Whenever an individual or couple begins fertility treatment, the hope is that all goes well and pregnancy occurs during the first cycle. Unfortunately, that is not often the case. It doesn’t matter whether a woman is under the care of her own OB/GYN or a reproductive specialist, the success rate from the first treatment cycle is not very high…
IF AT FIRST YOU DON’T SUCCEED…
In reality, more than one treatment cycle is often necessary; in fact, more than one type of treatment may be needed as well, in order to conceive. When it takes more than one cycle or treatment type, doctors are able to learn more about the patient and their particular fertility issue, using the information gathered to develop an enhanced treatment plan for cycles in the future.
As a patient begins the fertility treatment process, the reproductive specialist or OB/GYN will recommend some very basic testing to determine a diagnosis. This work-up will also help the doctor determine a beginning point for developing a treatment plan.
The following three tests are typically used for initial diagnosis and treatment planning:
Semen Analysis:
This male factor testing is comprehensive, determining the total number of sperm, the sperm’s size and shape, as well as looking at the way the sperm swim and in which direction. There are a number of other factors reviewed during the sperm analysis process, such as the volume of semen collected, semen color, and how it clumps and liquefies. This test is a critical component in the initial work-up. If the semen tested is normal, or if mild male-factor infertility is found, low-tech treatment options are often suggested. If more severe male factor infertility is observed during the semen analysis, In Vitro Fertilization (IVF) with ICSI may be recommended.
Blood Work:
Blood work is collected to look for female factor infertility. The blood is evaluated to determine a woman’s ovarian reserve (OR); the levels of both reproductive hormones, Anti-Müllerian hormone (AMH) and Follicle Stimulating hormone (FSH), are tested. Normal levels of these hormones indicate that the ovarian reserve is fine. When the levels are normal, doctors will start the fertility treatment with low-tech options. When abnormal levels are found in the blood work, more advanced treatment options, such as IVF, may be recommended as the first step in the fertility treatment process.
Hysterosalpingogram (HSG):
An HSG is a type of X-ray that looks at a woman’s fallopian tubes and uterus, assessing whether they are open or blocked. No matter what the results of the semen analysis and the blood work are, if both fallopian tubes are blocked, there is a physical issue that must be considered in the treatment planning process. Typically, reproductive specialists will recommend IVF when both tubes are blocked; IVF allows them to completely bypass the blocked tubes. An Intrauterine Insemination (IUI) may be recommended as a treatment starting point if one or both tubes are open and the blood work results and semen analysis support a more low-tech approach.
Although the initial test results provide a reproductive specialist with some basic information, the first treatment cycle provides more specific information about how an individual will respond to treatment. When a patient does not get pregnant in the initial cycle, the doctor will use that information to change the current plans and protocols in an effort to improve conception chances in subsequent treatment cycles.
TRY, TRY AGAIN
Reproductive specialists can learn something from each completed cycle, whether or not they are successful. An IUI cycle can supply information about the response to medication prescribed. IVF cycles allow reproductive specialists to look at the eggs throughout the different stages of development. Reproductive specialists often evaluate failed treatment cycles in several different ways.
Doctors and staff will look at the following in order to fine-tune the fertility treatment plan:
- The response to prescribed medications is always important to note. The type of medication and dosage may need to be adjusted based on a woman’s physical reaction.
- The thickness of the uterine lining is an important consideration; estrogen may be needed to thicken the uterine lining in order to create a better physical environment for the embryo to attach and develop.
- Semen quality should be re-evaluated before each insemination or fertilization attempt. If the semen quality has negatively changed since the initial evaluation, the reproductive specialist may determine that alternative treatment steps may be necessary.
- If the eggs do not get fertilized when the sperm and egg are placed together through conventional methods, reproductive specialists often move quickly to the next potential step. In an effort to increase the possibility of fertilization, intra-cytoplasmic sperm injection (ICSI) may be used. With this method of fertilization, an embryologist chooses one specific sperm and inserts it directly into the egg for fertilization.
- Embryo development is equally important. While some eggs may fertilize appropriately, they may not develop appropriately due to an egg quality issue. If the egg quality is poor, conception is challenging. Understanding how a woman’s fertilized eggs are developing gives the doctor valuable information to change a treatment course if necessary.
Many patients, individuals and couples, must make some very difficult choices when working through an infertility diagnosis and subsequent treatment. There is so much information to consider and so many personal questions to answer. Many patients wonder how many times should they try a particular type of treatment before moving on to the next step, such as moving from IUI to IVF. When considering moving to a different type of treatment, reproductive specialists will look at the information gathered from prior cycles, as well as the documented statistics for current success rates. Because success rates often tend to decrease after three to four attempts, doctors will consider that information when recommending potential changes to a fertility treatment plan.
FAILURE IS THE KEY TO SUCCESS
An unsuccessful cycle should never be perceived as a failure; instead, look at it as a chance to learn valuable information that may help you achieve your family-building goals. Each cycle completed gives your reproductive specialist the opportunity to find the best ways to individualize and improve your fertility treatment program. Helping you and other patients fulfill their dream of a successful pregnancy is your reproductive specialist’s ultimate goal!
The reproductive specialists and highly skilled professionals at the Center of Reproductive Medicine (CORM) are recognized for their outstanding success in helping patients to conceive. With conveniently located clinics in Houston, Clear Lake, Beaumont, and a new satellite office in Pearland, our team at CORM is dedicated to providing the very best in reproductive medicine and fertility treatment, ensuring exceptional attention and care is given to each and every patient/couple in need. In addition, the physicians and staff at CORM will work closely with you throughout your treatment, offering all the information and explanations necessary for you to make informed decisions based on your individual reproductive medical needs.