The first pregnancy achieved through in vitro fertilization (IVF) from a human egg and sperm was reportedly from Monash University in Australia in 1973 under Drs. Carl Wood, John Leeton and Alan Trounson. That pregnancy only lasted a few days and today we would refer to such an occurrence as a chemical pregnancy. On July 25th, 1978, Louise Brown was born in Manchester, England as a result of an embryo created and implanted by Drs. Patrick Steptoe and Robert Edwards. History was made and a world of opportunity opened for those suffering from infertility problems or unable to carry a pregnancy themselves.
Since those early days, doctors and scientists have continually looked at ways to improve IVF success rates. One of the most important factors in determining IVF outcome is the quality of the egg and sperm. There are no clinically proven ways to improve egg quality once a decline in egg quality has begun, since women are born with all the eggs they will ever have. Typically egg quality begins to decline around the age of 38 years. Poor egg quality is caused by diminished ovarian reserve and is strongly associated with chromosomal abnormalities in embryos resulting in poor implantation rates, increased rate of miscarriage and birth defects. Alternatively, men develop new sperm every 74 days. Therefore, even a slight changes in lifestyle choices often results in improved sperm quality.
Here are 6 tips on how to improve IVF outcomes:
Freeze your Eggs
According to SART (Society for Assisted Reproductive Treatments), which records approximately 90% of all ART clinic cycles in the USA, age is a significant factor in ensuring a successful IVF cycle. Overall live birth rates for singletons in 2017 were as follows:
- Under 35 years-old: 33.6%
- 35-37 years-old: 26%
- 38-40 years-old: 16.9%
- 41-42 years-old: 8.5%
- Older than 42 years-old: 2.8%
In addition, the percentage of abnormal eggs increases with age. Studies have shown that women in their 20’s have mostly healthy eggs (around 20% of their eggs are abnormal), whereas by the age of 40, around 80% of her eggs are no longer healthy.
If you are not ready to start a family and/or have not selected a parenting partner, a good option to protect your fertility future is to stop your biological clock and freeze your eggs. Frozen eggs remain the same biological age as when they were cryopreserved, thereby boosting your chance of a future pregnancy. It is recommended that women consider freezing their eggs prior to their 38th birthday.
Alternatively, there is the option of creating embryos and freezing the embryos for future use. In more recent years the success rates of fresh embryo transfers and frozen embryos transfers is almost identical. In December 2020 (yes there is some good news from 2020), a baby girl was born in Tennessee, USA, from a 27-year-old frozen embryo! Embryos that were created in 1992 were donated to another couple and resulted in the birth in 2017 of Emma, followed in 2020, with the birth of Molly. Ben Gibson, the father, has cystic fibrosis, and his wife, Tina, is also a carrier. Fearing they may pass the disease on to their children, they elected to work with embryos graciously given to them by another couple.
Annual Hormone Check
It is also recommended that every woman monitors her hormones levels at least once a year from the age of 28 years onwards. Any fluctuation in her reproductive hormones (Follicle Stimulating Hormone, Estrogen, Luteinizing Hormone and Anti-Mullerian hormone), or a change in your cycle should be a cause for concern. (Concern but not alarm!) If your hormone levels begin to fluctuate, we recommend a consultation with a specialist in reproduction with hormone levels tested twice a year going forward.
Although it rarely happens that women may have elevated reproductive hormone levels under the age of 38 years old, all that is required is a blood test once a year to monitor hormone levels. It is perhaps better to know that your hormones are in balance than to learn too late that your egg quality is no longer optimal. A visit to an IVF clinic will result in not only a blood test for your hormone levels, but an Antral Follicle Count (AFC) ultrasound which will show the number of your “resting” follicles. The more follicles seen, the higher the ovarian reserve. In addition, the Anti-Mullerian (AMH) hormone blood test will be a good indication of whether or not a woman still has a large pool of growing follicles and therefore that she will continue to produce more viable eggs.
Healthy lifestyle
A healthy diet is highly recommended for both men and women. A Body Mass Index (BMI) for females below 35 has consistently resulted in better IVF success rates. In addition, higher BMI increases the risk of complications during retrievals. Male fertility rates are easier to improve as new sperm takes just 74 days to mature. Within a 3-month period a man can adjust his lifestyle and see improvements in his sperm quality and quantity. Your best friend is water. Stay hydrated as blood flow in the body can quickly decrease from dehydration. Drinking 64oz/2L of water each day is recommended.
Smoking, Alcohol & Drugs
Smoking, caffeine, alcohol and use of drugs should be avoided completely, as they are regularly linked to difficulties in conceiving. All medicines, including over the counter, have risks. Your doctor may recommend medicine changes once she/he knows you intend to achieve a pregnancy. If medicines are not absolutely necessary, it is recommended that you avoid taking them
Vitamins & Supplements
There are some supplements and vitamins that are believed to increase egg quality. Be warned that there is an absence of strong scientific evidence on this subject. Foods rich in antioxidants and zinc are encouraged. Try avoiding trans fats, refined carbs, processed foods and excessive salt and sugar. In other words, try eating healthy.
DHEA (dehydroepiandrosterone) Supplements have demonstrated some improvement in egg quality and quantity. It appears that it improves the low androgen levels in women with diminished ovarian reserve. This improved level appears to affect egg quality positively. Typically, between 25 to 200 milligrams a day for 8 weeks prior to an IVF cycle is recommended. Using CoQ10 (Coenzyme Q10) supplements may also help improve egg quality and implantation rates. CoQ10 is an important nutrient for mitochondria (from high school biology class: mitochondria are the cells that provide energy to the eggs and product ATP that helps the cells properly divide). The use of DHEA and CoQ10 is presently lacking in scientific backing and remains experimental.
The older the woman, the fewer mitochondria in her cells. One theory is that reduced mitochondria are closely related to lower fertility rates. Newer research appears to indicate that B Vitamins provide positive nutrient to mitochondria.
We highly recommend you consult with your doctor before taking any vitamin or supplement.
High Success Clinics
Just because a clinic is close to your home, does not mean that is your best choice. Individual clinic success rates should be reviewed. In the USA, clinic success rates can be reviewed on the SART (Society for Assisted Reproductive Technology) website: www.sart.org. However, these statistics alone do not provide a clear picture. Some clinics turn away patients with low chances of success, whilst other clinics will assist these patients. Some clinics transfer only one embryo per cycle whereas others may transfer multiple embryos per cycle.
In addition, we highly recommend that you interview and research at least three clinics. Although IVF clinics are similar to one another, there are differences that you need to tease out. Costs can differ significantly between practices. The real, yet undiscovered, gem of any IVF clinic is the embryologist. That elusive scientist behind the scenes is mainly responsible for the amazing success rates the clinics achieve. Make sure you know who the embryologists are, their reputation and qualifications and how long they have partnered with the clinic.
Another avenue to pursue is recommendations. If any of your friends, colleagues, and relatives have been through the process, ask who they worked with. Personal references are usually very trustworthy.
Finances, religious beliefs, and relationship dynamics all play a role in choosing your IVF clinic. Feeling that you are understood by your clinic and that they have the staff that respond to your inquiries and phone calls satisfactorily are important to your mental health as you navigate your IVF journey. It is for all these reasons that we have recommended that you book a consultation with at least three IVF clinics before making your final decision. Once you have done your research, looked at the statistics and completed a consultation, you will be ready to decide and can move forward knowing that this was the right decision for your care.
Thank You!
012021Art000019
