Couples with fertility problems that might consider having in vitro fertilization treatment have a valuable resource in the SART success rate report. This study comes out annually. The report for IVF treatments performed in 2010 was just released.

Clinics collect their outcome data live births and report the outcomes of all IVF cycles to SART by November of the following year. SART then compiles the data and publishes it by about 3 months later. This allows the public to study IVF success rates or egg donation success rates for any specific clinic.

Not every IVF program in the US reports to SART but the large majority do. All clinics are required by law to turn in their outcome statistics to the CDC (US government). The CDC IVF report is then published annually with information on all clinics that follow federal law and give their data to CDC (some refuse to report it).

The CDC report on IVF clinic statistics is an excellent resource - but it comes out about 9 months later for any given year than the corresponding SART report.

Patients needing fertility treatments should investigate IVF success rates at clinics they are considering for treatment. Success rates vary dramatically between programs – do not assume that all centers are equally capable at getting you pregnant.

Although there can be many variables involved in success rates, the overall quality of the IVF program and the IVF laboratory are 2 of the most important factors impacting the chance of success.

The SART report shows clinic specific data on live birth outcomes that are categorized in several ways.

By female age

• Female age has a significant impact on fertility
• SART breaks down in vitro fertilization success rates based on female age group for cases with women using their own eggs
• Our live birth success rate for 2010 for women under age 35 was 60.3% per egg retrieval (fresh embryos)

By own vs. donor eggs

• Egg donation success rates are higher than for cases using own eggs
• Our live birth success rate for 2010 using donor eggs was 81.6% per embryo transfer (fresh embryos)

By fresh vs. frozen embryos

• Statistics for embryo transfers using frozen embryos are shown separately from cycles with fresh embryos
• Success rates with frozen embryos have improved significantly in recent years
• Using frozen embryos, our live birth success rate for 2010 for women under age 35 was 52.0% per embryo transfer
• Using frozen embryos, our live birth success rate for 2010 using donor eggs was 70.0% per embryo transfer

PDF version of  Advanced Fertility Center of Chicago’s 2010 SART report

To see the 2010 SART report and check IVF live birth success rates:

• Go to the SART website
• Click on the state that you want on the US map
• A list of all SART member clinics in that state will come up
• Click on the clinic you want to see success rate results for
• Click “ART Data Report” (at bottom) – that clinic’s IVF results for 2010 will come up
• If you want to see another year, select it from the pull-down menu

If a clinic that you are considering has low success rates compared to national averages or other clinics in your area – go to a clinic with higher success rates. It probably will give you a better chance to have a baby.

Our website has links to the CDC and the SART reports and discusses them in more detail with examples showing how to interpret clinic-specific and national average tables.

A comparison of clinic success rates may not be meaningful because patient medical characteristics, treatment approaches and entrance criteria for ART may vary from clinic to clinic.

Until the last few years all donor eggs cycles were done with fresh eggs retrieved and fertilized the same day with the male partner’s sperm. Over the years egg donation using fresh eggs has become highly successful at some fertility clinics in the US.

Live birth rates with fresh donor eggs are over 70% per fresh transfer procedure at the best egg donation clinics. Success rates at these same donor egg programs using fresh eggs are over 50% for live birth per transfer using a single embryo for transfer. This approach almost totally eliminates the risk for multiple pregnancy.

In recent years the techniques for freezing and thawing eggs have advanced significantly. As a result of these advances, success rates at some frozen donor egg banks has increased from about 10% success in the past to approximately 50% – at least this is what they claim.

Accordingly, business models have developed for frozen donor egg banks. Egg banks sell frozen donor eggs on a per batch or per egg basis. This can make the cost of using frozen eggs seem to be less than the cost of egg donation with fresh eggs. However, there are some significant problems with this approach.

1. Uncertain and relatively low success rates – with low success rates the cost per baby is actually higher
2. Uncertainty about long-term health issues for the children born from frozen eggs

Currently, success rates using frozen donor eggs are not well documented – or consistent between different centers. There are certainly babies being born from frozen eggs. However, the number of births is tiny in comparison to the many thousands of births using fresh donor eggs that occur every year in our country. There are very few published reports on live birth success rates per cycle using frozen donor eggs.

A few egg bank centers claim to have success rates above 50% with frozen donor eggs. However, other clinics using frozen donor eggs are not saying anything about their live birth success rates – and this is not being tracked and reported publicly by SART or the CDC at this time. In my opinion, the use of frozen donor eggs is an area in our field with a high likelihood for couples to pay a lot of money for something with (at best) very uncertain results.

