Better Infertility Treatment Success Rates

Nov. 12, 2002 -- Science is helping more and more people become parents and experts say the technology and the success rates are getting better all the time.

According to the American College of Obstetricians and Gynecologists, about 15 percent of couples in the United States are affected by infertility. While the majority of these cases are effectively treated with medical therapies like medication and surgery, some couples are left to seek more advanced technologies to help them conceive.

In vitro fertilization, introduced to the United States in 1981, is one of the more popular solutions. Through the end of 1999, more than 177,000 babies have been born from all assisted reproductive technologies, including IVF, according to a count by the American Society of Reproductive Medicine and its affiliate, the Society for Assisted Reproductive Technology.

And the real news now is that these technologies are getting even better at treating infertility. "The biggest advance that has taken place over the years is the increase in success," says Dr. Richard Paulson, chief of the Division of Reproductive Endocrinology and Infertility at the University of Southern California in Los Angeles.

And that success rate has improved dramatically. Some estimate the current success rate to be about 50 percent per cycle of treatment. That is compared to a success rate of about 14 percent almost 20 years ago.

Getting Better All the Time

Many factors have contributed to the increase in success. And one technique that many experts credit was the development of ICSI, or intracytoplasmic sperm injection, in 1992.

During the ICSI procedure, a single sperm is injected into a single egg to form an embryo. It gave many men facing low to zero sperm counts the opportunity to father children using assisted reproductive technologies.

"We can take sperm from the ejaculate, we can take sperm from the epididymis, we can even take sperm from testicular biopsies," says Dr. William Gibbons, director of the Jones Institute of Reproductive Medicine at the Eastern Virginia Medical School. "These were very effective ways of initiating fertilization and allowing these couples to conceive."

Aside from this large advance, experts say that much of the dramatic increases in pregnancy success rates are due to many small developments and new understanding in the field of infertility treatment.

One example is something that is so small as to initially seem trivial — the use of a soft catheter to transfer embryos into the uterus.

"Typically the embryos would be transferred with a stiff catheter because it was easy to get in and many physicians didn't bother using a soft touch for putting the embryos into the uterus," explains Dr. Sherman Silber, director of the Infertility Center of St. Louis and author of How to Get Pregnant: With the New Technology.

"It just makes sense, if you think about an IUD, it creates irritation of the uterine lining and that irritation prevents implantation. And so you can imagine that if you irritate the uterine lining while you put an embryo in, that has got to have a negative effect on implantation," he adds. "Doctors are paying much more attention to this seemingly trivial issue."

Pausing the Clock

Other researchers credit advances in cryopreservation, or the freezing of reproductive cells like sperm and fertilized embryos to maximize the efficacy of the advanced reproductive technologies.

While this approach has not yet been as effective for preserving eggs or ovarian tissue, researchers see advances in that area paving the way to more widespread use of that approach to in effect pause the biological clock for women who find their reproductive fitness declining over time.

For example, by the time a woman reaches her 40s, only one in 10 of her eggs is likely to develop into a baby, compared to the two out of three that would have developed in her 20s. The hope is that freezing a woman's eggs or ovarian tissue will give older women a better chance of having a family.

"This would hopefully lock in her pregnancy rate as someone who is 25 years old instead of someone who is 45 years old," says Gibbons.

Other research has supported this hope by finding that while women find the viability of their own eggs declining, the age of a woman who receives a fertilized embryo matters much less.