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,
vaginal estrogen,
estrogen patches
or even estrogen injections.
Doesn’t matter.
The type of progesterone, however, does matter.
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 2 used vaginal progesterone and
a daily injection of progesterone.
The 3rd group used vaginal progesterone
and a progesterone injection every 3 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
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
matter how long you take the estrogen.
The amount of time for progesterone however
is very important.
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,
3 new tips for maximizing
the chances for 1st time IVF success.
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