The business model for selling frozen donor eggs can be attractive for those interested in recruiting donors, stimulating them, retrieving the eggs and freezing them for later sale to recipient couples. This is very similar to the current situation for donor sperm banking.

The big difference is that sperm freezes and thaws quite well but eggs are much larger cells and do not tolerate the freezing and thawing process well. Because of the damage to the egg that can occur with the freeze/thaw process, success rates with frozen eggs are generally reported to be significantly lower than with fresh eggs.

Another concern is the potential for birth defects or other problems in the children arising from frozen eggs. It is very possible that this will not be a problem at all. However, at this time there are not enough studies that have looked at the long-term health of the offspring using frozen eggs to make a thorough assessment of whether there are negative consequences for the resulting children.

Donor sperm is been frozen and kept in quarantine for 6 months, then the sperm donor is retested for infectious diseases. If the repeat testing for infectious diseases is negative then the sperm can be released from quarantine for use.

The sperm quarantine process should eliminate the risk of infection from virus (such as HIV) in the semen because it allows time for antibodies to develop in the donor within the 6 month quarantine time. The repeat testing of the sperm donor would find the antibodies and the sperm would be disposed of.

As far as I know, there has never been a case of an infectious disease passed on through transfer of a donor egg. With hundreds of thousands (possibly millions) of egg donation cycles performed worldwide over the past 30 years, the risk is extremely low for any significant infection to be transmitted with fresh egg donation.

Therefore, we should not think we need frozen egg banks in order to reduce the risk of infectious disease transmission – because this does not seem to be a significant risk. It appears that the main reason that frozen eggs are used for egg donation at this time is that it suits the business models for some providers of fertility services.

Egg banks could also provide a convenient way for couples to search online egg donor databases to find a suitable donor. However, I suggest that this is not a good reason to move from the tried and tested, safe and effective method of fresh egg donation.

The best approach is to continue using fresh donor eggs until:

1. Research demonstrates that using frozen eggs is a safe procedure for the resulting children
2. Success rates with frozen donor eggs are better documented for the clinics providing that service

Consumers of egg donation services should certainly know if they are paying their money for a a 70% expectation to have a baby – or only a 10% chance for  success.

Another way to say it is, “If it ain’t broke, don’t fix it”.

Our donor egg success rates

Our egg donation costs

See our list of available egg donors

How to donate an egg

A comparison of clinic success rates may not be meaningful because patient medical characteristics, treatment approaches and entrance criteria for ART may vary from clinic to clinic.

This report is a useful resource for couples pursuing fertility treatment. Success rates are significantly different between programs. When you go through an IVF cycle you are not getting the same treatment at every program.

It’s not like going out and buying a Jeep:

• If there is a Jeep dealer closer to home, or a little cheaper – then a Jeep is a Jeep, so buy it there
• However, IVF is not a commodity
• IVF at one clinic may result in an average success rate of 25% while at another clinic it might be 60% for the same age group
• In vitro fertilization at “Clinic A” does not equal IVF at “Clinic B” – so do your research

Our IVF success rates
Our egg donation success rates

The clinics must turn in their data every year (to SART and the CDC)  in November for the IVF cycles performed during the previous calendar year. SART then takes a few months to prepare the report and publish the results on the web.

The CDC (Centers for Disease Control and Prevention), a US government agency, also publishes annual IVF success rate reports

• However, release of the CDC report is delayed by about 8 to 10 months after the SART report
• The CDC’s report is more comprehensive and includes more clinics with additional analysis of data beyond clinic success rates
• The drawback of the CDC report is the additional delay before publication

To go to the 2009 SART report and check IVF live birth success rates for any SART member clinic, follow these steps:

• Click this link: www.sart.org
• Click on the orange button “IVF Success Rate Reports”
• Click on the state that you want on the US map
• A list of all SART member clinics in that state will come up
• Click on the clinic you want to see results for
• Click next to “ART Data Report” (at the bottom) and that clinic’s IVF success results for 2009 will come up

Study the report in the area relevant to you – own eggs and age 40, or donor eggs, etc. If a clinic is missing from the SART or CDC reports it is probably a bad sign. Find out why they did not report – or go elsewhere. Buyer beware.

If you check the success rate information for a clinic you are considering for treatment and find that they are low compared to national averages or other clinics in your area – go to a clinic with higher success rates. It would likely increase your chance to have a baby with IVF.

A comparison of clinic success rates may not be meaningful because patient medical characteristics, treatment approaches and entrance criteria for ART may vary from clinic to clinic.

I see a lot of couples that fail IVF at other in vitro fertilization programs and then come to us for their 3rd or 4th or 5th IVF attempt. They seek an IVF clinic that can give them a better outcome. Recently I’ve been hearing a similar story from couples that have failed at certain other IVF clinics in the Chicago area.

