Should I proceed to IVF

Few questions for you. First, I am 40 1/2 and have two kids naturally. No known fertility problems. Estradiol: 53.2 / FSH: 6.4 /anti-mullerian hormone test 1.1... all normal.  Had last child 2.5 years ago... two chemical pregnancies since.  Been trying now for 10 months and RE suggests, or understands, moving to IVF to increase chances based on age alone. Says if we have patience to keep trying naturally, would probably happen eventually.   My regular OB says keep trying on my own (we've done 3 cycles of AI with no luck).. his partner  recommends getting the job done with IVF...insurance won't cover any more AI, but will cover up to 3 IVF cycles. What would you recommend? Keep trying and let the biological clock tick.. or go ahead with IVF?  Also, is there a greater chance for birth defects with IVF? And what are your thoughts on the genetic testing available on embroys before implanation? Also, do you recommend more than one embryo being transferred back at my age if we do this?   I am so torn, but trying to coordinate schedules each month, facing the disappointment and getting older each month makes me want to move foward with IVF.  I know it's no guarantee, but with my good fertility history, chances  would be good (according to RE).

[Elaine Brown, MD]

Hi!

The First thing I am going to recommend is to LOVE the two angels you have!

Having put that two cents in, I would agree with your RE that according to the data, you have a good chance of success with IVF.  Because your insurance covers it, I don't see a big down-side.  Certainly if you don't succeed you can continue to let Mother Nature do her best work afterwards.

If you were my patient, I would discuss PGD with you (that is biopsy of the embryos to determine if they are normal before transfer)--the data seem somewhat conflicting though, and you might do just as well with day 5 blast transfer.  It seems that most abnormal embryos don't survive to this stage.  There is no guarantee either way (natural or IVF) so it will be important to have discussed your strategies for antenatal testing (eg do you want CVS, amnio, nuchal translucency scan, etc) ahead of time.

I would have to determine how many embryos to transfer based on the quality of the embryos, as well as statistics, and your wishes.  High order multiple pregnancies are not desireable for many reasons.

A good site to check out is GoIVF.com.  It has tons of information, and Dr Zouves is wonderful with "mature" clients.

Good luck!
Dr B

[Anna_Short]

Given that you do have insurance coverage for IVF, I'd certainly move forward.  One piece of advice -- determine how many cycles can be covered, and how a "cycle" is defined.   I had a child from IVF at age 38.  We went through unsuccessful AI cycles and I believe the clinic would have done an IUI cycle every month until our IVF insurance kicked in (we needed to have been married over a year) just to keep busy if we had not determined it wasn't worth pursuing if it wasn't working.  On the other hand, once we were in IVF territory, the clinic was very interested in a good outcome as it affects the statistics they use for marketing.  I was oversuppressed in my first cycle, and we stopped that cycle before retreival but it still counted as our first cycle.  In our 2nd cycle, it still looked as though I was not ovulating as well as they would have liked but I pushed to complete the cycle so as not to lose the chance again while insured.   I was lucky -- 3 eggs, 2 blasts, one beautiful baby!!

Anna Short
http://www.infertility-options-info.com/infertility-insurance