In Vitro Fertilization has traditionally been considered a treatment reserved for severe pelvic factor infertility or for couples who have exhausted all less aggressive treatment options without reproductive success. With the widespread clinical availability of ICSI, IVF is now also a first line treatment option for severe male factor infertility. Recently, IVF has become far more commonly performed (in the USA).
The increasing success (pregnancy rates) of the ARTs, the rapid growth in the number of IVF centers available, and the apparent shift in focus among a large percentage of (fellowship trained) infertility specialists from surgical repair of the pelvis to IVF (which bypasses the pelvis) all appear to be causes for the tremendous increase in the frequency with which IVF is recommended (and performed).
For perspective, consider that a briefing paper on “Infertility and National Health Care Reform” prepared by RESOLVE and the American Fertility Society in 1993 included as major points:
- the majority of infertile couples require only conventional medical and surgical treatment, and
- less than 2% of women who seek treatment for infertility undergo Assisted Reproductive Technologies (ART), such as IVF.
This shift in treatment toward IVF is alarming, partially because many infertile couples (a) sense that IVF is currently the only appropriate treatment available to them (regardless of their underlying infertility problem), (b) often undergo a tremendous financial burden to undergo ART procedures (many insurance policies do not cover IVF making the out of pocket cost to the couple high), and (c) may have a better chance of achieving a pregnancy with traditional infertility care than with IVF.
In 1999, the Center of Human Reproduction in Chicago published a methodologically sound (prospective randomized) clinical trial comparing IVF (head to head) with a standard infertility treatment algorithm (similar to that proposed in this Couple’s Guide) as the first line treatment for infertile couples who presented to their office. This study reports that the pregnancy rates were higher and the costs were lower in the standard treatment group.
In 1999, my own observations of infertility practices (at least in New Jersey) strongly suggest that ARTs are now being recommended much more often than in the (recent) past. In many IVF centers the conventional medical and surgical treatments actually comprise only a small percentage of the clinical infertility practice.
A detailed discussion of IVF (including appropriate indications, patient selection, and patient preparation) is provided in the tutorial on infertility procedures.