What to do if your first IVF cycle fails

These couples asked their fertility doctor why our clinic (Advanced Fertility Center of Chicago) has higher IVF and donor egg success rates than they have. They have been told that “Dr. Sherbahn cherry picks the best patients and does not treat patients with a low chance to get pregnant”. In other words they are accusing me of turning patients away with a low chance for pregnancy in order to cherry pick only the best patients and thereby artificially pump up our success rates.

It is a total crock. Patients that fail IVF again and again are likely to do IVF related research on the internet. They will find the CDC and SART websites where they can see if another clinic in their area has better pregnancy rates than the program where they failed.

How to research IVF success rates at US clinics

• People are often motivated enough at that point to drive farther to a clinic that might give them a better chance for success.
• Therefore, people that fail and often have egg quality problems or other issues holding back their success will tend to switch to programs with higher success rates after they have done research.
• This results in programs like ours with higher than average success rates getting more patients with previous failures - which tend to be the most difficult cases.
• As a result, we will get relatively fewer “easy” cases

We do not send patients away or tell them we will not do IVF on them unless they are menopausal or otherwise clearly have a very low chance of success. I believe that if the couple has about a 5% or better chance of success and has been educated about their chances – we should allow them to cycle here. Taking patients with a 5% chance of success is certainly not “cherry picking”

• Some fertility specialists with big egos and poor quality IVF programs either just can’t accept the fact that their IVF programs aren’t very good – or perhaps they’re in denial and really believe that other programs have better success rates because they “cherry pick”
• Either way it’s pitiful

The clinics with low success rates often say that the reason IVF success rates are different between clinics is because:

• Patient populations are different between clinics
• Criteria for canceling IVF stimulation cycles are different
• The number of embryos transferred is different
• The percentage of single embryo transfer cases performed is different

Because these things can be different between clinics they claim that comparing success rates is not valid. However, just because comparisons are not perfect does not mean that comparisons should not be made. We cannot expect 100,000 IVF patients coming to 500 clinics across America to all have equal potential for a successful pregnancy. Every case is different, every egg and every sperm is unique and even the uterus can vary to some extent.

• However no clinic gets all the good cases, and no clinic gets only bad cases
• A mix of patients will present themselves to every clinic for treatment

If we look at success rates of clinics in the US according to the CDC and SART 2008 data sets (see graph below), we see a range of live birth success rates for cycles using fresh donor eggs from 25% to 81% per transfer. The national average for 2008 was 55% per transfer.

Our donor egg success rates

Egg donation cycles should be homogeneous with little chance for “cherry picking”. This is why I use donor success rates here for comparison.

• Egg donors are generally quite young – usually under 35 years old
• The recipients tend to have an a normal uterus – a low percentage of patients have uterine problems
• It is therefore unlikely that uterine problems would be a significant factors affecting a clinic’s overall egg donation success rates
• So how can we explain the dramatic differences in success rates between clinics doing egg donation?
• The differences are not due to the quality of the donor’s eggs or the recipient’s uterus or the number of embryos transferred
• These variations in success rates are a result of differences in treatment protocols and quality control in the IVF labs

Execution from beginning to end is critical:

• Proper regulation of IVF stimulation of the egg donor and the recipient properly
• Performing the egg retrieval procedure expertly and at the right time
• Many variables exist in the in vitro fertilization laboratory which impact the quality of the embryos
• Choosing the proper high quality embryos for transfer
• Properly performed embryo transfer using ultrasound guidance is critical for a good outcome

Can there be differences in patient selection and other factors for egg donation cycles?

• Yes

Will these differences have a substantial impact on success rates?

• No. This is why egg donation is an excellent model for comparing IVF clinics.

Consumers of fertility services should go to the CDC and SART websites and study egg donation success rates of the programs that they might consider going to for IVF or for egg donation. This is a way to compare IVF clinics which pretty much eliminates the “cherry picking issue.

• So to the fertility doctors that accuse other doctors with higher success rates of “cherry picking”, I say:
• Stop whining and put your energy into fixing the problems in your own IVF program instead of making excuses for why another clinic is doing better than you are.
• Or consider quitting IVF and focus on artificial inseminations and infertility surgery

It is a simple problem without a simple solution:

• Single embryo transfer success rates are lower than when 2 are transferred
• Couples want a baby (or twins) ASAP, and they don’t want to pay for multiple IVF attempts
• They fear failing to become pregnant more than they fear the risks from a twin pregnancy

This dilemma is often due to the fact that the large majority of patients in the US are self-pay for all costs associated with IVF. In the US the average cost of IVF is about $10,000 (for monitoring and procedures) and about $3500 for the medications. With these high costs, couples will often push for at least two embryos for transfer – even if the female partner is young.

