IVF program selection criteria
In vitro fertilization (IVF) is intended for patients experiencing infertility, for those with certain medical indications, for patients interested in selecting unaffected embryos to prevent a genetic disease, and in other circumstances constituting the need for gestational carrier.
Before IVF is tried, the care team will ask:
- Have simpler and less costly treatments been tried?
- Is there a reasonable chance you will get pregnant?
Based on the above, the following criteria are used to decide if a person can start IVF.
- Tubal absence
- Endometriosis or tubal disease unresponsive to treatment
- Ovarian dysfunction
- Male factor infertility
- Unexplained infertility
- Recurrent pregnancy loss
- Selection of unaffected embryos to prevent a genetic disease
- Absence of uterus
- Other reasons that may lead a person to need a gestational carrier
A person must also meet:
People using their own oocytes:
- Have a better chance for pregnancy if they are less than 40 years of age.
- May be accepted if they are 40 to 42 years of age with regular menstrual cycles. They must understand the chance of pregnancy and live birth is less with age. IVF must start at least 6 weeks before their 43rd birthday.
- IVF treatment for people using their own eggs is rarely used over the age of 43. People age 43 and 44 must meet certain criteria in order to qualify.
People using donor oocytes:
- Eggs from an anonymous or known oocyte donor may be used up to a person’s 50th birthday.
People using frozen embryos:
- These must be used by the carrying person’s 50th birthday.
People using a gestational carrier:
- Single parents must be less than 55 years of age.
- One person of a parent couple must be less than 55 years of age.
- Embryos must be made using at least 1 of the parents’ gametes (egg(s)/sperm).
- All couples and single people using donor gametes or a gestational carrier will be seen by the program’s health psychologist or another approved health psychologist. They must have counseling before treatment. Psychological concerns may deny or delay IVF. See the Psychosocial Issues section.
Your care team will care for your health and mental stability as the best they can during fertility treatment. Certain psychosocial issues may have a poor effect on treatment planning, pregnancy, and parenthood, such as:
- Untreated or inadequately treated mental health. People with or showing signs of severe psychiatric conditions must be treated.
- Current suicidal or homicidal thoughts.
- Current use of psychiatric (or other) medicines that may cause harm during pregnancy.
- Untreated or inadequately treated substance use, abuse, or dependence, both past and present. No person with current alcohol, narcotic, or illicit drug abuse can start IVF until they finish an approved substance abuse program. Random drug screening may be needed if a person has a history. The IVF cycle will be stopped if a person has a positive drug screen.
- People who smoke have poorer stimulation and a lower live birth rate. People who smoke will be asked to quit. They should go to a smoking cessation program. A provider may order NicoDerm patches or Zyban.
- Lack of agreement or conflict between partners about the treatment plan. Couples with signs of a severely dysfunctional, unstable, or abusive relationship must do approved couple and/or individual therapy.
- Not preparing for the stresses of treatment, pregnancy, and parenthood. This could be due to current or predicted stressors, lack of physical and/or emotional support, or not understanding treatment. All people who start IVF must be able to give informed consent before any procedures.
- Past founded reports of child neglect or abuse, or other criminal behavior. IVF may not be started if a person will not be able to provide safe care.
Evidence of any of the above does not mean a person cannot do IVF. It only means the issue(s) will need to be addressed before starting. The program health psychologist will work with people to make and start a treatment plan.
Good general physical health is needed. A person cannot have serious, untreated chronic illness.
This is to be sure a person has a healthy IVF cycle and pregnancy. A person’s body mass index (BMI) must be below 50 before a cycle can start. An infertility evaluation can still be done if a person’s BMI is greater than 50. The care team can talk with you about ways to lower BMI also. Go to nhlbisupport.com/bmi/ to learn more.
Having a BMI over 50 can:
- Lead to higher cancellation rates
- Lessen stimulation of the ovaries (fewer follicles stimulated)
- Limit the care team when retrieving eggs because of poor access to the ovaries
- Cause serious risks when intravenous (IV) sedation is used, such as trouble breathing
- Breathing issues can cause problems during egg retrieval
- Lead to a high-risk pregnancy
Access to the ovaries will be assessed at the 1st visit. Weight loss may be needed before doing an IVF cycle if the ovary(ies) cannot be seen.
Diabetes can affect fertility. It can also complicate a pregnancy. If a hemoglobin A1c is needed, it will be ordered.
The hemoglobin A1C must be less than 6.5 before starting IVF.
Sexually transmitted infection (STI) screening
Blood tests for HIV, Hepatitis B surface antigen (Note: This is antigen, not antibody.), and Hepatitis C antibody are needed. Blood tests are needed within the past 5 years or if your partner has changed.
These may be ordered by your primary care provider. The results may be mailed, faxed, or hand carried to your 1st appointment. This testing can also be done at UI Health Care the day of your 1st appointment.
Other testing (childbearing partner only)
You must have a:
- Blood test of immunity to Rubella
- Blood test of immunity to Varicella, unless you had the varicella vaccine or chicken pox
- Blood type
- TSH (thyroid stimulating hormone) blood test within the last 3 years
Keep going to your primary care provider for your yearly exam, and to get your:
- Breast exam
- Mammogram if 40 years and older
- Pap smear (as recommended by your provider)