Unfortunately, not everybody has success on their first IVF attempt.
For those couples who need to repeat an IVF cycle, a common question they will ask their
doctor is “what are you going to change?”
This brings up a very interesting question.
Does changing the IVF medication protocol actually help?
Stay tuned
There are many different IVF stimulation protocols.
There is an assumption amongst many infertility patients that if an IVF treatment didn’t
work,then it was because the wrong protocol was selected and therefore it needs to be
changed in order to be successful.
Is this true?
In IVF, we can measure things like how many eggs were retrieved, how many of those were
mature eggs, how many of those fertilized and how many developed and reached the blastocyst
stage.
These parameters can be compared from one cycle to the next.
In order to make these comparisons, it is important to understand that there is a tremendous
amount of variation in how the ovaries respond to medication from one month to the next.
Here are a few examples from my IVF center.
In each case, the medication protocol was the same.
This patient had 7 eggs retrieved on her first attempt, 4 eggs on the second attempt and
9 eggs on the third attempt.
If the doctor had changed the medication protocol in between each cycle, it would have been
mistakenly assumed that these differences were due to the changes in the medication
protocol rather than variability in response of the ovaries.
Here is another example.
This patient only had two eggs retrieved on each of the first two attempts.
Then, on the third attempt, we retrieved 5 eggs and then 9.
It seemed like she was getting better with each attempt but then on the 5th attempt,
only 3 eggs were retrieved.
If there is so much variation from one attempt to the next, how can we determine if changing
the medication protocol is helpful or not?
Honestly, it is very difficult.
One method is to look at a large group of patients who have completed an IVF cycle without
pregnancy and then split them into two groups.
One group will repeat the same medication protocol and the other group will have a change
in their protocol.
That is exactly what was done in this study.
The researchers in this study looked at approximately 4500 IVF patients who underwent more than
one IVF cycle within a year.
About half of them repeated the same IVF protocol and the other half underwent a different one.
The two groups were very similar.
The patients in each group had a similar age, weight and infertility diagnosis.
In total, there were five different IVF protocols that were used in the study.
The researchers separated the patients based on the protocol they used first.
There was a lot of data produced in this study.
I am not going to go through every group because the conclusions were similar.
I will show you the data from the most commonly used medication protocol.
First, let’s look at the number of eggs retrieved.
Here is the number retrieved in the initial protocol.
This is the number collected when the protocol was kept the same for a subsequent attempt
and this is for those patients who had their protocol changed.
In this group, those patients who had their protocol changed actually did slightly worse.
Here is the percentage of eggs that were fertilized which is called the fertilization rate.
As you can see, there was no difference in the fertilization rate regardless of whether
the protocol was kept the same or changed.
This held even for those patients that had a poor fertilization rate in the first attempt
The same was true for the percentage of embryos that reached the blastocyst stage.
What about normal embryos?
Some couples opted to test their embryos frto chromosome abnormalities.
This is known as preimplantation genetic testing or PGT.
When the researchers analyzed the percentage of normal embryos, they also found there was
no benefit to changing the medication protocol compared to keeping it the same
Our InfertilityTV bottom Line is this.
Changing the IVF medication protocol just for the sake of “doing something different”
does not appear to improve a number of important IVF parameters.
It is perfectly reasonable to repeat the same protocol.