Reality vs Expectation in IVF

Reality vs Expectation in IVF

Among the female patients I see who are mostly in their late 30s and early 40s, there is a perception that IVF is the ultimate treatment of choice for fertility problems and there is a great expectation that IVF will reward them with a much longed-for baby more effectively than procreating naturally.  

My natural fertility practice provides me with a unique vantage point. Many of my patients lack accurate, unbiased information on the statistics and success rates of IVF treatments and significantly overestimate the capabilities and efficiency of them. 

Success rate? 

  • Their success rate vs my success rate:
    Many women believe the UK average success rate for IVF is applicable to themselves or compare the success rate figures given by clinics when making a choice. A comparison of clinic success rates is often NOT meaningful. These statistics mean little when it comes to the individual’s own treatment. As with any medical condition, the cause of the infertility is most critical, and success varies accordingly. Patient medical characteristics and treatment approaches vary from clinic to clinic. Success rates need to be stratified by patient characteristics, such as age and cause of infertility that will affect the probability of success.
  • It is essential to understand what IVF statistics mean. When it comes to IVF, there is no standardisation for reporting “success”. I see many private IVF clinic websites which give misleading information about their ‘success rates’. Success can mean anything including clinical pregnancy rates per embryo transferred or per embryo transfer treatment or per embryo transfer cycle or per treatment cycle or per eggs collected or fresh/frozen or donor eggs/donor sperm. Do the statistics refer to Live births or Clinical pregnancies?
  • HFEA’s success rate means the success rate per embryo transfer. The success rate recorded by the HFEA does not correlate with the live birth rate (take-home baby) as following embryo transfer and positive pregnancy tests, patients may still experience loss.
  • The success rate per embryo transfer itself is misleading, because a large number of women who start an IVF cycle never get to the embryo transfer stage, either because their ovaries are unresponsive or because the eggs fail to fertilise and the cycles are cancelled so they are not included in the statistics given.
  • The success rates in IVF differ greatly between your early 30s and your late 30s. However, with natural conception, the age disparity is far less.
  • While it’s harder for older women to get pregnant, and the chance of a chromosomally abnormal child increases, these problems do not increase as sharply as we fear – except perhaps for those trying IVF or artificial insemination.
  • The below percentages are from the HFEA (2016 data). They show the average chance of live birth after IVF treatment per fresh embryo transferred, using a woman’s own eggs and partner’s own sperm.
Aged under 35 29%
35-37 23%
38-39 15%
40-42 9%
43-44 3%
Aged over 44 2%

 

  • One in five IVF cycles result in a live birth in the UK but that is for women under the age of 35 – the odds drop significantly for older women.
  • Does a woman’s fertility drop off a cliff at 35?
    The IVF response and odds of success drop off a cliff at 35. However natural fertility declines gradually.
  • So long as a woman menstruates and ovulates, she is potentially fertile. Women can conceive during the transition period to menopause so women are advised not to be lax on birth control unless they wanted to get pregnant.
  • The widely cited statistic that one in three women aged 35 to 39 will not be pregnant after a year of trying, for instance, is based on an article published in 2004 in the journal Human Reproduction. Rarely mentioned is the source of the data: French birth records from 1670 to 1830. The chance of remaining childless—30 per cent—was also calculated based on historical populations. The 300-year-old fertility statistics still in use today.
  • Can you buy time by egg freezing?
    Many women are aware of their biological clock ticking and freezing of eggs is promoted as a fertility preservation method but the likelihood of this resulting in a live baby in the future is minimal with the present technological limitations. There are many blocks to a live baby from surviving each step of egg freezing, thawing, fertilization, cell division and embryo/foetal development, pregnancy maintenance, etc. Women need to know egg freezing risk.
  • IVF success rates remain relatively low worldwide. IVF live birth rates peaked in 2001–2002 and since then we have seen worldwide a decline of IVF birth rates. This decline seems in part to be a result of the adoption of unproven new additions to IVF procedures which are yet to be proven to be of merit.
  • IUI and IVF are utilised for unexplained subfertility. There is an assumption that IVF has added value over sexual intercourse for couples with unexplained subfertility. But there is insufficient evidence to conclude that IUI or IVF are more effective than sexual intercourse.
  • This applies to miscarriage as well. There is no evidence that IVF is more effective in promoting a sustainable pregnancy.
  • Since the birth of the first baby conceived through in vitro fertilization in 1978, the evaluation and treatment of the patients with infertility have undergone significant changes. Interest in identifying the underlying causes of the infertility problem has diminished significantly and IVF is promoted as a means of bypassing many underlying fertility problems which are often multi-factorial in nature.
  • Treating the underlying causes of infertility and improving natural fertility is the most effective way forward.  Cheaper, more targeted and many occasions it may be more successful than IVF.

 

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