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Ask The Expert: Optimizing Conception

I spoke with a patient today about optimizing conception. Her concerns were age and cervical factor. At age 39, there are relatively few eggs of relatively poor quality available. She had surgery on her cervix a few years ago for a Pap smear concern, and her cervix was somewhat closed. Here is what I told her:

The main problems we are addressing are cervical factor and diminished ovarian reserve. Inseminations work for cervical factor, but do not do much for egg problems.

Ovulation induction with injectable medications like Follistim or GonalF would offer about twice the pregnancy rate of a natural cycle. The concern is the increased risk that attends this - the chance of multiple gestation and all its problems, miscarriage, and clinical aneuploidy (Downs Syndrome et al). For this reason, I don't often recommend this route. It is standard fertility therapy, but risky.

For egg problems a better choice is IVF with CCS. With this approach we intentionally stimulate multiple eggs and inseminate all of them in the lab. The resulting embryos are then tested to find the ones with normal chromosomes. They are stored (vitrified) and then warmed one at a time for later transfer.

IVF+CCS offers the highest implantation rates availablein fertility treatment, in the range of 60-70% per transfer (some groups are even higher). And the process carries relatively low risk of multiples, miscarriage, and clinical aneuploidy.

The main problem is that the treatment is expensive; but there is good return on the money spent.

The other concern is that not every woman that undertakes the treatment finds a healthy embryo to transfer.

All these are options. The choice depends on cost, risk, and outcomes. From my point of view, IVF+CCS offers the best outcomes when IUI does not work.

- Philip Chenette, M.D.

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