Because of the emotional, physical, and financial toll exacted by IVF, it is preferable that no one undertake a one‑shot attempt. If a couple can only afford one treatment cycle, IVF is probably not the right course of action. After all, with conventional IVF there is only about one chance in three that it will result in a live birth ‑and a tremendous letdown if it fails. It is thus unreasonable to undergo IVF with the attitude that “if it doesn’t work the first time, we’re giving up.” In vitro fertilization is a gamble even in the best of circumstances. Statistically speaking, a woman’s under 39 years of age, using her own eggs, having selected a good IVF program is likely to have a better than 80-90% chance of having a baby within three completed attempts (fresh and frozen transfers), provided that she has adequate ovarian reserve, (the ability to producing several follicles/eggs in response to gonadotropin stimulation), has a fertile male partner (or sperm donor sperm) with access to motile sperm and, has a normal and receptive uterus capable of developing an “adequate uterine lining”. Women of 39-43 years of age, who meet the same criteria, will likely have about half that chance (40%- 45%). When the most “competent” embryos are selected for transfer using a new genetic process known as comparative genomic hybridization (CGH), the birth rate per single, completed IVF cycle is likely to exceed 60% (regardless of the age of the egg provider) and, more than 85% within three such attempts. Unfortunately, there will inevitably always be some women/couples who in spite of best effort at conventional IVF are destined to remain childless. In my considered opinion, it rarely advisable to undergo IVF more than three IVF attempts using the same approach each time. There is of course one important caveat, namely, that in women where the reason for repeated IVF failure is finally uncovered, it would indeed be justifiable (emotional, physical and financial resources dependent) to continue trying, using a defined and new approach that addresses the reason for prior failures. A specific case that illustrates this point comes to mind. It happened a few years back when a 42 year old Australian patient who had undergone 22 prior failed attempts at IVF elsewhere presented to me for treatment. After discovering a hitherto unrecognized immunologic implantation dysfunction (IID) linked to autoimmune hypothyroidism and activation of uterine natural killer cells (Nka). I took her through an IVF attempt with her own eggs, but only this time I incorporated selective immunotherapy. She conceived and went on to have a healthy little boy. This case serves to illustrate that the time to stop doing IVF should not only be based on the number of prior failed attempts. The time to stop is when there is no “remediable” explanation for failure. Older women and those who have diminished ovarian reserve can often benefit from stockpiling their embryos over several successive egg retrievals and then testing these collectively (once) for chromosomal integrity (i.e., “competency”) using CGH. Thereupon one or two “competent” embryos can be transferred at a time with a high expectation of success. This process is called “Embryo Banking” with Staggered IVF” (see elsewhere on this blog). Alternatively, given the low success rate after 43 years of age such women might be advised to rather do egg donor IVF. Here, regardless of the age of the embryo recipient the IVF birth rate after a single attempt is about 60% and better than 85% within three IVF attempts. When conventional IVF with or without “Embryo Banking” with CGH embryo selection fails to yield a successful outcome, other options such as ovum donation, IVF surrogacy, or adoption should be considered. Couples who choose to undergo IVF should be encouraged to view the entire procedure with guarded optimism but nevertheless they should be emotionally prepared to deal with the ever‑present possibility of failure. It is important however, for IVF patients to be made to realize from the outset that an inability to become pregnant should never be considered a reflection on them as individuals.
Fertility Topics Explained from the Experts at SFS