When to Move to IVF: Success Rates, Freezing and Genetic Testing

Answered by the Jivo Healthcare coordination team rather than Dr. Pai directly: each referring doctor is assigned a relationship manager who collects and documents the case file, shares it with the Fortis coordinator and Dr. Pai's team, and returns a review with further guidance within 48 to 72 hours.

Three drug classes now exist: GLP-1 agonists (semaglutide), GLP-1/GIP combinations (tirzepatide, marketed as Mounjaro), and a GLP-1/GIP/glucagon combination about to be released. Injectable semaglutide starts at 0.25 mg subcutaneously, rising gradually to 2.4 mg; an oral form (Rybelsus) is also available but must be taken daily rather than weekly. Mounjaro, launched in the US two years earlier at roughly $1,000 a month, was released in India at about one-sixth of that cost (roughly Rs 15,000 to 20,000 a month) because of the scale of global obesity; with semaglutide's patent expiring in March and around eleven companies preparing to launch competing versions in India by April, prices are expected to fall further.

Ozempic is semaglutide. Untreated obesity itself carries heart, kidney, liver, joint and psychological risks that dwarf the drug's own side effects, which Dr. Pai compared to the rare risk of a plane crash or of liver failure from paracetamol, neither of which stops those products being used. He attributed the outsized scrutiny to how much public attention weight-loss drugs attract, not to an unusual risk profile compared with other common medications such as blood pressure drugs.

These drugs are not used during pregnancy. Dr. Pai's protocol is to bring the patient's weight down, stop the drug, wait about a month for it to wash out, then begin ovarian stimulation, retrieve eggs, freeze embryos, and transfer roughly a month later. He noted that around 50,000 unplanned pregnancies occurred among women on Ozempic in the US with no reported harm, and drew a parallel to metformin, once considered risky in pregnancy and now used throughout it.

Clomiphene 50 mg twice daily from day 2 to day 6, plus HMG 150 IU on days 7 and 9. HMG is avoided in PCOS patients because of hyperstimulation risk; PCOS is diagnosed by an antral follicle count above 15 with a necklace pattern on ultrasound and a high AMH, which Dr. Pai called their gold-standard test. He also recommends AMH testing for daughters to check ovarian reserve, with egg freezing considered before age 35 if a woman is not yet married.

European registry data shows that among women under 34 who begin IVF, around 70 percent achieve pregnancy by the end of three cycles, rising to 89 percent by the end of six cycles.

Modern freezing technology means a single stimulated cycle can produce enough eggs and embryos for several future attempts. A frozen embryo bank built up since 1990 and holding close to 150,000 embryos lets patients whose first transfer fails, or who want a second child years later, draw on frozen stock rather than repeating a full stimulation cycle.

For patients with an AMH as low as 0.3 to 0.4 nanograms per ml who decline donor eggs, platelet-rich plasma injections or stem-cell therapy are tried, while being candid that these interventions may not restore a patient's own egg supply.

Embryos are cultured to the blastocyst stage, a small biopsy is taken, and only genetically normal blastocysts are transferred. Using this approach across three IVF attempts, 80 to 90 percent of patients achieve a pregnancy, framing IVF's biggest downside as simply the possibility of not conceiving rather than any specific medical complication.