A short essay
Prof Homburg, Anil Gudi and Amit Shah
This is the question that every couple will ask when first consulting with a fertility specialist. The answer is not easy to come by. At the end of the first 12 months of attempting conception, about 85% of the general population under the age of 38 years will have succeeded and if persisting for a further 12 months, this number will have risen to 94%. For the remainder, there are many treatment options open to them depending on the cause of the infertility. Probably the best outlook is for those with problems of a lack of, or very irregular, ovulation. For those couples who have a severe problem with defective sperm or a tubal blockage, in-vitro fertilisation (IVF) is the required treatment, as it is for couples with an undetectable cause of their infertility and all treatment alternatives have failed to produce a pregnancy. Probably the most helpful aid in predicting the chances of pregnancy in couples undergoing IVF is the age of the female partner. Auxillary aids for this prediction include the level of anti-Mullerian hormone (AMH) in the blood, the number of egg-containing follicles in the ovaries that can be counted on an ultrasound examination (AFC) and an examination of the level of FSH in the blood on day 2-4 of the menstrual cycle. The latter has proved remarkably unreliable as a predictor of pregnancy except when very high, mostly ruling out any chance, whereas the first two, although more promising, have proved disappointing. Both AMH and AFC can accurately predict the response of the ovary to stimulation with appropriate drugs (gonadotrophins) i.e. the number of eggs with a potential for producing a pregnancy. In general, the more eggs that can be produced, the greater the chance of pregnancy. However, when we looked at AMH levels in women undergoing IVF, we found that we were surprised by the number of women who were conceiving despite very low levels of AMH which we thought would predict a nil chance of pregnancy. Our conclusion from this research was ‘never say never’! On the strength of the AMH and AMC alone, nobody is now denied access to IVF treatment. It should be said, however, that when combining female age, AMH and AFC, couples can be counselled with a fair degree of accuracy regarding their chances to conceive on this treatment.