Wednesday, Dec 04th

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Success Rates in IVF

 

What are my chances Doc? 

 

"There are lies, damn lies and then statistics"
Benjamin Disraeli

One of the most difficult questions you will ask is what is the success rate of the unit that you plan to attend. It is one of the most important questions that you will want to know so why is it often so hard to get a straight answer?
The success of a IVF unit can be made to almost any number desirable. The honest answer is that most patients will fail to achieve a pregnancy than succeed -simple fact.

The problem arises as there are so many ways to represent the data

Pregnancy rate ( judged by positive pregnancy test or detection of fetal heart by ultrasound ) per stimulation cycle, per egg retrieval or per embryo transfer ?

e.g 200 IVF cycles with 35 deliveries

150 embryotransfer   arrows   arrows arrow arrows
175 egg collections     arrows      
200 IVF cycles arrows          
  17% 23% 23% 27% 30% 33%
35 deliveries arrow-ivf arrow-ivf        
40 advanced pregnancies     arrow-ivf arrow-ivf    
45 clinical Pregnancies         arrow-ivf  
50 positive pregnancy tests           arrow-ivf

 

Another point to concider is the policy and patient population of the IVF unit:

Patient selection
Individuals have widely ranging pregnancy likelyhoods and units with a higher number of women over ,lets say 38 years of age, will have a lower total pregnancy rate.

Cancellation
By canceling patients with poor ovarian response will increase the total pregnancy rate

Number of embryo transferred
Number of fresh embryos transferred is one of the most simplest ways to increase pregnancy rate.

It should not be the aim of the media to report great advances in reproductive medicine as the information can be misinterpreted and lead to false hopes.
More often than not a new method is only applicable a select population of patients.

 

HFEA National Livebirth Data 2000-2001 <38 all ages
All IVF/ ICSI Cycles Started 25.1% 21.8%
IVF+ICSI per ET 28.9% 25.4%
Frozen embryo per ET 16.9% 14.7%

 

Recently in the media the transfer of embryos at the blastocyst stage has been reported with high success rates-but this is not applicable to all patients as some patients after electing to wait for the embryos to develop to blastocyst stage have no embryo transfer at all!

No. patients Embryotransfers Positive pregancy tests Pregnancy rate Actual pregnancy rate
100 100 40 40%(40/100) 40%
100 60 40 66%(40/60) 40%

 

It is advisable to discuss the suitability for blastocyst transfer as many units may recommend transfer at the blastocyst stage if there are many oocytes collected or if previous IVF attempt have been unsuccessful with good quality embryos.
A couple who have undergone several unsuccessful IVF attempts may be more willing to accept an IVF attempt with no embryo transfer at the end of their treatment.

The literature reports take home baby rate as 20% and is accepted that success after IVF largely depends on the age of the women with pregnancy rates dropping after the age of 40 to less than 5%

How are you best to be advised then? Choosing a clinic

The answer is not easy and cannot be reduced to just a number but as in many things look for long and extensive experience, innovation and compassion.
Review the general reputation of the professionals and learn as much as you can. Talk to friends and finally trust your own judgment. 

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