What are in vitro fertilization (IVF) and embryo transfer?

The classic, unproven dogma that ovarian endometrioma should be removed in all infertile women prior to IVF has been recently questioned. There is currently insufficient data to clarify whether the endometrioma-related damage to ovarian responsiveness precedes or follows surgery. Both endometrioma-related injury and surgery-mediated damage may be claimed to be involved and the relative importance of these two insults remains to be clarified. Convincing evidence has emerged showing that responsiveness to gonadotrophins after ovarian cystectomy is reduced. Conversely, the impact of surgery on pregnancy rates is unclear since no deleterious effect has been reported. Of relevance here is that surgery exposes women to risk related to a demanding procedure whereas risks associated with expectant management are mostly anecdotal or of doubtful clinical relevance. We recommend proceeding directly to IVF to reduce time to pregnancy, to avoid potential surgical complications and to limit patient costs. Surgery should be envisaged only in presence of large cysts (balancing the threshold to operate with the cyst location within the ovary), or to treat concomitant pain symptoms which are refractory to medical treatments, or when malignancy cannot reliably be ruled out.

Please click on the required question..

• 1 What are the objectives of infertility treatment?
• 2 Why have I been advised to take folic acid as part of my infertility treatment?
• 3  Although my ovaries have eggs in them, my tests show that I am not releasing them (anovulation) and this is causing infertility. How can this be treated?
• 4 If I take drugs to induce ovulation (ovulation induction) for my infertility, are there any risks?
• 5 How is ovulation induction treatment for infertility monitored?
• 6 How does clomiphene citrate work for infertility?
• 7  How effective is clomiphene in the treatment of infertility?
• 8 Could I experience any problems whilst taking clomiphene?
• 9 Is there any advantage in having an injection of HCG to ensure ovulation?
• 10 How does tamoxifen work?
• 11 How can hyperprolactinaemia be treated?
• 12 How does metformin work?
• 12A How does letrozole work for infertility?
• 13 How do gonadotrophins work?
• 14 What are the risks for me if I receive gonadotrophin therapy?
• 15 What are recombinant gonadotrophins?
• 16  What is ovarian hyperstimulation syndrome (OHSS)
• 17 How is ovarian hyperstimulation syndrome treated?
• 18 How does electrocautery (ovarian drilling) work for infertility associated with polycystic ovary syndrome (PCOS)
• 19 I have been found to have endometriosis. How should this be treated to improve my chance of conceiving?
• 20 Tests have shown that I have problems with my Fallopian tubes. What can be done about this?
• 21 I have fibroids. How should these be treated to improve my fertility?
• 22 My post-coital test has shown that my mucus is stopping the sperm from swimming (mucus hostility). What can be done?
• 22a How can male infertility be treated?
• 23 When can intrauterine insemination (IUI) improve our chance of achieving a pregnancy?
• 24 What is in vitro fertilization (IVF) and embryo transfer (ET)
• 24A IVF single or double embryo transfer?
• 25 What is intracytoplasmic sperm injection (ICSI)
• 26 How do tubal surgery and IVF compare?
• 27 What are egg donation and egg sharing?
• 28 What is selective embryo transfer?
• 29 Investigations have shown no obvious cause for our difficulty achieving a pregnancy. Are there any treatments for our unexplained infertility?
• 30 We have tried a variety of treatments but we still have not achieved a pregnancy. Why should this be?
• 31  We are finding the investigation and treatment of our fertility problems to be ever more stressful. Can stress be a cause of infertility?
• 32 How can we determine which fertility unit is likely to be the best for us?
• 33 Where can I obtain more information?
• 34 Infertility Support Groups.
  
  
  

Thank you for choosing to visit us.

This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.

I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.