Criteria

The indications for In Vitro fertilization include tubal factor infertility, endometriosis, male factor infertility, immunologic infertility and unexplained infertility.

Tubal Factor Infertility

Tubal and pelvic adhesion-related disease accounts for approximately 25% of cases of infertility. In Vitro fertilization has proven far more successful than conventional surgical approaches in cases of severe tubal damage. IVF therefore should be considered the primary therapy for women who have poor prognosis tubal disease and especially in instances where prior tubal surgery has not resulted in pregnancy. The prognosis for these patients as a group is very favorable.

Endometriosis

Moderate to severe endometriosis can lead to infertility; however minimal (Stage I) and mild (Stage II) endometriosis may also lead to reproductive difficulty. More advanced disease may distort the pelvic anatomy by scar tissue formation and may cause deleterious immunologic changes in the pelvic cavity. When infertility is unresponsive to typical medical or surgical treatments, IVF can offer success rates similar to those couples who have tubal factor-related infertility. In general, IVF pregnancy rates are relatively unaffected by the stage of disease.

Male Factor Infertility

Approximately 40% of couples have male factor as the primary cause for infertility. The normal sperm parameters on conventional semen analysis include the concentration of greater than 20 million/ml with motility (movement) greater than 50% and more than 30% normal forms (World Health Organization Criteria, Third Edition).

Abnormalities on semen analysis may be related to low concentration and/or poor motility, and/or decreased normal forms. The causes of abnormal semen analyses are manifold and specific treatment by a urologist or andrologist may be in order.

IVF has become increasingly effective in the management of profound male factor infertility. The probability of fertilization is increased by the ability to inseminate a high number of motile sperm cells with eggs in the Petri dish. More recently, direct intracellular (egg) sperm injection or ICSI has further improved the chances for successful fertilization in cases where sperm quality is very poor.

Following ICSI, the per transfer pregnancy rates are actually similar to those seen in patients with other indication, once successful fertilization has been achieved. IVF should also be strongly considered in cases where the husband has cryopreserved sperm prior to chemotherapy, radiation therapy or radical surgery for malignant disease.

Immunologic Infertility

Antisperm antibodies may be suggested by an abnormal post coital test, suboptimal motility on a routine semen analysis or past vasectomy reversal. Antisperm antibodies may be present in the male and/or the female reproductive tracts leading to infertility.

IVF pregnancy rates for patients with antisperm antibodies are comparable for those in the general IVF population. If the husband has the antisperm antibodies (e.g. post-vasectomy reversal), ICSI may be necessary to assist fertilization.

Unexplained Infertility

Unexplained infertility is a diagnosis of exclusion reserved for approximately 10-12% of infertile couples. If pregnancy has not occurred with other less aggressive forms of treatment, patients with unexplained infertility may well benefit from IVF. IVF success rates are very good for these couples, typically better than for patients with pure tubal factor infertility. Importantly, IVF may prove diagnostic in some of these cases due to unknown sperm or egg defects which may only be known in the context of a decreased fertilization rate, abnormal oocyte quality, or poor embryonic development.