Guidelines from the American Society for Reproductive Medicine (ASRM) were established many years ago for the maximum number of embryos to transfer (see table below). These guidelines take into consideration the age of the female and other criteria that help predict risks for having a multiple pregnancy.

ASRM guidelines have been modified over the years – with the recommended maximum number for transfer being reduced each time. I believe that the ASRM guidelines on the maximum number of embryos for transfer are excellent.

See PDF document with ASRM transfer guidelines

Currently the guidelines suggest a maximum of 1 to 2 embryos to be transferred for a female partner under 35 years old if the transfer is being done on day 2 or 3 – and a maximum of one embryo to be transferred for that age group if the transfer is being done on day 5. These maximum numbers are for patients considered to have a “favorable prognosis”.

When female age is over 35, the maximum number of embryos allowed increases. Everyone knows about the Octomom mess – a situation where a physician went way overboard – with a patient that was just as far out there…

Favorable prognosis would be couples having their first IVF attempt, good embryo morphology scoring, left over embryos available for freezing, or a previous successful IVF cycle. The guidelines allow transfer of additional embryos for patients that have a less favorable prognosis.

When single embryo transfer is performed, blastocyst embryo transfer on day 5 after fertilization appears to be the best method. Embryos that have continued developing normally to the 5th day have a higher chance of implanting than do day 3 embryos (on the average).

• Learn more about blastocyst transfer and multiple pregnancies
• Learn about day 5 blastocyst embryo grading

A common dilemma that comes up regarding the number of embryos to transfer is seen in couples that have had an unsuccessful IVF cycle. They come back to talk to their doctor about what to do in order to have a successful outcome after IVF has failed. If these patients have transferred 2 embryos with the failed cycle – it is fairly common that they ask – “can we transfer 3 if we try IVF again at your clinic?”

If the female partner is less than 35 years old this would be a violation of the guidelines which suggest that the maximum number to transfer should be 2 – regardless of whether it is being done on day 3 or day 5 – even in the “less favorable” prognosis situations.

So if the infertility specialist says that it would not be a good idea to transfer more than 2 embryos, sometimes the patient responds with; “My friend went to another clinic and she’s younger than me. They transferred 3 embryos and she has beautiful baby now. So why won’t you let us transfer 3 embryos if we understand and accept the risks?”

The consumer of fertility services may be putting their entire life savings on the line with this treatment. Because of that, they sometimes feel strongly that they should be able to take the risk of a multiple pregnancy if they choose to. When it comes to deciding on how many embryos to transfer – how much say should the couple have, and how much say should the doctor have?

The reality of a competitive marketplace is that patients will take their money to the clinic they believe will serve them best. Sometimes that will be a clinic that is willing to transfer more embryos because they’re afraid that if they are limited to 2 (for example) that they will fail and never have a family because that doctor was too conservative.

Some IVF centers operate in a geographic area that does not have much competition from other clinics. I think it is much easier to set strict guidelines on the maximum number of embryos that can be transferred in such an environment – as opposed to an environment such as the Chicago area (and many others) where there are 15 or more IVF programs patients can choose from.

In some countries in Europe there are laws restricting the maximum number of embryos that can be transferred with in vitro fertilization. In the US there are not laws like this. One difference in those European countries is that usually the government is paying for IVF. If the government pays for it, then perhaps it is reasonable for them to restrict the maximum number of embryos for transfer. Apparently, those governments believe it is important to put a limit on the number of embryos transferred in order to minimize multiple pregnancies and the complications that can occur.

However when the infertile couple is paying the ticket, it may not be reasonable for government to regulate the number of embryos transferred. There are about 14 states in the US that have some level of health insurance mandate for infertility treatment coverage. The rest of the states in the US have no mandate – and there generally is very little health insurance coverage for fertility treatments in those states.

In Illinois, some couples have insurance coverage for IVF and many do not – even though there is officially a mandate for health insurance to cover IVF on the books. The state has allowed loopholes – so many companies do not provide the coverage that was written into the law.

I find that couples with good health insurance coverage for in vitro fertilization tend to be more conservative on average with the number of embryos that they ask to have transferred as compared to patients that are paying completely out of pocket. Couples paying on their own tend to be more aggressive and transfer higher numbers of embryos. This is not surprising. Patients often say; “We want to try to get more bang for our buck”.

Fertility treatment costs can be substantial, particularly with the too common scenario where the health insurance does not cover any of the costs.

