Table 1: 2023 IVF Success Rates with Frozen Embryos (not genetically tested)
Biologic woman’s age Less than 35 years old 35–37 years old 38–40 years old 41–42 years old
Greater than 42 years old
or pelvic venous disorders that may compromise IUI success.
The IVF process The medical advances for beginning life dwarf what can be done during and at the end of life—a divide that is clearly evident in the complex orchestrations of the IVF process, which spans from retrieving eggs or collecting sperm to fertilizing, storing and transferring embryos.
To harvest eggs, the biologic mother undergoes serial hormone injections and ultrasound monitoring for ovarian stimulation. At the end of this 8–14-day stimulation phase, she then undergoes an ultrasound-guided egg retrieval. Often, sperm are collected from the biological father on the same date. Later that day, fertilization occurs—either through conventional mixing of eggs and sperm or more frequently, ICSI. If one or more embryos successfully develop, they will be monitored typically through day 6 or 7 of development by an embryologist and may be tested for aneuploidy or screened for more specifi c inheritable genetic conditions.
An embryo may be transferred on day 3 or 5 as a “fresh” transfer, or months to years as a “frozen” transfer. The resultant number of embryos range from zero to multiple—meaning that brothers and sisters of diff erent ages can all be conceived on the same day. In the case of a “frozen” transfer, the person carrying the pregnancy is prescribed medications to prepare the uterine lining for a pregnancy and undergoes sonographic monitoring. When the time arrives, the embryo is transferred to the uterus using ultrasound guidance. If pregnancy is achieved, it is monitored
18 IRQ | SUMMER 2025
Estimated IVF Live Birth Rate per Embryo Transfer
41% 35% 26% 16% 12%
by serial beta-hCGs and subsequent ultrasounds. When successful, care is typically transferred from an REI specialist to an OB at 7–10 weeks. Among many variables, the prominent factor in the success rate of IVF is age (Table 1). Additional consideration is given to the number of prior successful and unsuccessful attempts.
Additional options Fulfi lling the dream of motherhood, as illustrated in the description of the new mother holding her baby at the beginning of this article, may necessitate options outside of the intended mother and father, such as the use of donor eggs, sperm or a surrogate. Using younger donor eggs specifi cally can overcome the age-related decline in fertility and egg quality. In gestational surrogacy, a third party carries the pregnancy after an embryo transfer, with the embryo created from the intended parents’ autologous or donor eggs and sperm. The screening, selection and legal agreements of gestational surrogacy extend well beyond the scope of this article.
Finally, cryopreservation—one step within IVF—aff ords the hope of future fertility. Some chemotherapies can negatively impact fertility. If time and resources allow, a woman can preserve eggs that may otherwise be lost in the treatment of cancer or other gonadotoxic therapy. Those eggs can be fertilized at that time and the resultant embryo(s) can be stored and later transferred back to this patient, a gestational carrier or donated to a new couple seeking the dream of parenthood.
Conclusion The fi elds of IR and REI share not only a timeline of innovation but also a growing intersection in patient care. Dr. Dotter, the father of IR, would likely be proud to see his discipline supporting hopeful parents in becoming mothers and fathers themselves. And should that seemingly eff ortless picture of the new mother with her IVF-conceived baby ever be interrupted by a postpartum bleed, IRs will be there and ready.
For more detailed information on the procedures, complexities and the short- and long-term outcomes of ART, see the article by Graham et al.8
on the
subject or visit the Society for Assisted Reproductive Technology at
sart.org. Knowing the development, birth and now thriving lives of these two specialties write one poetic truth: what IR did to the scalpel, REI did to the stork.
References
1. Dotter CT, Judkins MP. Transluminal Treatment of Arteriosclerotic Obstruction. Description of a New Technic and a Preliminary Report of Its Application. Circulation. 1964;30:654-70.
2. Johnson MH. Robert Edwards: the path to IVF. Reprod Biomed Online. 2011;23(2):245-62.
3. Akhatova A, Aimagambetova G, Bapayeva G, Lagana AS, Chiantera V, Oppelt P, et al. Reproductive and Obstetric Outcomes after UAE, HIFU, and TFA of Uterine Fibroids: Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2023;20(5).
4. Liu J, Han L, Han X. The Eff ect of a Subsequent Pregnancy After Ovarian Vein Embolization in Patients with Infertility Caused by Pelvic Congestion Syndrome. Acad Radiol. 2019;26(10):1373-7.
5. Cannarella R, Shah R, Hamoda TAA, Boitrelle F, Saleh R, Gul M, et al. Does Varicocele Repair Improve Conventional Semen Parameters? A Meta-Analytic Study of Before-After Data. World J Mens Health. 2024;42(1):92-132.
6. Prasivoravong J, Marcelli F, Lemaitre L, Pigny P, Ramdane N, Peers MC, et al. Benefi cial eff ects of varicocele embolization on semen parameters. Basic Clin Androl. 2014;24:9.
7. Shlansky-Goldberg RD, VanArsdalen KN, Rutter CM, Soulen MC, Haskal ZJ, Baum RA, et al. Percutaneous varicocele embolization versus surgical ligation for the treatment of infertility: changes in seminal parameters and pregnancy outcomes. J Vasc Interv Radiol. 1997;8(5):759-67.
8. Graham ME, Jelin A, Hoon AH, Jr., Wilms Floet AM, Levey E, Graham EM. Assisted reproductive technology: Short- and long-term outcomes. Dev Med Child Neurol. 2023;65(1):38-49.
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