The treatment of infertility, especially when using in Vitro Fertilization, can be a difficult process. It is a process that can be conducted in many different ways, depending on the philosophy of the doctors responsible for determining the protocol that will be used. We have found after more than twenty years in the field, that the best approach is one that maximizes the chances of success in each individual, by taking into account the fact that each woman is different and should be treated that way.

The concept of individualized care is based on the fact that there is tremendous variation in the fertility potential among women. Fertility potential refers to the ability of an individual to get pregnant, which in terms of IVF success is defined by the number of genetically normal eggs present in the ovaries. Age alone is not a very good way of determining this fertility potential because women start life with varying numbers of eggs, and at any given time in their lives, an individual may have more or less than the average number left depending on how many she started with. We have seen women barely out of their twenties who have few eggs remaining and are functionally menopausal, and occasionally women in their mid-forties who have more than twenty eggs retrieved during in Vitro Fertilization. As a consequence, it makes little sense to treat all women with the same protocol or medication dosage if the goal is to maximize success.

The number of genetically normal eggs available varies from woman to woman and even in the same woman from month to month. It is important to take this into consideration when determining whether to start treatment in a given month and how to conduct this treatment. We use the number of follicles present in the ovaries, as determined by ultrasound on day 3 of a natural cycle, and the FSH and Estrogen levels on that same day to determine whether or not to start an IVF cycle. The number of follicles present correlates pretty well with the number of eggs that will be retrieved that month. The FSH level is an indication of how easy or difficult it will be to stimulate the follicles to grow. These both can vary month to month. Sometimes it is necessary to monitor a woman for several months before finding the right time to start an IVF cycle. This is especially important in older women who have fewer eggs to start with.

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