Pros of single embryo transfer – SET:

• Greatly reduces risks for having multiple pregnancy (in rare cases the embryo splits and there are identical twins)
• Single pregnancies have lower risks for complications such as premature birth, etc.

Cons of single embryo transfer:

• Single embryo transfer success rates are lower than when more are transferred (from 1 “fresh cycle”)
• Therefore, potentially higher financial costs for continued treatments

Mild IVF (or micro, or mini IVF) seems to be slowly growing in popularity over the last few years. Is it a good fertility treatment?

• The basic concept is to do in vitro fertilization after a low level of ovarian stimulation with oral medications (possibly with some “low dose” injectables as well).
• This is in contrast to the usual method of ovarian stimulation for IVF which involves more aggressive stimulation of the ovaries with multiple injections over about 8 to 15 days.
• The standard method of stimulating is done in order to try to get about 10 or more eggs to work with for in vitro fertilization.
• The IVF cycle cost for mild IVF (including medications and everything) should be less than the total cost for standard in vitro fertilization
• However, the success rates for standard IVF are much higher
• Success rates with mild in vitro fertilization are much lower – often in the range of about 5% to 15% per attempt, depending greatly on the age of the female

Why do we try to get so many eggs for “standard” IVF?

IVF success rates are much higher with a “good” number of eggs due to the substantial drop-off that is seen in early embryo development.

The chart below shows the average number of eggs, mature eggs, fertilized embryos, “good” embryos on day 3, blastocyst embryos on day 5, etc. in three age groups of women at our clinic.

• If there are extra embryos available for freezing, we freeze on day 5 and day 6 (possible freezing shown by purple arrow going up).

As shown in the chart, in the average case there is progressive drop-off over time with in vitro fertilization. Human reproduction is not extremely efficient – if we were mice or cows we would be efficient reproducers. Alas, we are not so lucky – we are stuck being human…

• We expect drop-off in the eggs and embryos in the fertilization and development process
• Therefore, having more eggs at the beginning makes it more likely to have at least one embryo at the end that is strong enough to make a baby
• Read more about the IVF process and how it increases efficiency of human reproduction

So if we do mild IVF and we only get a few eggs instead of a larger number as in standard IVF, do we still get enough to end up with a good pregnancy success rate?

• The short answer is no. On the average, low egg numbers will translate over to low chances for success.
• With mini or micro-IVF:
  • The IVF stimulation process is easier for the woman
  • Medications are cheaper
  • The cost for one cycle of IVF should be substantially less
  • But the pregnancy success rate is much lower compared to conventional in vitro fertilization
  • What good is cheap and easy if you don’t have a baby?

What is the best number of eggs to get?

• The answer depends on what the goal is
  • > 10 eggs = The highest possible chance for success – and likely to have leftover embryos for freezing
  • 5-9 eggs = Slight to moderate reduction in the fresh cycle success rate – and reduced chances for having leftover embryos for freezing
  • 1-4 eggs = Substantially lower success rate, particularly in older women – almost never any leftover embryos for freezing
  • The chart below shows our live birth rate per egg retrieval procedure by age group and number of eggs retrieved
  • Read more about number of eggs and IVF success rates by age

Let’s review some of the claims made by some US IVF doctors that are pushing mini-IVF

• Claimed by some fertility doctors: “Mini IVF is a cost effective treatment option for young women attempting to conceive”.
  • This depends on how you measure “cost-effectiveness”. If the total cost for a successful cycle (baby) is the measure, then mini-IVF will not measure up to the cost-effectiveness of conventional in vitro fertilization at a clinic with high IVF success rates.
  • For example, if it costs half as much for the IVF cycle (including all medications) but the success rate is 1/4 of standard IVF at a good program – then it is not “cost-effective”. In this example the average cost per live birth would be twice as much for mini-in vitro fertilization as for standard IVF.

• Claimed by some fertility doctors: Mini-IVF is a dramatically lower cost option that simplifies IVF for patients and maintains the same success rates”.
  • It’s not polite to call another doctor a liar, but this is simply not true. Unfortunately, not all fertility doctors tell the truth.
    
  • Mini or micro IVF has a much lower chance of success for the large majority of couples.

• Claimed by some fertility doctors: “For older patients, the success rate with micro-IVF is even higher than with conventional IVF”.
  • This is generally not true. As shown in the chart above, our in vitro fertilization program had a 7% live birth rate per egg retrieval procedure for women 41-42 if they had 1 or 2 eggs vs. 35% if they had over 10 eggs (yellow columns on chart). Mini-IVF tends to produce low egg numbers.
  • However, it is possible that the success rate would be similar for standard and mini-IVF for the subset of women that respond very poorly to aggressive stimulation with standard medication protocols.
    • Either method would be likely to give them a low number of eggs to work with and a low chance for success.

