Two studies may help researchers learn more about IVF success factors

Of the tens of thousands of women who visit infertility clinics every year, some will never get pregnant, and doctors often can't explain why. Researchers at the School of Medicine are launching two studies they hope will help women undergoing in-vitro fertilization and shed light on what factors affect their outcome.

For one study, researchers in the Department of Obstetrics and Gynecology are seeking 76 women who have been diagnosed with endometriosis and need IVF. Endometriosis, a condition in which tissue from the inside of the uterus grows outside the uterus, is associated with inflammation, pain and infertility.

"Some people think up to half of infertile women may have endometriosis," said Lynn Westphal, MD, associate professor of obstetrics and gynecology and lead researcher of the studies. Doctors aren't sure why endometriosis so frequently causes fertility problems, except that in an extreme case it can distort the anatomy of a woman's pelvis. In more mild cases, doctors hypothesize that inflammation somehow changes the normal environment of the uterus, fallopian tubes or ovaries.

The researchers will be testing the effects of rosiglitazone, a drug currently on the market to treat diabetes, on the success rate of IVF in women with endometriosis. "Potentially, we may improve their outcome," said Westphal. "We think the rosiglitazone could help with the inflammatory effect."

Currently, Westphal said, women with endometriosis are treated no differently than other women undergoing IVF.

For a second study, researchers are recruiting 30 women undergoing their first IVF cycle. They will analyze how factors including age, hormone levels and fertility diagnoses affect IVF success.

"We know fertility declines with age, but no one has done this type of prospective study before," said Westphal. "They've been mostly retrospective." She thinks that designing a controlled experiment will give researchers a better understanding of the factors affecting IVF outcome, rather than just analyzing statistics.

One portion of the study will look at whether using birth control pills to manipulate a woman's cycle before IVF influences the final outcome. Though it seems counterproductive, it is common for doctors to prescribe birth control in the month leading up to IVF. This gives women control over their schedules, and also reduces the chance of ovarian cysts.

"The majority of fertility centers in the United States rely on using birth control pills," said Westphal.

The Stanford researchers will also collect blood from the patients, which they hope to eventually use to identify genetic markers that influence the outcome of IVF.

"If we find that there are genetic factors that predict how someone's going to respond, then we can tailor the protocol more specifically to individual patients and improve pregnancy rates that way," said Westphal.

In the long run, Westphal hopes the studies improve the success rates of IVF and make the process easier for women. She stressed that for IVF, as with many health issues, educating women about how and when to seek help is important.

To participate in either study, women must be under age 40 and able to visit the Stanford clinic on a regular schedule. For more information, call the IVF clinic at 498-7911.

Sarah C.P. Williams is a science-writing intern in the Office of Communication & Public Affairs at the School of Medicine.