— Simple ultrasound scans could be equally good at predicting a woman's chance of IVF conception success as the expensive, invasive and time-consuming hormone tests currently used, researchers say.
During IVF treatment, women receive medication to promote egg maturation in their ovaries. Doctors then extract these eggs from the ovaries and fertilise them in the laboratory.
Some womens ovaries fail to produce any eggs for IVF, however, and in such cases the treatment fails. Because the fertility treatment generally costs $10,000 to $15,000, many prospective patients undergo tests beforehand to assess the chances the therapy will work.
These tests involve giving women drugs that boost the production of follicle-stimulating hormone in their bodies. If a woman has functioning ovaries, her body will successfully reduce the artificially elevated levels of this hormone by the time a blood test is conducted one week later. But these drugs can cause unwanted side effects such as hot flashes and dramatic mood swings.
More, more, more
In the new study, Janet Kwee at the Free University in Amsterdam in the Netherlands, and colleagues, investigated whether ultrasound scans provide a better alternative to this hormone test. They recruited 110 women experiencing fertility problems and carried out ultrasound scans of their ovaries.
The technique involves using ultrasound to simply count the number of follicles fluid-filled sacs in the ovary which nurture developing eggs. The more follicles a woman has, the more eggs she can produce, and the more likely IVF treatment will be successful.
A healthy woman might have anywhere from two to 20 follicles that mature each month, but only one reaches the final stages of development and releases an egg during ovulation.
Fertility medication works by making all of the follicles reach this final stage of development. Having a higher number of follicles translates into a higher number of eggs that doctors can extract, fertilise with sperm in the laboratory dish and then implant in a patients uterus.
Women who had high numbers of follicles indicated by the ultrasound test were more likely to have a successful IVF treatment, Kwees study confirmed 82% of the time the test positively identified women who later went on to conceive successfully.
These study participants had also undergone the hormone test, which had an equally good ability to predict a successful outcome. Since the ultrasound test can provide helpful clues without side effects, it is a preferable means of predicting IVF success, Kwee says.
"Far from perfect"
Fertility expert Marcelle Cedars at the University of California San Francisco Medical Center in the US says that the ultrasound test is a lot easier because it does not require multiple visits by a prospective patient.
But David Adamson, president-elect of the American Society for Reproductive Medicine, says that women considering IVF might want to undergo both tests to assess whether IVF might work. Theyre both helpful, but neither of them is right 100% of the time, he explains. The reality is that lots of these tests are far from perfect.
Even when these tests indicate a woman has a slim chance of IVF success, it does not necessarily mean it is impossible, stresses Phillip Patton at the Oregon Health and Science University Fertility Program in Portland, Oregon, US. You have to be careful with that diagnosis because it is devastating.
Journal reference: Reproductive Biology and Endocrinology