In Vitro Fertilization - IVF- Success Rates

The Jones Institute has the first and therefore the oldest program in the United States, with the first IVF baby born in this country. Her birth date was December 28, 1981. By December 2007, 3,440 babies were born with assistance from our program.

The main factors affecting IVF outcome include the following:

• age of the woman ( and consequently, her ovarian reserve )
• normalcy of the uterus, and semen quality
• success or failure of fertilization and cleavage in vitro
• number of embryos transferred and cryopreserved
• adequacy of the luteal phase after transfer

In addition, success rates increase as the number of IVF stimulation attempts increase, probably ranging to a maximum of three to four stimulation cycles.

Success Rates

Average statistics may not apply to an individual patient or couple within an age or treatment group. Success rates vary depending on many factors including the causes of infertility, the adequacy of ovarian reserve ( as measured by cycle day - 3 serum FSH, LH, estradiol levels, and the clomiphene citrate challenge test ), and the number, maturity, and quality of eggs retrieved.

It is important to understand the philosophy with which the Jones Institute approaches the management and treatment of infertility. Here, our goal is to help couples achieve their dreams of having children. The Jones Institute does not pre-select patients; in other words, we do not exclude couples due to the presence of factors that may negatively impact their success rates. For example, one third of our female patients are "low responders ( they are more than 37 years of age and / or have a day - 3 FSH greater than 10 mIU / ml ( normal range is between 3 - 10 mIU / mL for the assay used in our laboratories ). In addition, another third of our patients performed at least one failed IVF cycle elsewhere. These two factors are typically considered to compromise success; nonetheless, we have been able to achieve pregnancies in many of these cases. As a consequence, the Jones Institute offers all couples the possibility of enrollment and participation in an IVF attempt to have their own genetic children.

The exception to this rule is the presence of a female older than 43 years of age and / or with an FSH level greater than 15 mIU / mL on basal cycle day - 3 ( the value of FSH is laboratory - dependent, therefore these thresholds apply to values obtained in our laboratories ). These patients are directed to egg donation, a program that offers a high chance of conception.

In addition, and up to a certain point, success rates in our program increase as the number of IVF stimulation attempts increases. There are several methods of calculating pregnancy rates. Here, we include our most recent results for IVF and donor egg cycles, our cryopreserved cycle pregnancy rates, combined pregnancy rates for the years 1981 - 2007, and the so - called total reproductive potential success rates. Our IVF rates include information on female age because a disproportionately high number of treated young females may result in higher than "normal" success rates. This is an important factor when comparing success rates from different treatment centers as fertility usually begins to decline in females aged mid to late thirties.

Current Events: Latest IVF News and Results

It has almost been a year since the opening of the new Jones Institute IVF lab and operating room in our own facility at EVMS.

We performed a total of 206 IVF and donor egg retrievals and transfers, and 83 frozen embryo transfers in the new IVF/OR facility between March and December 2007. The pre-op/recovery/operating room (OR) areas are working efficiently under the supervision of Robin Lee, RN, and her staff. It is rewarding to hear patients’ comments about the high degree of satisfaction with the facility as well as the overall operation. They report lower stress levels, need for less pain medication as well as faster recovery in a more friendly and familiar atmosphere than when we were located at the hospital.

The combined efforts of highly professional nurses, experienced embryologists and dedicated anesthesiologists from Atlantic Anesthesia have allowed us to achieve excellent results and provide individualized patient care.

Our continuous efforts to provide excellent care have resulted in high clinical pregnancy rates in the last 6 months (Jones Institute series #93, July through December 2007).

IVF

The mean female’s age was 34 years (range 28-43 years), the average number of mature eggs retrieved was 11, and 45% of cycles provided embryos for cryopreservation.

The clinical pregnancy rate per transfer was 44%.

The mean number of embryos transferred was 2.18.

Not surprisingly, the pregnancy rates were directly influenced by patient’s age: <30 years: 50%; 30 – 34 years: 47%; 35 – 37 years: 48%; 38 – 40 years: 33%; and >40 years: 11%.

Donor eggs

The average donor’s age was 28 years, and the donor egg recipients ranged from 34 to 49 years.

The clinical pregnancy rate per transfer was 50%.

The mean number of embryos transferred was 2.0.

The IVF lab, OR facility, equipment and maintenance are in compliance with AAAAF accreditation requirements, with a planned follow-up air quality analysis in the first quarter of 2008.

Always looking for expanding the services and increasing patients’ satisfaction, we are anxiously waiting for final agreements with insurance carriers to start performing selected endoscopic surgeries in the new facility.

In Vitro Fertilization ( IVF ), donor eggs, and embryo cryopreservation

Outcomes of previous years are available from the CDC reports ( Centers for Disease Control, USA ). Here, we present an update of our IVF and donor egg programs with the more current figures. Pregnancy results are expressed as clinical pregnancy rate per embryo transfer cycle and are calculated based on the demonstration of a gestational sac by ultrasound examination four weeks post - embryo transfer.

Table 1 shows results for the period 2000 - 2007 of IVF ( fresh transfers ) and of cycles of cryopreserved - thawed embryo transfers of patients with good prognosis ( women less than 38 years of age, with a normal ovarian reserve based on serum day - 3 FSH levels and who underwent stimulation with a long [ luteal ] Lupron protocol in combination with recombinant FSH ), as well as the outcome of donor egg cycles. As can be observed, IVF patients with good prognosis have an excellent outcome with very similar results to those of donor eggs.

Table 1 - Jones Institute IVF Success Rates 2000 - 2007
( includes ICSI )

Success rates depend heavily on the female's age. Table 2 illustrates this factor for the period 2000 - 2007 for all IVF cases at the Jones Institute ( only excluding donor egg cycles ).