Mild IVF is a reasonable option for some patients

• However, in the US it is a situation of “buyer beware” as it is being aggressively sold by some clinics using sales pitches full of hype and little truth.

PR: wait… I: wait… L: wait… LD: wait… I: wait… wait… Rank: wait… Traffic: wait… Price: wait… C: wait…

There are two websites that report IVF success rates annually to the public:

• CDC website (Centers for Disease Control and Prevention)
  • CDC is a US government agency
• SART website (Society for Assisted Reproductive Technology)
  • SART is an organization dedicated to the practice of IVF in the US
• Links to these sites that report IVF success rates

The CDC IVF Success Rate Report for 2008 report has not yet been released. In vitro fertilization statistics are currently available from the CDC for 1999 through 2007.

In late February 2010 the Society for Assisted Reproductive Technology (SART) released the IVF Success Rate Report for 2008 cycles.

The SART report is released every year on the web and is available to the public. Almost all reputable in vitro fertilization centers are members of SART. Members are required to submit their in vitro fertilization data annually. Each clinic has its own listing page that shows its success rates on the SART website.

To view any clinic’s success rates through SART:

1. Go to the SART website
2. Click on IVF Success Rate Reports
3. On the map, click the state that you are interested in.
4. A list of all reputable SART member clinics in that state comes up.
5. Click on any individual clinic – a page called “Clinic Contact Information” appears. At the bottom click the link next to “ART Data Report”. You will go to a page showing that center’s in vitro fertilization success rates for 2008.
6. To see the center’s IVF statistics from a previous year, use the pulldown menu at the upper left where it says “Select Year”.

Although clinics with low success rates don’t mention it, there are large differences in success rates between clinics

There are number of reasons for this, but the biggest difference between different clinics is the degree of quality control within the system.

Patients often ask me why our success rates are so high. The answer is simple.

• We invest in the best technology and work hard to maintain ideal quality control
• It is much easier to do “average IVF” than it is to do “high quality IVF”
• High quality ovarian stimulation for IVF can result in better egg quality
• High quality embryo culture in the lab can result in better embryo quality
• High quality embryo transfer procedure to put them back in the uterus results in a higher chance for embryo implantation

Some clinics in the Chicago area tell patients that our success rates are high because of our “patient selection”. They say that “Dr. Sherbahn gets the easy cases” and that their center gets more of the difficult cases. This is absurd.

• After couples check success rates on the CDC or SART websites, they do not gravitate to clinics with low success rates.
• They do the exact opposite. They go to clinics with higher success rates – and avoid further treatment at clinics with low success rates.
  • The effect is that clinics with higher success rates get a mix of more difficult cases compared to clinics with low rates.
• The more times a couple has failed in vitro fertilization, the more likely they are to check success rates online to research their options.
  • Learn more about what to do if your first IVF cycle fails

So do your research before you do your IVF

Look up the live birth success rates on the SART or CDC sites and make an informed choice – before your first cycle. I suggest that you trust your in vitro fertilization cycle to a clinic with success rates at or above the national average.

A comparison of clinic success rates may not be meaningful because patient medical characteristics, treatment approaches and entrance criteria for ART may vary from clinic to clinic.

Can you freeze eggs in an attempt to preserve fertility for a future pregnancy?

• Yes, egg freezing (oocyte cryopreservation) is being done – some women freeze eggs to try to reduce the impact of aging on fertility
• Success rates for IVF with fresh eggs are high in young women
• Success rates for IVF using frozen eggs are generally much lower – but are improving. This technology is rapidly evolving.

There is currently controversy about:

• Who should be offered egg freezing?
• What should women of different ages be told about their chances for having a baby with frozen eggs?
• Are women who freeze eggs well informed about the chances to have a baby in the future with their frozen eggs?

What do recent studies show regarding pregnancy success rates using frozen eggs?

Egg freezing is relatively new

• IVF with fresh eggs has reportedly resulted in the birth of about 3 million babies worldwide
• IVF with frozen eggs has resulted in the birth of about 2000 babies worldwide
• Studies continue to investigate whether the older “slow freezing” technology or the newer method of “vitrifying” eggs will be better

Older studies

• Studies from the 1990′s to early 2000′s showed pregnancy success rates with frozen eggs of about 2% to 10% (live birth rate per embryo transfer cycle).

