Failed pregnancies; early or late reflect genetic or obstetric problems, influence the outcome of fertility in IVF like in natural conceptions. Diabetes and hypertension do not affect fertility but can cause complications of pregnancy. Fertility problems in family of either partner are suggestive of tendency of low fertility. If it is genetics related, IVF results will be influenced.
Menstruation is also clinical manifestation of the ovarian and uterine functions. Infrequent periods reflect infrequent ovulation and may need higher dosage of FSH for longer periods. Oligomenorrhoea is also a sign of poorly developed uterus.
In PCO more oocytes retrieved but fewer fertilize due of greater number of immature ones.
Endometriosis lower fertilization, implantation & pregnancy rates compared with tubal factor.
Tubal Dysfunction. Success depends on age of woman, and uterine efficiency Hydrosalpinx negatively affects implantation rates even with IVF. Salpingectomy prior to IVF is suggested.
Uterus is important for implantation and plays a pivotal role in the success of IVF. Congenital malformations envisage poor results. Fibroids and adenomyosis are associated with poor outcome. Fibroids present difficult problem. Presence lowers implantation; removal may distort the cavity to the extent that it may hinder implantation and fetal growth in presence of scar tissue.
Prediction of ovarian response to FSH: Fewer antral follicles on TVS monitoring means; low ovarian reserve, require more gonadotrophins for longer duration and there is increased risk of cycle cancellation.
Women at risk for OHSS have typical polycystic or multi-follicular ovaries (MFO).
High basal day-3 FSH lowers success. Low or excessive response to treatments than desired decreases prognosis. Increasing the dosage is not beneficial in term of pregnancy outcome if the standard regimen has failed to produce results. Poor response is extremely resistant. There may be good response, good ova and fertilization but poor implantation and ongoing pregnancy.
Male Factor . Motility, morphology and count of sperms determine the choice of ART procedure
- Sperms:<1 million in swim up IVF/ICSI can be performed,
- < 500,000 sperms/ml, ICSI is the only choice.
- In normospermic male ICSI has no benefits. No difference in IVF & ICSI results. ICSI may be detrimental by producing poor Embryos. Similarly no benefit of ICSI in unexplained Infertility. Implantation is higher in IVF 30%, in ICSI, 22%, so are pregnancy rates 33% Vs 26 %.
- In azoospermia, if sperm cells can be obtained from the epididymis or testes, IVF/ICSI is the only choice