being less expensive -- but it also has a lower success rate. The key difference between this program and regular IVF is that no fertility drugs are used to stimulate the ovaries. In most cases, only one egg is retrieved, so no extra embryos can be frozen.
Gamete intrafallopian transfer (GIFT) and zygote intrafallopian transfer (ZIFT) were developed to take advantage of the fallopian tube as nature's incubator. In GIFT, the eggs and sperm are loaded into a catheter and injected into the tubes, where fertilization occurs naturally. GIFT is acceptable to some religious groups that otherwise oppose IVF. The disadvantage of GIFT and ZIFT is that they both require an additional surgical procedure -- a laparoscopy, in order for eggs and sperm (GIFT) or early embryos (ZIFT) to be transferred back to the tubes. In addition, with GIFT due to a relatively non-precise selection of eggs, the chances of pregnancy may be compromised and chance of high order pregnancy increased.
Donor Egg IVF
Donor egg IVF allows women whose ovaries do not produce eggs to bear children. The infertile woman becomes the recipient of eggs donated by a friend, relative or volunteer donor. The donor eggs are fertilized in the lab with sperm from the husband of the infertile couple. Resulting embryos are transferred to the infertile woman's uterus.
Once experimental, this treatment is now becoming a standard form of care. It is recommended for women with premature ovarian failure, for women with impaired ovarian function, for carriers of a genetic disease, and for women whose fertility is declining with age, or who are past menopause.
There are also couples who have had repeated failure at IVF. After three or more cycles of IVF, a couple might want to consider trying donor egg IVF, which has a higher success rate. Success rates for donor egg IVF can be two to three times higher than with regular IVF. Much of this success is due to the use of young, normally fertile donors. The disadvantages of donor egg IVF are the higher cost and that the couple will bear a child that is not genetically the offspring of the woman who carries the pregnancy.
There is a growing movement to recommend donor egg IVF rather than regular IVF as a first step to any patients over 42 years of age. Success rates nationally for regular IVF for women over 40 are 7.2% per cycle. On the other hand, the rates for women over 40 using donor egg IVF are 31%. If a younger sister or relative is willing to be the donor, this can be a very attractive option for a couple.