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In Vitro Fertilization

Jean Omega Fleurgin

Florida National University

Advanced Primary Care of Family 

Professor:  Jorge Brito

November 17, 2022

In Vitro Fertilization

According to the American Society for Reproductive Medicine (ASRM), one-third of patients treated by fertility specialists have male infertility, one-third have female infertility, and the other third have a combination of male and female infertility or unexplained difficulties. Keeping this in mind, the Centers for Disease Control and Prevention (CDC) predicted that 12 percent of all women between the ages of 15 and 44 have trouble becoming pregnant and keeping a baby to full term. In the United States, 7.5 percent of sexually active men had gone to a reproductive specialist at least once, according to the survey results.

When attempting to reproduce, even couples who do not have any reproductive concerns may run into problems. According to estimates provided by the National Women's Health Resource Center, non-infertile couples between the ages of 29 and 33 have a 20-25 percent chance of conceiving during any given month if they are of childbearing age. It is predicted that sixty percent of all relationships will result in a pregnancy without the participation of any reproductive treatments. If a couple is unable to conceive for whatever reason, they may consider in vitro fertilization (IVF) and other reproductive treatments. According to the CDC (2020), 38.1% of patients undergoing fertility therapy were under the age of 35. In 2015, patients in this age range made approximately 21 percent of the total patient population. In 2015, individuals in this age range accounted for 19.4 percent of all patients. In 2015, there were a total of 231,936 cycles of fertility therapy carried out in the United States, as stated in a major report on assisted reproductive technology (ART) that was published by the CDC. About 99 percent of all assisted reproductive technology operations included the use of IVF. This assignment will focus on establishing whether In Vitro Fertilization compared to intrauterine insemination affect the chance of fertilization within a fertilization cycle.

PICOT

In women of childbearing age (P), how does IVF (in vitro fertilization (I) compare to IUI (intrauterine insemination) C affect the chance of fertilization O within a Fertilization cycle? T

The patient population chosen are woman of childbearing age, particularly those between 25 years to 35 years. This population is chosen because it has been recorded to have received majority of the assisted reproductive techniques, owing to their desire to have children, and increasing rates of infertility. Additionally, it is at this age when most couples are committed to having children, while some of them may be infertile. Intrauterine insemination was used for comparison, since it is another form of assisted reproduction technology which may help couples who struggle to have a child. It is different from in vitro fertilization in the sense that sperms are injected directly in to the uterus, while in the latter, a fertilized egg (already viable) is injected in to the uterus of the patient. This research is focused on determining whether in vitro fertilization affect the chances of fertilization withing a fertilization cycle.

The Vulnerable Population

Social determinants of health (SDOH) are "the situations in which individuals are born, develop, live, work, and mature, in addition to the larger collection of factors and institutions affecting the environment of everyday life," as defined by the World Health Organization (WHO). Social and environmental stresses, including food shortages, insecure shelter, and inadequate access to conveyance, among many others, have been shown to have a considerable negative influence on health, often contributing to as much as 90% of an individual's health condition.

Women of childbearing age are mostly affected by social determinants of health, including being a female, having low income, and poor housing among others. In as much as these women would like to have children, most of them find themselves in a tight spot, since they may not even have enough money or income to take care of themselves and the newborn (van der Meer et al., 2022). In cases where such women enter in to a relationship and turn out infertile, (whether them, or their spouse), it becomes challenging, since they may not have sufficient funds to seek for specialized treatment like assisted reproduction methods like IVF or IUI. As a result of infertility, these couples struggle with psychological trauma, and stigma, as some cultures perceive children as important, and not having them makes one worthless. As it is a role of a woman to have children, most of the time, women end up taking the cultural blame of infertility, without fertility test to confirm their fertility, which further increases the torment stigma they receive, even from close family members. One of the risk factors is low level of literacy, which obviously leave people unaware of the potential or available options for people who having challenges with conception.

Review of Literature

In vitro fertilization (IVF) is a therapy for infertility that is widely used because it is successful; nevertheless, success rates vary depending on the patient as well as cycle-specific circumstances (Starosta et al., 2020). IUI is most successful for women who suffer from ovulatory dysfunction and have unexplained infertility. On the other hand, it has the lowest success rate for women who suffer from tubal factor and stage III-IV endometriosis. This makes it challenging to generalize treatment for patients who have fertility issue, arriving at the use of IVF as a standard treatment for such patients

In a study conducted by Sicchieri et al., (2018), it was mentioned tat the success rate of IUI were 7.59% on average. This is way less than the success rate for IVF, which is considered to be around 55% on average

Because one of the major different mechanisms of action of IUI and gonadotropin stimulation is to promote ovulation, it is rational to predict a greater chance of conception in individuals with ovulatory issues compared to others with other types of infertility (Yildirim et al., 2017). Therefore, if the patients have other types of infertility, it would not be solved by IUI consequently, leading to the few and reduced clinical success rates. . According to authors, after therapy with gonadotropin stimulation and intrauterine insemination (IUI), individuals with subfertility have been shown to have an average clinical pregnancy outcome of 17.1% and a live birth rate of 11.4% per cycle. There are several factors that may determine whether or not a woman will get pregnant, including her age, the cause and length of any infertility she may have had, the width of her endometrium, and the amount of pre – ovulatory follicles.

