When Should You Begin Trying ART Procedures?

Dr. Richard P. Marrs

Deciding when ART procedures should be incorporated into your treatment is a balancing act.  If you wait too long, the chances for success will decline.  If you start too soon, you may be spending large amounts of money, and undergoing difficult physical procedures, that aren’t really necessary.

On the surface, the timing appears simple.  As soon as conventional infertility treatment fails to produce a pregnancy, you should move on to ART.  That’s because your age plays such a pivotal role in the ability of ART procedures to be successful.  All ART procedures require healthy eggs – and as you age, your eggs age with you.  So waiting too long to start ART procedures may create a situation in which the eggs can’t work.

On the flip side, however, you should be wary if your doctor recommends that you move on to expensive and invasive ART procedures without first exhausting conventional treatment.  A 35-year-old woman with ovulation problems should be placed on drugs for ovulation control as a first step in her treatment.  She should not be directed immediately to IVF or GIFT.  Yet in some infertility centers, the use of sophisticated ART technologies has run rampant.  While it has obvious benefits for the doctors who are doing these expensive procedures, this “go straight to the top” treatment philosophy is not in the patient’s best interest.  It’s bad enough that it escalates cost and invasiveness.  What’s worse, it doesn’t produce any better pregnancy statistics than conventional therapy.  While our 35-year-old woman with ovulation problems may very well get pregnant with a GIFT procedure, she should accomplish the same result with a simpler, and considerably cheaper, drug therapy.

So how do you know when you’re ready?  In many cases, your gut will tell you.  If you’re feeling stuck in your treatment, it’s time to discuss those feelings with your doctor.  If, cycle after cycle, there’s no positive outcome, it’s time to reevaluate the need for ART procedures.  Don’t waste months – even years – with conventional therapy that’s not working.  It will only diminish your odds with assisted reproductive technologies.  In our clinic we follow a simple rule: A maximum of six cycles of any technology should be attempted, no matter what the technology that’s being used.  After this point, chances of that technology producing a pregnancy diminish.  So if it hasn’t worked by the sixth try, cut your losses and move on to the next alternative.  There has to be a concerted effort by both you and your doctor to make prudent, appropriate decisions when you’re considering moving on to ART procedures.  To ensure this, your discussions should include your age, the facts about your individual medical condition – giving particular consideration to the viability of your fallopian tubes and the quality of your partner’s sperm – and your budget.

A Personal Note From Dr. Marrs

…Assisted reproductive technologies have been around for almost 20 years, and procedures have changed dramatically.  During that time, advances have been made and knowledge has increased.  Viewing the physiologic process of human reproduction through In Vitro Fertilization has improved not only our ability to increase pregnancy outcomes using ART, but to treat routine infertility disorders.
 If you and your doctor do come to the conclusion that you would be helped by an ART procedure, make sure you understand which one is best for you.  Be clear about its cost, as the financial impact can be overwhelming.  And make sure you understand its success rate, not only nationally but at the center you’ve chosen.  All ART procedures fail more often than they succeed.  If you’ve done this homework, your expectations will be hopeful but realistic.

*The information provided is directly quoted from Chapter 12 of Dr. Richard Marrs’ book, “Fertility Book”.  Permission granted by Dr. Richard P. Marrs.
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