What are the Chances of Success with IVF?

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Everyone considering IVF clearly needs to know the success rates achieved by the program they plan to work with, and yet correctly estimating anyone's particular chances is quite difficult due to the many variables involved such as age, cause of the infertility, health of the woman's uterus, and quality of the sperm.

Similarly, judging a program based on its pregnancy rate can be fraught with error. Programs can improve their pregnancy rates by refusing to treat older women or poor candidates. They can turn away couples with previous failures. They can also transfer large numbers of embryos, inflating the pregnancy rate but also producing a dangerously high multiple (and high-order multiple) pregnancy rate. Since policies vary from program to program, it is virtually impossible to determine the quality of program based upon pregnancy rates.

Nevertheless, a reasonable benchmark for all programs is an ultrasound proven pregnancy rates of at least 25% (although our rates are much higher). This should be highest among younger patients and is usually quite a bit lower in the patient over 40 (10% or less). The highest pregnancy rates are usually seen in young couples (under 30) with severe male factor infertility: these rates can approach 50-70%. Note that for no type of patient is the chance 100%, nor is it 0%.

One of the great difficulties with IVF is that it is very hard to know when to stop. We cannot with certainty predict who will ultimately succeed with IVF and who will not.  A poor prognosis patient may conceive in the first IVF cycle, and a supposedly good prognosis patient may still be unsuccessful after their third or fourth cycle. Random chance (plain old luck) has a lot to do with how soon success will come. Clearly though, there must be a point at which we can no longer blame bad luck for continued failure.

Unfortunately, we don't know everything there is to know about fertility and there are almost certainly a host of rare problems that may prevent successful embryo implantation. Finding this break point between chance and pathology is enormously important and is therefore the focus of a great deal of current research. The best evidence we have currently is that the "point of diminishing returns" is reached after IVF cycle number three or four. This applies in cases where IVF has produced a reasonable number of good quality embryos for transfer. If, on the other hand, only unhealthy embryos result from the first IVF cycle, then the chances of success are much lower than normally found and the decision may be to stop IVF at that point.

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