Methods to Increase Success in IVF Treatment

What is the Success Rate of IVF?

The success rate of IVF is particularly inversely proportional to the woman's age. As a woman’s age increases, the chances of success decrease due to the decline in egg quality. When a woman is under 35, the pregnancy rate can be around 70%, whereas this rate drops to 20% after the age of 40.

Factors Affecting IVF Success

Factors influencing the success of IVF treatment include the woman's age, embryo quality, the characteristics of the uterine lining, presence of chronic diseases, nutrition, healthy lifestyle habits, the experience of the medical team, and the conditions of the laboratory.

♥ Age is the most important factor determining IVF success. As age increases, ovarian reserve decreases and egg quality declines simultaneously. This leads to fewer high-quality embryos and lowers the success rate of IVF.

♥ Gynecological conditions such as polycystic ovary syndrome (PCOS),endometriosis, fibroids, and polyps can affect IVF outcomes. In patients with PCOS, ovarian hyperstimulation syndrome may develop, causing excessive hormone levels that can reduce embryo implantation chances. In endometriosis, embryo quality is often lower compared to those without the condition, and there may be differences in progesterone receptors in the endometrium. Fibroids and polyps can occupy space in the endometrium or trigger uterine contractions, thus preventing embryo implantation.

♥ Lifestyle is another key determinant of IVF success. Smoking, alcohol, obesity, very low body mass index, and unhealthy eating habits negatively impact egg and sperm quality, and therefore embryo quality. Regular exercise and a healthy Mediterranean-style diet are recommended for all women planning pregnancy, and especially important during IVF treatment.

♥ Treatment protocol and medication dosing significantly affect the number of eggs retrieved and, consequently, the number of embryos. Drug dosages are individualized based on the patient’s weight, height, body mass index, age, and ovarian reserve.

♥ For patients with recurrent IVF failures or recurrent miscarriages, genetic testing during IVF (PGT) may improve the chances of success. This allows selection of genetically normal embryos with the highest potential for implantation.

♥ When hormone levels rise excessively during IVF treatment, freezing the embryos and transferring them in a later cycle—after preparing the uterus in a more optimal hormonal environment—can improve IVF success rates.

How to Improve IVF Success?

1. Evaluation of Ovarian Reserve
2. Improving Embryo Quality
3. Embryo Transfer Techniques for IVF Success
4. Uterine Preparation and Endometrial Thickness
5. Impact of Laboratory Conditions on Success
6. Role of Genetic Testing (PGT) in IVF Success
7. Importance of Lifestyle and Nutrition in IVF Treatment
8. Hormonal Support and Medication Use

1. Evaluation of Ovarian Reserve

Ovarian reserve is assessed through antral follicle count via ultrasound or through blood tests. If, on an ultrasound performed on the 2nd or 3rd day of the menstrual cycle, the number of 2mm follicles in both ovaries is fewer than 5–7, it is considered a sign of low ovarian reserve.

Similarly, if the FSH level measured on the 3rd day of the cycle is above 10 mIU/ml, or if the AMH level measured at any point in the cycle is below 1.1 ng/ml, this also indicates decreased ovarian reserve.

Low ovarian reserve can lead to a reduced number of eggs and embryos in IVF treatment; in some cases, no eggs may grow, or the few eggs that are collected may not fertilize or develop into embryos, leaving no embryos available for transfer. This can result in higher IVF cycle cancellation rates.

Therefore, for patients with low ovarian reserve, it is very important to:

• Determine the appropriate maximum stimulation medication doses,
• Monitor closely to prevent early ovulation of the few developing follicles,
• Ensure that microinjection (ICSI) is performed by experienced embryologists, and
• Maintain optimal laboratory conditions for embryo culture.
• All of these can significantly increase the chances of success in IVF.

2. Improving Embryo Quality

Embryo quality is one of the most critical factors determining IVF success. The quality of the embryo is directly influenced by the quality of both the egg and the sperm.
To improve embryo quality:

• Use antioxidant and omega-3 supplements before treatment,
• Follow a healthy diet,
• Manage chronic diseases, and
• Avoid alcohol and smoking.

The treatment protocol applied, especially hormone levels on the day of the trigger injection, can also affect embryo quality. Choosing the right protocol based on the patient's age and ovarian reserve, and close monitoring during treatment, can help improve embryo quality.

Additionally, the fertilization technique used, the experience of the embryologist performing the procedure, and lab conditions (pH, temperature, particle count in the environment) have a direct impact on embryo quality.

Patients with poor embryo quality should undergo genetic evaluation and receive counseling based on the results.

3. Embryo Transfer Techniques for IVF Success

Embryo transfer is the final and most delicate stage of IVF treatment. The carefully developed embryos are placed at the top of the uterus under ultrasound guidance, using a gentle technique that avoids stimulating uterine contractions while passing through the cervix.

The experience of the physician performing the transfer plays a crucial role in the success of this step.

4. Uterine Preparation and Endometrial Thickness

During IVF treatment, while the ovaries are being stimulated and eggs are growing, the uterine lining (endometrium) is also monitored. As the eggs mature, the endometrium should thicken in parallel.

The endometrial lining should be at least 7 mm thick and display a trilaminar (three-line) pattern on ultrasound. In patients where the endometrium remains thin, pregnancy chances are reduced. These patients should be evaluated for intrauterine adhesions using hysteroscopy. If adhesions are present, they should be removed, and an anti-adhesion gel should be used to prevent recurrence. Additional treatments like growth factors, PRP (Platelet-Rich Plasma),or exosome therapy may be used to help thicken the endometrium.

5. Impact of Laboratory Conditions on IVF Success

Since embryos develop in the laboratory during IVF treatment, it is crucial that the lab environment mimics the human body as closely as possible. Laboratory conditions—such as pH level, temperature, and air particle count—directly affect embryo quality. IVF centers perform regular measurements to maintain these standards, including calibrating equipment and adjusting ventilation systems to ensure optimal conditions.

6. Role of Genetic Testing (PGT) in IVF Success

Although not routinely performed, preimplantation genetic testing (PGT) is recommended for patients with recurrent IVF failures, recurrent miscarriages, chromosomal abnormalities, or a history of pregnancies or births with chromosomal issues. Transferring embryos with a normal genetic structure—those with the highest implantation potential—can significantly increase pregnancy chances.

7. Importance of Lifestyle and Nutrition in IVF Success

Lifestyle is a major determinant of IVF success. Smoking, alcohol use, obesity, very low body mass index, and poor diet negatively affect both egg and sperm quality, and therefore embryo quality. Recommended physical activities include yoga, pilates, walking, and swimming. Regular exercise and a healthy Mediterranean-style diet are strongly recommended for all patients planning a pregnancy, and are especially important during IVF treatment.

8. Hormonal Support and Medication Use

After embryo transfer, it is essential to consistently take the appropriate hormonal support to maintain the uterine environment. Based on estrogen levels during treatment, this support may include a combination of estrogen and progesterone or progesterone alone. Hormonal therapy should be continued regularly until the pregnancy test. If the test is positive, support typically continues until around the 9th week of pregnancy.