Recent studies

• A recent study from an Italian group found similar fertilization and embryo development rates of vitrified versus fresh eggs. Vitrification is a relatively new freezing method.
  • This study involved 40 cycles in women (average age 35.5)
  • The ongoing pregnancy rate (beyond 12 weeks of pregnancy) with vitrified eggs was 30% per cycle.
  • This is a good rate since only 3 eggs can be inseminated under Italian law.
    • Study by L Rienzi, et al, Human Reproduction; January 2010

• A 2009 study of 23 IVF cycles using frozen eggs (average age 31.5)
  • There were 14 pregnancies, 1 miscarriage and 13 ongoing pregnancies (57% per transfer)
    • Study by J Grifo and N Noyes, Fertility and Sterility; May 2009

• A large multicenter Italian study compared IVF using fresh vs. frozen eggs
  • Italian IVF clinics tend to have lower success rates because only 3 eggs can be inseminated per cycle (by law)
  • They compared 2209 cycles with fresh eggs to 940 cycles with frozen eggs
  • The success rate was halved using frozen instead of fresh eggs
  • 748 thawing cycles in women less than 39 years old (average age 33.6)
    • Live birth rate per transfer with frozen eggs was 13.3% (age < 39)
  • 192 thawing cycles in women 39 and older (average age 40.5)
    • Live birth rate per transfer with frozen eggs was 8.1% (age 39+)
  • Study by A Borini et al, Fertility and Sterility; January 2010

Aging and female fertility issues

Many women pursue advanced education and career advancement – and delay childbearing. Fertility specialists commonly see women with fertility issues due to aging in their late 30′s and 40′s who  are disappointed when told that it may be too late to have a baby with their eggs.

When an “older” woman switches to using “young” donor eggs, she is very likely to have a successful pregnancy outcome. Some women are comfortable moving on to using donor eggs to have a baby. For others, using their eggs is critical.

Think of the uterine lining as the “garden”  and the embryos as “plants”:

• Aging does not compromise the garden
• Aging “weakens” the plant
• That is why success rates with egg donation are so high – regardless of the age of the recipient woman
• Egg freezing could let women extend their biological clock and delay childbearing for social or professional reasons.
• Women could “self-donate” eggs – freeze and store them for the future in case they age significantly by the time they want a baby.

Risks of egg freezing to the woman donating are low:

• Women are stimulated with medications as for IVF to produce multiple eggs prior to aspirating eggs from the ovaries and freezing.
• The rate of serious complication (severe ovarian hyperstimulation, serious bleeding, infection, etc.) is less than 1%.
• There is the risk that women might delay having children because they have frozen eggs that they expect to have success with. Some would have poor results later after thawing, fertilization and embryo development.

Questions and potential problems with elective oocyte cryopreservation to  delay childbearing

• Do the women have realistic expectations of the pros and cons and alternatives to freezing their eggs?
• What effect would deferral of childbearing with egg freezing have on our society if it becomes common?
• Will some fertility doctors mislead women about benefits of this process for their own economic gain?
• Is it proper to allow women to make their own decisions about using this new technology now, or should “social” egg freezing to extend fertility be reserved for the future – after we have better outcome studies?
• At what point is an “experimental” procedure done enough, understood enough, and researched enough so that it is no longer considered experimental?

The definition of ‘‘experimental procedures’’ according to the Practice Committee of the American Society for Reproductive Medicine (ASRM):

• “Procedures (including tests, treatments, or other interventions) for the diagnosis or treatment of infertility will be considered experimental or investigational until the published medical evidence regarding their risks, benefits, and overall safety and efficacy is sufficient to regard them as established medical practice.”

What is the position of the American Society for Reproductive Medicine (ASRM) regarding egg freezing?

It appears that the current position of the ASRM is:

• Egg freezing is appropriate for women with cancer and other medical conditions needing treatment that is likely to impair their fertility.
  • These women usually do not have any other good option for having a baby with their own eggs.
• ASRM currently discourages egg freezing for women who want to electively extend their fertility into the future. Apparently, this is due to concern that there is some risk, and could even be harm done by using new technology prematurely.
  • “Prematurely” means before both safety and efficacy have been reasonably established.
• When eggs are frozen, it should only be done with appropriate informed consent in an IRB approved study protocol.
• There is not enough data to properly inform women about chances for success using frozen eggs.
• There is not enough data to know if egg freezing might cause an increase in problems in children.

Conclusions about egg freezing

• Egg freezing for extending female fertility is showing great potential for the future.
• It is currently being used for women with cancer that need treatments that impair their future fertility.
• Some IVF clinics are offering social egg freezing to extend fertility.
• Although some recent studies report good success rates for IVF with “young” frozen eggs, there is little data on success rates using “older” eggs.
  • Women considering freezing eggs tend to be in their late 30′s and early 40′s.
  • We need more outcome data using frozen eggs in this age group.
• This is an evolving technology with important questions still to be answered before it is “ready for prime time”.

