When should you do IVF?

Nobody wants to do IVF. Whenever a couple or individual comes to a fertility clinic, the goal is to work as naturally as possible to maximize the chances for pregnancy. So IVF can feel like a scary direction, both financially and emotionally.

But if it’s been more than six months of trying naturally together, there are three situations in which IVF may make the most sense:

1. Low sperm quality

Whenever male subfertility is present, couples may try to improve their odds through lifestyle changes, vitamins, medication, or intrauterine insemination.

But none of the above are as effective as IVF. That’s because IVF bypasses all the concerns associated with sperm count, motility, morphology, or obstructions related to previous vasectomy or a congenital absence of the vas. All those issues become non-issues with IVF plus ICSI. (ICSI, intracytoplasmic sperm injection, places the sperm into the eggs. No swimming required!)

In other words, as long as the DNA being carried by the sperm is healthy and normal, IVF is exceptionally successful. (That’s why you might consider getting a karyotype and DNA fragmentation test done beforehand, to confirm normal genetics.)

2. Fallopian tube issues

When there’s something compromised about your fallopian tubes, it’s very rare that they can successfully reopened through cannulation. Fallopian tube issues are pretty tricky; hard to diagnose, hard to test, and hard to fix. IVF can be handy because it completely bypasses your tubes.

So if your eggs and sperm are good quality, your uterus structure is healthy, and your health is good, IVF can help the sperm reach the egg, and get you pregnant.

3. Lots of low-quality eggs

This situation is more complex. Many couples, particularly when women are over 35, increasingly worry about egg quality.

You might think IVF wouldn’t help much, because simply placing a sperm inside the egg does not increase its quality. 93% of first trimester losses are related to embryo quality, 90% of which come back to the egg. So egg quality is a serious concern in any fertility setting.

Here’s how IVF helps in this scenario: numbers. Instead of the 2-4 eggs we encourage people to have intercourse or inseminations with, we would be aiming for 10, 15 or 20 eggs with IVF. It’s like one or two years of trying, all focused on a single cycle. Your odds are better with more eggs, even if quality doesn’t improve.

That said, IVF isn’t always best.

For example, if you have low egg quality and low egg quantity, IVF may not help much. Likewise, when the issue is something simple like a treatable uterine structure abnormality or overall health factor, IVF is unlikely to be successful.

So although IVF remains our gold standard of therapy, it’s not for everybody.