Success rates in assisted reproduction

The assisted reproductive methods are no longer unknown to couples with fertility problems. The most common used are Intrauterine insemination (IUI) and In Vitro Fertilization (IVF) with or without Intracytoplasmic Sperm Injection (ICSI).

Many couples proceed with this method without knowing the true success rates. They have to know these numbers in order to decide which method to choose and not be misguided about the pregnancy rates.

So let’s say that a couple with no fertility matters tries to conceive with intercourse, during ovulation. The man has no sperm problems. The woman, proper egg production and open Fallopian tube. The success rates are 6%.

In other words, every woman who tries to conceive, has 94% of failing! But don’t be scared. We need to explain here that a couple has to try for at least a year. After this period, we assume that they face fertility matters and start doing medical tests for further investigation.

Therefore, during this 12-18 months period of trying the success rate of 6% multiplies.

Intrauterine insemination (IUI)

The Intrauterine insemination (IUI) is a relatively simple method of assisted reproduction. We process the sperm that have been washed and concentrated. Then, we place them directly in the woman’s uterus with a long, thin, flexible tube (catheter).

When we do not use fertility medication, we call the process natural cycle. If the fertility specialist must perform an ovarian stimulation with gonadotropin or clomiphene citrate pills, we name the cycle after it.

Many couples believe that their fertility problem is solved with Intrauterine insemination and pregnancy will happen soon. The truth is that with this procedure we raise fertility rate (we double or even triple it, depending on the woman’s age), but still the rate is between 15-18%.

So, the Intrauterine insemination procedure is not a panacea. It offers higher success rates to intercourse.

If we take into account the low cost of the Intrauterine insemination, the ease of the procedure, its repeatability and the fact that it doesn’t hurt the woman, we see that the success rates are satisfying.

We have to think that we will need three Intrauterine insemination cycles in order to have a good success rate. Many gynecologists suggest six cycles. In this case, the specialist must take into consideration not only the reasons of infertility, but also the psychological and economical situation of the couple.

A lot of times the couple gets disappointed from the continuous Intrauterine insemination failures. So, when they have to take the next step (the IVF procedure) they feel discouraged.

So, the role of a gynecologist, specialized in assisted reproduction, is to:

  • Suggest the appropriate treatment
  • Determine the duration
  • Inform the couple for the next step in case of failure
  • Take into consideration the factor that the couple may be disappointed or discouraged and suggest psychological help, if needed.

In Vitro Fertilization

This method means a lot of expenses, stress and patience for a couple. It also means medical intervention. The most important though is that many people think that the IVF rates are extremely high and by the end of the therapy, they will have their baby in their arms.

There is no doubt that the purpose of a gynecologist specialized in IVF is the same to an infertile couple: childbearing. Furthermore, the specialist has to make sure that the procedure is safe for the woman, short and affordable.

It is very important for the couple to be informed about what IVF really means. Read more here

Given the number of embryos that can be legally tranfered in the uterus during the embryo transfer, which is the last IVF step, the success rate is between 45-48%.

But what does this number really mean?

This number refers to women under the age of 35 years old. After this age the success rates start dropping every year. For instance, a 40 year woman has a 12% chance of getting pregnant, whereas a 44 year old drops at 2-3%. It is important to note that the percentages mentioned above, as well as those mentioned below, refer to women on average regardless of their hormone profile. Also, if there are any anatomic abnormalities, previous failed cycles and partner’s sperm quality. Every couple has its own success rates that are impossible to define accurately. For this reason, evaluation is not always approximate but still estimated according to the percentages already mentioned.

Also, the total success rate for a woman (until 35 years old) undergoing the treatment three times, comes to 70%.

The next unknown factor of these percentages are their true meaning. Let’s say we have a woman of 34 years. The IVF success rate is 45%. What does it mean? Pregnancy success rates may refer to a positive pregnancy test (biochemical pregnancy). Or to the detection of foetal heart beat via ultrasound, a few weeks after completing a treatment cycle (clinical pregnancy). However, during the first weeks of pregnancy, a significant percentage of conceptions never reach the heart beat at the beginning stage. So we see that biochemical pregnancy success rates are significantly higher compared to clinical pregnancy success rates.

It becomes even more complicated when considering the IVF live birth success rates (take home baby rate).

Among pregnant women, the miscarriage rate is about 15%. The rate of miscarriage drops as the pregnancy is progressing well. But it is still different for every woman and increases depending on maternal age. This happens because of the high frequency of chromosomal abnormalities. Moreover, the miscarriage rate for women undergoing IVF treatment is about 20%. This is due to the fact that these women encounter pregnancy complications more often and are categorized as high risk pregnancies. So, we notice that the IVF birth success rates are even lower.

We also understand that the procedure is even more complicated when we think of those women undergoing IVF treatment that never reaches to the stage of embryo transfer. Even though they start ovarian stimulation, their cycle is cancelled due to many reasons. For instance no response to medical ovarian stimulation and no collected oocytes (empty follicle syndrome). Other reasons may be no egg fertilization by spermatozoa (failed fertilization), no embryo transfer, or because of anatomic abnormalities.

Of course, the cases we mentioned above do not occur altogether, but one per case. However, each one of these facts reduces the success rates. If success rates include all women initiating an IVF treatment, then percentages are considerably lower compared to those including only women that successfully reached the embryo transfer stage. Because, the latter group of women has overcome the risk of dropping out of IVF treatment.

Moreover, embryo quality plays an important role in IVF. The better the embryo morphology, the higher the success rates.

All the above become even more complicated if we take into account intra-cytoplasmic sperm injection (ICSI), blastocyst culture, oocyte in vitro maturation (IVM), natural cycles, preimplantation genetic diagnosis (PGD). Also, the use of cryopreserved oocytes, sperm or embryos, assisted hatching and ovarian stimulation protocols (short, long, ultra long and ultra-short), agonist or antagonist and recombinant or human gonadotropin administration make it even more difficult for us to understand.

The outcome is that success rates are different for each case of undergoing IVF treatment. We use statistics in many sciences (economics, politics) and whoever refers to statistics should be very careful, either the doctor, or the patient.

On one hand, the fertility specialist is responsible for avoiding to create unrealistic expectations. On the other hand, the couple has the right to know its own realistic per-cycle success rate. They must not take irrespective of international IVF pregnancy rates into account, because they may not coincide with the couple’s personalized predicted success rate and the specific assisted reproduction unit statistics report.

This doesn’t mean that international IVF statistics reports are useless. On the contrary, all IVF data provided by statistics are valid as they are extracted from a wide study population. In our country, where the population isn’t large, it is quite difficult to collect enough data.

It is important though to distinguish between overall success rates, and this specific assisted reproduction unit’s success rates, without forgetting each couple’s medical record and reasons of infertility.

In conclusion, the infertile couple should understand that Assisted Reproductive Technologies are not a panacea for overcoming infertility and cannot promise that a woman will get pregnant, even more taking a baby home. However, IVF is the most reliable and safe way of experiencing parenthood. In experienced hands, success rates are promising and every year is increasing, following scientific progress.

We hope that in the near future IVF treatment options will be more promising compared to the present status.

Our goal is to achieve a 60% success rate in the majority of treatments. This way, we will motivate couples to initiate IVF treatment and make it a less stressful and less expensive experience.

Until today, in Gyn Care we are proud of our high IVF success rates, even in challenging cases such as older women, diabetes and endometriosis.

Our success, apart from knowledge and specialization, is due to the careful investigation of the infertility reasons. Also their successful treatment and the decision of the most suitable method for each couple play an important role.

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