The Advanced Fertility Center of Chicago is currently involved in an IRB approved study on egg freezing using vitrification technology.

• Read more about our egg vitrification study
• Call us  for details about enrolling in this study.
  • 847-662-1818

Our society has evolved and many women are pursuing advanced educations and career advancement – and delaying childbearing as a result. However, in general women should be more knowledgeable about the impact of delaying childbearing on fertility potential.

Fertility specialists know this is a problem. We commonly see women in their late 30s and early 40s that are very bright and well-educated who are surprised and very disappointed when told that it may be very difficult (or impossible) to get pregnant and have a baby using their own eggs.

I like to use a “garden” analogy when discussing infertility with patients. The uterine lining is the “garden”  and the embryos are the “plants”. As women age, the garden is rarely the problem – the plant is often the problem. This is why using donor eggs is so successful regardless of the age of the recipient woman.

When an “older” woman switches to using “young” donor eggs, she is much more likely to end up with a high quality “plant”. The ability of the uterus to accept implantation of embryos does not decline significantly with aging (the older garden is receptive).

Sometimes when in vitro fertilization (IVF) is not successful, women ask about using a surrogate to carry their embryos – hoping that would solve the problem. However, it is not an effective solution. We would be switching from her uterus (which is not defective) to using another woman’s equally receptive uterus. There is no point in it.

However, switching to higher-quality eggs from a younger woman is more likely to result in successful pregnancy outcome. If the problem is in the “plant” then we can switch the “seed” and expect a better chance for success. But switching the “garden” doesn’t help because that was not the problem.

So what should women and their primary care doctors do regarding aging and fertility issues?

Women that might want kids (or more kids) in the future should:

• Educate themselves regarding fertility and female age
• Ask their doctors to test their egg supply as they get into their 30′s

Tests of the egg supply are referred to as “ovarian reserve” tests.

Blood tests for ovarian reserve

• Day 3 FSH, LH and estradiol
• AMH, anti-mullerian hormone

Ultrasound tests for ovarian reserve

• Antral follicle counts
• Ovarian volume

However, regardless of the ovarian reserve, female age is a very important consideration.

Conclusions:

• Many women want to have kids – but delay it too long
• Our society is not educating women well about aging and fertility
• Women should learn about declining fertility potential – and be tested for it

In a perfect world:

• Women would be well educated about fertility and aging
• Early screening for ovarian reserve should be done by the OB/GYN, or other MD
• Then women can make well-informed choices about delaying childbearing
• Society should better accommodate childbearing during educational and early workforce years

Related links:

Age and fertility

Fertility after 40

IVF and age

Testing for egg supply – ovarian reserve

Egg donation
__________________________________

• An abnormal number of chromosomes is referred to as aneuploidy
• Aneuploidy causes the increased rate of miscarriage with aging
• Aneuploidy is responsible for most of the decline in fertility with advancing age (both with and without IVF)

In recent years research has shown the importance of a structure in the egg called the meiotic spindle. This spindle is involved with aligning chromosome pairs so proper division of pairs can occur during egg maturation.

• As women age they are more likely to have an abnormal spindle apparatus that does not efficiently line up chromosomes prior to division
• This causes a higher likelihood for an unbalanced chromosomal situation in the mature egg – and then in the embryo

A recently published study (referenced below) might help us to understand why some women have more chromosomally abnormal eggs at a given age. This study was performed in mice, but may well have relevance for human reproduction as well (in many ways we aren’t as different from mice as we might like).

• The researchers identified a specific gene mutation in mice that is associated with a high rate of chromosomal abnormalities in the eggs and embryos
• The gene is called Bub1
• They showed that this gene is involved in regulation of division of pairs of chromosomes during egg maturation
• The severity of the chromosomal problems increased with age
• Because the chromosomal abnormalities were passed on to the resulting embryos, there were high rates of loss after embryo implantation

This could give us insight into reasons for some couples having infertility, repeated miscarriages, or repeated failures with in vitro fertilization. More research is needed in this area.

If humans are found to have a similar gene, it is possible that a blood test could be developed to see if women are at increased risk for having eggs and embryos with chromosomal abnormalities. Then fertility specialists could more accurately advise couples about effectiveness of available treatment options.

Reference for article discussed above:

S. Lelanda, et al: Heterozygosity for a Bub1 mutation causes female-specific germ cell aneuploidy in mice. PNAS August, 2009; Pages 12776-12781.

Links to related pages:

Eggs and chromosome problems

Age and fertility

IVF and age

Fertility and IVF in women after age 40

Egg donation

PGD, preimplantation genetic diagnosis: Should we test chromosomes of embryos?