The objective with In Vitro Fertilization is to expertly transfer one or
two “competent” embryos to an optimal and receptive uterine environment
and then hormonally support implantation. This requires a very
individualized and meticulous approach to the evaluation and treatment
of those factors that influence IVF outcome:
In 70-80% of cases, failed reproduction is a consequence of egg/embryo incompetence. The number of eggs a woman produces is influenced by her ovarian responsiveness to gonadotropin fertility drugs. This responsiveness in turn relates to her proximity to menopause. Ovarian responsiveness can be assessed by measuring FSH / estradiol (E2) and Inhibin B on the 3rd day of a prior menstrual cycle, and measuring AMH at any time in the cycle. If the plasma FSH level measures greater than 9.0MIU/ml in association with plasma estradiol level of less than 70pg/ml by EIA, and/or the plasma inhibin B level is less than 45pg/ml, and AMH of less than 2.0ng/ml, it would suggest the possibility ofdiminishing ovarian reserve (DOR). This indicates a need to be more aggressive and strategic in the design of an individualized protocol used for controlled ovarian stimulation.
While the most important variable in IVF is structure and execution of the ovarian stimulation protocol, there is also little doubt that the quality of the IVF laboratory is also pivotal. However, in my experience, most reputable IVF programs have laboratory staff who are highly disciplined and efficient when it comes to structure and process, and are very capable of performing highly technical procedures such as intracytoplasmic sperm injection (ICSI), embryo biopsy, and assisted hatching (AH). In fact, poor IVF outcome results can usually be traced to clinical, rather than laboratory deficiencies. IVF procedures should only be performed by those who have the necessary experience and skill set, lest fertilization rates and embryo quality be severely compromised.
In 70-80% of cases, failed reproduction is a consequence of egg/embryo incompetence. The number of eggs a woman produces is influenced by her ovarian responsiveness to gonadotropin fertility drugs. This responsiveness in turn relates to her proximity to menopause. Ovarian responsiveness can be assessed by measuring FSH / estradiol (E2) and Inhibin B on the 3rd day of a prior menstrual cycle, and measuring AMH at any time in the cycle. If the plasma FSH level measures greater than 9.0MIU/ml in association with plasma estradiol level of less than 70pg/ml by EIA, and/or the plasma inhibin B level is less than 45pg/ml, and AMH of less than 2.0ng/ml, it would suggest the possibility ofdiminishing ovarian reserve (DOR). This indicates a need to be more aggressive and strategic in the design of an individualized protocol used for controlled ovarian stimulation.
While the most important variable in IVF is structure and execution of the ovarian stimulation protocol, there is also little doubt that the quality of the IVF laboratory is also pivotal. However, in my experience, most reputable IVF programs have laboratory staff who are highly disciplined and efficient when it comes to structure and process, and are very capable of performing highly technical procedures such as intracytoplasmic sperm injection (ICSI), embryo biopsy, and assisted hatching (AH). In fact, poor IVF outcome results can usually be traced to clinical, rather than laboratory deficiencies. IVF procedures should only be performed by those who have the necessary experience and skill set, lest fertilization rates and embryo quality be severely compromised.
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