IVF & Fertility
Evidence-based guidance for your fertility journey, from evaluation to treatment
Overview
Infertility is defined as the inability to conceive after 12 months of unprotected intercourse (or 6 months for those over 35). It affects approximately 1 in 6 couples, and male factor contributes to 40-50% of cases, making partner evaluation essential from the start.
The fertility treatment ladder typically progresses from timed intercourse with ovulation induction, through intrauterine insemination (IUI, usually tried for 3 cycles), to in vitro fertilization (IVF). Steps can and should be skipped when clinically indicated -- for example, proceeding directly to IVF for blocked fallopian tubes, severe male factor, or advanced maternal age.
IVF success rates vary significantly by age: under 35, live birth rates per transfer are 45-55%, declining to under 5% for those over 42. Single embryo transfer is now standard for good-prognosis patients, and preimplantation genetic testing (PGT-A) is offered for advanced age, recurrent pregnancy loss, or prior failed cycles. Frozen embryo transfers have comparable or superior outcomes to fresh transfers. Throughout this journey, emotional support is not a luxury but a core component of care.
Symptoms
Inability to conceive
Not achieving pregnancy after 12 months (under 35) or 6 months (over 35) of regular unprotected intercourse.
Irregular or absent periods
Menstrual irregularities may indicate anovulation, which is the most common female cause of infertility.
Recurrent pregnancy loss
Two or more miscarriages warrant a full workup including karyotyping, thyroid, clotting factors, and uterine evaluation.
Known risk factors
Endometriosis, PCOS, fibroids, prior pelvic surgery, chemotherapy exposure, or advanced age may prompt earlier evaluation.
Male factor indicators
Low sperm count, motility, or morphology contribute to nearly half of all infertility cases. Semen analysis should be part of initial workup.
Emotional distress
Grief, frustration, relationship strain, and decision fatigue are normal responses to the fertility journey and deserve acknowledgment.
Treatment Options
Fertility workup
Day 3 FSH/E2, AMH, ultrasound (AFC), HSG or SIS, TSH, prolactin, and semen analysis form the foundation of evaluation.
Ovulation induction
Letrozole (first-line for PCOS) or clomiphene citrate stimulate ovulation for timed intercourse or IUI cycles.
Intrauterine insemination (IUI)
Washed sperm placed directly in the uterus, timed with ovulation. Usually tried for up to 3 cycles before escalating to IVF.
In vitro fertilization (IVF)
Ovarian stimulation, egg retrieval, laboratory fertilization, and embryo transfer. Single embryo transfer is standard for good-prognosis patients.
Egg/embryo freezing
Fertility preservation for medical reasons, elective planning, or as part of an IVF cycle for future frozen embryo transfers.
Lifestyle optimization
BMI 19-30, folate 800mcg+, CoQ10 (400-600mg/day for egg quality, especially over 35), limit caffeine under 200mg, no smoking.
Frequently Asked Questions
Have Questions About IVF & Fertility?
Romy can answer your questions, help you track symptoms, and prepare you for doctor visits with personalized, evidence-based guidance.
Related Conditions
PCOS (Polycystic Ovary Syndrome)
Navigate PCOS with evidence-based information on diagnosis and management
Endometriosis
Understand endometriosis symptoms, diagnosis, and treatment options
Thyroid & Reproductive Health
Understand how thyroid disorders uniquely impact women's health and fertility
Adenomyosis
Learn about adenomyosis -- when endometrial tissue grows into the uterine wall
Important Notice
This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult your healthcare provider for medical decisions specific to your situation.