In Vitro Fertilization Techniques and Considerations

Primary IVF Techniques

The American College of Obstetricians and Gynecologists recommends ovarian stimulation with follicle-stimulating hormone (FSH) for approximately two weeks from the onset of menses, followed by ultrasound-guided transvaginal oocyte retrieval under intravenous sedation, with a cited success rate 1

The American Society for Reproductive Medicine suggests that IVF with elective single embryo transfer (eSET) has become increasingly preferred to minimize multiple pregnancy rates while maintaining acceptable pregnancy rates, with ongoing pregnancy rates exceeding 38% 2, 3, 4
When IVF-eSET achieves ongoing pregnancy rates exceeding 38%, it becomes the preferred treatment over intrauterine insemination with ovarian stimulation (IUI-OS), according to the European Society of Human Reproduction and Embryology 2, 3, 5, 4
Modified Natural Cycle (MNC) IVF involves minimal or no ovarian stimulation, retrieving the naturally developing oocyte(s) during a woman's regular menstrual cycle, as recommended by the National Institute for Health and Care Excellence 2, 4, 6

The American Society of Clinical Oncology recommends embryo cryopreservation as the most established fertility preservation method, involving conventional IVF followed by freezing of fertilized embryos for future use, with high success rates in women under 40 years of age 1
The American Society of Clinical Oncology also recommends oocyte (egg) cryopreservation, involving ovarian stimulation and retrieval followed by freezing of unfertilized eggs, suitable for women without partners or those who prefer not to create embryos 1
Ovarian tissue cryopreservation may be considered when time constraints prevent standard ovarian stimulation protocols, according to the American Society for Reproductive Medicine 1

Above a pre-wash total motile sperm count (TMSC) of 3 million, conventional IVF is more cost-effective than ICSI; below 3 million, ICSI becomes necessary, as stated by the European Society of Human Reproduction and Embryology 2, 3, 5
Despite no evidence of increased congenital abnormalities, ICSI may be associated with higher rates of major birth defects compared to unassisted conception, according to the American College of Medical Genetics and Genomics 1

The American Society for Reproductive Medicine recommends that IVF success rates be based on live birth rates, which vary depending on factors such as the woman's age and the quality of embryos transferred 7
The likelihood of pregnancy after IVF is influenced by the cause of infertility, with some conditions responding better to treatment than others 8
Live birth is considered the primary outcome measure for assessing the success of IVF treatments, taking into account factors like the number and quality of embryos transferred 9

For men with low total motile sperm count, IVF with Intracytoplasmic Sperm Injection (ICSI) is a more suitable option, as it can overcome male factor infertility issues 8
The American Urological Association suggests that men interested in preserving fertility should avoid testosterone monotherapy, as it can suppress sperm production 10, 8
Embryo cryopreservation after IVF has been highly successful in women under 40 years of age, offering a viable option for fertility preservation 7

In vitro maturation (IVM) of immature oocytes is an alternative approach for patients with specific fertility challenges, providing an option for those with limited egg availability 11
The use of donor eggs, sperm, or embryos, as well as gestational carriers, may be considered for patients facing specific fertility challenges 7

The American Society of Clinical Oncology recommends that IVF techniques be used for fertility preservation before cancer treatments or for other medical indications, including embryo cryopreservation, oocyte cryopreservation, and ovarian tissue cryopreservation 11, 7