More First Time IVF success tips
The basics of IVF are similar from one patient to the next. Nobody wants to do IVF and those that must do IVF would prefer to do it only once. In this series of articles, we explore first time IVF success tips you can use to improve your odds.
Optimize the stimulation of the ovaries
To get the best egg quality, 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.
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.
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 does matter however. 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 two used vaginal progesterone and a daily injection of progesterone. The third group used vaginal progesterone and a progesterone injection every three 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 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.
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 how long you take the estrogen. The amount of time for progesterone however is very improvement. 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.