Table 2 - Jones Institute IVF Results 2000 - 2007
( all stimulation protocols, includes ICSI )

There are two ways to increase the odds of pregnancy. One is to freeze extra pre - embryos, if available, and the other is to try again.

At the Jones Institute, we have long been a leader in freezing embryos ( cryopreservation ). In patients who produce many healthy embryos, freezing these extra embryos can give another chance for pregnancy at a lower cost, thereby increasing cost - efficiency. Table 3 presents results of cryopreserved - thawed embryo transfer cycles for the period 2000 through 2007 ( results include all patients, all stimulation protocols and all stages of embryo freezing without any exclusion except donor eggs ).

Table 3 - Cryopreserved/Thawed Transferred Embryos 2000 - 2007
( all stimulation protocols, all embryos, pronuclear and cleaving stages )

The other way to increase long - term chances of achieving a pregnancy is simply to try again. While the chance for success on a second or third try are no higher ( or lower ) than on a first try, simply repeating the effort over time leads to a higher chance overall. Table 4 lists our total reproductive potential success rates ( TRP ). The TRP is an important indicator of success. It refers to the number of pregnancies obtained from only one stimulated cycle, as the result of a fresh embryo transfer cycle plus at least one additional cycle of transfer of cryopreserved - thawed embryos derived from that same stimulation. This process greatly reduces the costs for multiple transfer attempts. The Jones Institute consistently produces cryopreserved pregnancy rates among the highest in the world. As shown, IVF patients with good prognosis as well as recipients of donor eggs have a greater than 60% chance of pregnancy expressed as TRP.

Table 4 - Total Reproductive Potential, 2000 - 2007
( Luteal Lupron Protocol, all female ages, includes ICSI )

Embryo cryopreservation yields multiple advantages to patients. It is important for physicians and patients to understand and comprehend the total reproductive potential per cycle based on this assessment of overall pregnancy rates. Obviously, programs with poor cryopreserved pregnancy rates, or no cryopreservation program, offer a lower TRP pregnancy rate. We encourage you to discuss this with your physicians.

Male factor infertility is present in up to 40% of infertile couples. Intracytoplasmic sperm injection ( ICSI ) has become a "boom" in the treatment of men with sperm anomalies undergoing IVF. Table 5 presents results of ICSI compared to standard IVF during the period of 1994 through 2007. As shown, the utilization of ICSI in men with poor sperm parameters yields similar pregnancy results as those obtained with IVF in men with normal semen analysis.

Table 5 - Jones Institute Success Rates ICSI vs. IVF, 1994 - 2007
( luteal Lupron protocol, age < = 38 years )

Finally, we estimate that it is important to present our overall experience in IVF since its inception in the United States in 1981. The Jones Institute total experience is illustrated in Table 6.

Table 6 - Total IVF Experience at the Jones Institute
1981 - 2007

Hydrosalpinx and IVF Success Rates

During the past few years, evidence has accumulated that the presence of a unilateral or bilateral hydrosalpinx ( obstructed and dilated tube/s ) reduces the success rate after IVF and embryo transfer. The mechanism for this is not clearly understood although there is evidence for embryotoxicity in the tubal fluid and lack of expression of markers of implantation in these patients. There also is evidence that removal ( usually by a laparoscopy on an outpatient basis ) of the affected tube/s improves significantly the pregnancy rate. If you think that you have such affected tubes, please discuss this with your doctor.

Comparison of Success Rates Between IVF Programs

Patients are cautioned regarding making comparisons of success rates between IVF clinics based on the clinic - specific data reports released by the Society for Assisted Reproductive Technology ( SART ) and the Centers for Disease Control ( CDC ). Although SART issues a statement that these data should not be used for comparison, the fact is that they are used by patients and clinics alike for that purpose. There are many variables that influence IVF success rates and many variables exist among individual clinics that make comparisons almost impossible based on the released data. Some of these problems of the clinic - specific data reports include:

• The SART data are not divided into repeat and new IVF patients. For example, patients under the age of 35 in a particular clinic may have repeated failed IVF attempts before and would have a poor prognosis even though they have a favorable age.
• The population mix of individual clinics is totally unaccounted for in the SART - released data. For example, a clinic that pushes IVF treatment ( which may be justifiable in many circumstances ) as the primary modality of therapy for patients with non - tubal infertility may have higher success rates than a clinic that offers IVF to its patients only after many failed conventional treatments ( IUIs, for example ). The different population of patients being treated may largely account for the higher success rate, in this example.
• The criteria for patient acceptance and for cancellation prior to egg retrieval vary among clinics and, as such, influence pregnancy rates tremendously. For example, a clinic that does not accept patients beyond a certain age ( for example, age 40 ) and patients with poor ovarian response ( high basal FSH levels and abnormal clomiphene citrate challenge test ) will have higher success rates than a clinic that does not exclude these patients. Again, the higher success rates will be largely attributed to the patient population.
• The policy for fresh embryo transfer and embryo cryopreservation is very different among clinics and greatly influences the pregnancy rates. For example, clinics that culture all the embryos and transfer only the morphologically best embryos may have better fresh pregnancy rates than clinics that culture only the desired number of embryos for transfer and freeze all the rest at the pronuclear stage. There are many advantages in freezing excess embryos that include giving patients another chance for embryo transfer without repeating stimulation and egg retrieval and reducing the incidence of a multiple pregnancy.

These are only some of the examples that can be listed that clearly invalidate comparisons between IVF clinics based on the released SART clinic - specific data reports.

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All information on our Web site is provided for educational purposes. Your health care professional should always be consulted for specific treatment recommendations.