Fertility Series: Treatment Options
With celebrities documenting their day-by-day progress of their in vitro fertilization (IVF) journeys on their TikTok accounts and wellness gurus touting homemade fertility tonics on Instagram, it might raise the question for some women: what are my options for fertility treatments?
We asked Dr. Laura Detti, director of the Division of Reproductive Endocrinology and Infertility at Baylor College of Medicine, about fertility treatments, the latest advancements and when should women check their fertility.
Question: What is one thing you wish patients knew about fertility treatments?
Answer: There are more options than just IVF to improve fertility. Sometimes it’s education that we can provide for the patient to conceive easily. Other times we can do less invasive procedures to achieve the goal. Fine -tuning thyroid function and metabolism could be enough to achieve pregnancy, or we can induce ovulation with oral agents. We can also enhance sperm function by washing it and injecting it inside the uterus. I want patients to know that we can help them achieve their goals for fertility even if the conditions are not optimal.
Q: How have fertility treatments/technology changed over the last five years?
A: In terms of technology, we are now much better at detecting genetic abnormalities in embryos. We offer preimplantation genetic testing for aneuploidy (PGT-A) that looks for chromosome abnormalities. Another option is preimplantation genetic testing for monogenic diseases (PGT-M). This is where we can detect small genetic or molecular changes that can cause types of conditions like cystic fibrosis.
In terms of fertility treatment options, they are still more or less the same as they were when they were originally created in the late 90s, but we are now able to personalize the treatment to each patient. Micromanipulation in the IVF lab has allowed us to become more effective in achieving fertilization and embryo implantation, with intra-cytoplasmic sperm injection, embryo hatching, and embryo biopsy.
Q: It seems that more people have been more open with their IVF journey in recent years. What kind of impact does that have on people who are currently doing IVF or may be considering it?
A: There are about 8 million children born from IVF worldwide, and only a couple of years ago, there were 6 million children. That shows you that this approach to fertility is growing. Up until a few years ago, IVF was thought of solely a method for a couple who were infertile. Nowadays, IVF is seen more as a means to achieve a pregnancy in a faster way or when the “time is right” for the couple – for example, the growth in this approach may allow people to postpone pregnancy to a later age.
Q: With the new advances, how does this impact when women can have children?
A: As women age, their ability to get pregnant decreases. For example, a woman who’s 40 has just about a 15-20% chance of getting pregnant with one round of IVF. When we do the genetic analysis (we only recommend it to women older than 37 years) and transfer a genetically normal embryo, a woman’s chances of getting pregnant at any age are between 55-60%.
The key here is the genetically normal embryo. For women who are 40 years old or older, it is more difficult to find those genetically normal embryos. As women age, the ovarian reserve decreases and the number of genetically abnormal eggs, and hence embryos, increases.
Q: Is there a certain age when you recommend women to test their fertility?
A: There are two instances in which we see women want to test for fertility. One is when women are looking into having children now, but are not successful in their attempts, and another is when women are looking into delaying when they will have kids. In both of those instances, you can then make decisions based on those results. For example, there are some women who have a decreased ovarian reserve at a younger age, and those women would benefit from doing some sort of fertility preservation early on. They can do egg freezing in their 20s; then, when they’re ready to have a child in their 30s, they have a backup plan if natural conception does not occur.
Learn more about our Reproductive Endocrinology and Infertility services.
By Anna Kiappes