I have been getting a lot of Email from patients asking for more tips to increase their chances for first time IVF success. Here is our 2019 edition
IVF Success tip 1
Optimize the stimulation of the ovaries - To get the best quality eggs, the ovaries need to be stimulated with two different hormones - FSH and LH. FSH is the hormone found in medications like Follistim and Gonal F. Either of these medications will work great for your IVF protocol.
LH however is a little trickier. When FSH is injected into your body, it lasts a long time - very stable. When LH is injected, however, the body breaks it down very quickly. So if you are using a source of LH like Menopur, its difficult to know if you will get the LH effect that you want.
Here is a little secret. LH is very similar to the hormone hCG. They both act at the same receptors in cells. In many cases, LH and hCG do the same thing. hCG however has a little extra piece that LH doesn’t have. That extra piece makes hCG more stable. When you inject hCG it lasts a long time in your body.
As a result, IVF protocols that combine FSH and hCG may work better than FSH and LH. So ask your doctor for the low dose hCG protocol. Oh and one other advantage, hCG is a lot cheaper so you can save a few thousand dollars in medication costs
IVF Success tip number 2
Use the right kind of progesterone. You already know from our last video on first time IVF success that you should be doing a frozen transfer instead of a fresh transfer. To do a frozen embryo transfer, you first prepare the uterus with two medications - estrogen (to get the lining thicker) and progesterone to make the lining receptive to an embryo. It does not seem to matter what kind of estrogen is used. It can be oral estrogen, vaignal estrogen, estrogen patches or even estrogen injections. Doesn’t matter.
The type of progesterone does matter however. This last year, a study was presented involving about 1000 women who were doing a frozen embryo transfer. They were split into three groups. Group 1 took vaginal progesterone only. Group two used vaginal progesterone and a daily injection of progesterone. The third group used vaginal progesterone and a progesterone injection every three days.
What they found is that the group using vaginal progesterone only had lower pregnancy rates. So much so that they stopped adding patients to that group even before the study was over. There was no difference detected in whether injections of progesterone were added every day or every three days.
So for this tip make sure you are taking both types of progesterone. Vaginal progesterone every day and injections of progesterone every 3 days
IVF success tip number 3
Timing the embryo transfer. It turns out that not only does it not matter what type of estrogen you use, it also doesn’t matter how long you take the estrogen. The amount of time for progesterone however is very improvement. Progesterone changes the uterine lining to make it receptive to an embryo. For most women, the optimal time to place a blastocyst stage embryo into the uterus is on the 6th day of progesterone. There are some women, however, where the timing is different. For those women, it might be better to put the embryo into the uterus before or after the 6th day. To determine the correct timing, we need to do a test called an Endometrial Receptivity Array or ERA. To do this test, a woman must take her estrogen and progesterone the same way she would if she was planning to do an embryo transfer. But, instead of doing an embryo transfer, her doctor will take a sample of her uterine lining for the ERA.
Not all women should have this test before their first attempt. This test is best for women who have already have had multiple failed transfer attempts. However, there are some circumstances in which it might make sense to do it before a first attempt. Women who are obese, with a BMI over 30 have a higher rate of timing problems. They should consider the ERA before their first attempt. Another group would be couples who only have one embryo for transfer. Just to do everything to maximize their chances for what might be their only attempt.
OK there you have it, three new tips for maximizing the chances for first time IVF success.