In a different study that was carried out by Abe et al (2020) to ascertain age-adjusted general successful percentages for clients undertaking clomiphene citrate only minimal activation cycle (mini) in vitro fertilization (IVF) without any gonadotropin administration, it was discovered that the live birth rate for the initial ovum recovery cycle began in women aged 34 was 42.5%. This proportion is much greater than the projected success rate for patients who are having IUI treatment.

Potential for starting a family is a major factor in choosing IVF versus IUI. However, with the growing success of embryo cryopreservation, it is possible to achieve several healthy pregnancies over the course of several years from a single stimulated IVF cycle. This is in contrast to the results that can only be achieved through intrauterine insemination, which can only result in one pregnancy per cycle (although 10% of these pregnancies may be multiples). Ombelet et al., (2020) found that after a period of seven years, 43 percent of patients who had a kid created via in vitro fertilization ( ivf) technology sought for a subsequent therapy. Cumulative live-birth rates were reported to be rather encouraging for these individuals, ranging from 60% to 88% for embryos that were frozen, and from 50% to 69% for cycles that were fresh.

Proposal

After a deep literature search, I came it to a conclusion that In Vitro Fertilization had more chances of success when compared to Intrauterine Insemination. This is because, as outlined in the procedures for the both operations, IVF involves transferring an already life and viable embryo in to the uterus which increases chances of success. On the other hand, intrauterine insemination involves introduction of a sperm to the uterus so that the process of conception may happen naturally. This reduced the chances of fertilization when compared to introducing a viable embryo in IVF. Although several studies show that the success of IVF is also dependent on other factors, especially psychological factors, it has a higher success rate than IUI

This project will invite women who have had challenges conceiving, and who have medical indications for IVF to register for the trail and study. Several resources will be needed, including a fully equipped laboratory with the necessary equipment to facilitate harvesting of the eggs, sperms, and the other procedures, as indicated by Choe, & Shanks, (2022). Another resource that very crucial is money. Since the project utilizes technology, it is true to say that it will need a lot of money to operate. Therefore, the study will follow up on the patients who will be receiving IVF intervention recently, to determine how effective the procedure is, and to establish if it at affects chances of fertilization.

REFERENCES

Abe, T., Yabuuchi, A., Ezoe, K., Skaletsky, H., Fukuda, J., Ueno, S., Fan, Y., Goldsmith, S., Kobayashi, T., Silber, S., & Kato, K. (2020). Success rates in minimal stimulation cycle IVF with clomiphene citrate only.  Journal of assisted reproduction and genetics37(2), 297–304.

Centers for Disease Control and Prevention. (2020). 2018 Assisted Reproductive Technology Fertility Clinic Success Rates Report.

Choe, J., & Shanks, A. L. (2022, September 5). In vitro fertilization – StatPearls – NCBI bookshelf. National Center for Biotechnology Information.

Ombelet, W., van Eekelen, R., McNally, A., Ledger, W., Doody, K., & Farquhar, C. (2020). Should couples with unexplained infertility have three to six cycles of intrauterine insemination with ovarian stimulation or in vitro fertilization as first-line treatment?.  Fertility and Sterility114(6), 1141-1148.

Sicchieri, F., Silva, A. B., Silva, A., Navarro, P., Ferriani, R. A., & Reis, R. (2018). Prognostic factors in intrauterine insemination cycles.  JBRA assisted reproduction22(1), 2–7.

Starosta, A., Gordon, C. E., & Hornstein, M. D. (2020). Predictive factors for intrauterine insemination outcomes: a review.  Fertility Research and Practice6(1), 1-11.

Yildirim, G., Turkgeldi, L. S., Koroglu, N., Guler, S., & Talmac, M. (2017). Predictive factors for pregnancy outcome following controlled ovarian stimulation and intrauterine insemination.  J Pak Med Assoc67(3), 422-427.

van der Meer, L., Barsties, L. S., Daalderop, L. A., Waelput, A. J., Steegers, E. A., & Bertens, L. (2022). Social determinants of vulnerability in the population of reproductive age: a systematic review.  BMC public health22(1), 1-13.

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