When your fingers are crossed for that positive sign on a pregnancy test, women will try everything to boost their odds to conceive. But fertility treatment isn’t a one-size-fits-all situation, which is why it’s always different for each individual. “Every patient and couple is unique in terms of history, medical issues, considerations and wishes,” says Dr. Beth W. Rackow, MD, Fertility Specialist at Columbia University Fertility Center. “Although standard protocols for fertility treatment exist, there is always room for individualizing treatment.”
Of course, there are steps women can take to boost her chances of conceiving. “Prior to seeking fertility evaluation and treatment, a woman can attempt to improve her fertility by maintaining a healthy lifestyle (healthy diet and exercise habits and reasonable weight), limiting exposure to toxins such as alcohol, avoiding tobacco and recreational drugs, and avoiding many vaginal lubricants,” Rackow says. “Also, optimizing any medical conditions (hypertension, diabetes, etc.) and medications prior to fertility treatment and pregnancy is ideal.” In addition to eating healthy, getting enough sleep is also crucial, according to Norbert Gleicher, MD, Medical Director and Chief Scientist, Center for Human Reproduction. He adds, “Women over age 35 may benefit from 25 mg of DHEA per day.”
A woman should see a fertility specialist when she is under age 35 and has been trying to conceive for one year, age 35 or older and trying to conceive for six months, or if she has a known medical issue that could affect her fertility such as endometriosis, polycystic ovarian syndrome (PCOS), or a history of cancer treatment, advises Rackow. “After age 38, women should see a specialist after 6 months of trying, because women have less time to lose at that age,” Gleicher says.
So how do you know which fertility treatment is right for you? Ultimately, every woman will have a different course of action, “because causes of infertility are different,” Gleicher says.
However, it can be helpful to familiarize yourself with a few popular fertility treatment options, such as Needle-free IVF, which enables ovarian stimulation with the use of oral medications instead of injectable medications. “This is a great alternative for several reasons — great for women with a phobia of needles, for women who do not respond well to injectable medications and may have responded better to oral medications in the past, or for women who are interested in a lower-cost alternative to traditional IVF (the medications are less expensive than injectable medications),” Rackow says. “Fewer oocytes are produced during this ovarian stimulation regimen. This protocol is more commonly used for women with diminished ovarian reserve.”
But different doctors prefer different methods, and Gleicher isn’t a fan of the procedure. “Needle-free IVF is a marketing ploy and nothing else,” he says. “It means that one uses a woman’s natural cycle. But women in a natural cycle produce only one egg. And even that one egg is retrieved in about 6% of attempts. In other words, it is a great-sounding marketing tool but really bad medicine because, after female age, how many eggs/embryos a woman produces in an IVF cycle is the best predictor of pregnancy success. And that says it all! I would not recommend this to anybody.”
Mini IVF is another common option. “Mini-IVF uses lower doses of medication for ovarian stimulation during IVF, and the goal is to achieve the development of a few oocytes,” Rackow says. “Some women respond better to lower doses of injectable medications compared to higher doses of medications. This process can be beneficial because the risk of multiple gestation is lower, the risk of ovarian hyperstimulation (over-response to medications) is lower, and the cost is lower. This treatment can be used by women with normal ovarian reserve and those with diminished ovarian reserve.” However, Gleicher only recommends it for a particular group. “Since it is cheaper than a regular IVF cycle on a per-cycle basis, at CHR we only use it in young women with good ovarian function who cannot afford a regular IVF cycle,” he says. “Mini IVF is basically a natural cycle IVF mildly enhanced with very small quantities of fertility drugs. Like explained above, because this kind of IVF also produces small numbers of eggs and embryos, it, too, produces fewer eggs and embryos, which in turn means lower pregnancy rates.”
Another option is In Vitro Maturation (IVM), in which immature oocytes are removed from the ovary and cultured in the IVF laboratory until mature, then either fertilized with sperm or cryopreserved for future use, Rackow explains. “This process occurs either with the use of injectable fertility medications, or without medications,” she says. “IVM is best for females who have a limited window or no window for ovarian stimulation (i.e. need cancer treatment), thus immature eggs are removed from the ovaries, for those at high risk for ovarian hyperstimulation syndrome thus less stimulation of the ovaries is ideal, or those who should not be exposed to high levels of estrogen (i.e. estrogen-sensitive tumor). This treatment is considered less successful than IVF, so when possible, more traditional IVF should be utilized. Although IVM is used clinically and babies have been born from this process, it is still considered an experimental treatment.” Gleicher adds, “In patients who produce only few eggs and every egg is very valuable, we may try in vitro maturation. It sometimes works, but is still relatively ineffective.”
Ultimately, the best course of action is to come up with an individualized plan with your doctor, since there are plenty of options out there. “Available fertility treatments include ovulation induction with oral or injectable medications (for women who do not ovulate), controlled ovarian stimulation with oral or injectable medications (ovulating more than one egg per month increases the chances of conceiving), intrauterine insemination (IUI), in vitro fertilization (IVF) and the option of adding preimplantation genetic testing of embryos as part of the IVF cycle,” Rackow says. “Treatment for each woman or couple needs to be individualized, and a lot of testing and thought process goes into a provider’s recommendations for treatment.”