Success Rates & Age Factors

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1. How successful is IVF?
   
   The chances of success with IVF are directly related to the age of the woman who provides the egg. Good programs have almost 50% chance of a birth with one cycle when the egg provide is under 35 years of age. Between 35 to 39 years of age the chances drop to approximately 35-40%, while women in their early 40’s will have approximately 25% chance of a birth with one single fresh cycle of IVF. Success may be further affected by the condition of the uterus, especially the endometrial lining and also by the number of eggs that are produced, often referred to as the ovarian reserve. The results quoted by clinics will also vary depending on patient’s medical characteristics and treatment approaches.
2. What is the success rate with frozen/thawed embryos?
   
   As with IVF involving fresh embryos the age of the egg provider is the most important predictor of outcome. We have recently seen very good success with frozen thawed embryos when embryos have been generated at ZFC and even with embryos shipped in from other reputable programs. Generally, 70% of embryos stored on day three will survive the freeze/thawed process and we have been seeing a 40% ongoing pregnancy rate with frozen embryo transfers including all ages of egg providers. Where patients have predictable and reliable ovulation, the natural cycle can be used, whereas in patients with irregular cycles or patients in the perimenopause, a controlled cycle using natural estrogen and progesterone is preferred.
3. What are the options for women over 40 years of age?
   
   When the egg provider is over 40 years of age the chances of success using her own eggs decrease as we approach 45 and at age 45 the most aggressive IVF treatment using own egg will yield no greater than 1% chance of a birth. Between ages 40 to 42 the birth rate is in the range of 25% - 30% and between 43 to 45 approximately 12% - 15%. These percentages presume a normal FSH and estradiol on cycle day three.
   
   IVF with egg donation is an option for all patients when egg production or embryo quality appears to be the major factor. This is especially relevant for patients over age 40 especially with decreased ovarian reserve.
   
   Patients over 40 may benefit from special strategies to improve response by using an Antagon protocol which bypasses the direct ovarian suppression of Lupron. In addition, blood supply to the pelvis especially the ovaries may be improved by the addition of vaginal estradiol or suppositories of Viagra during the stimulation process. In addition, preimplantation genetic diagnosis (PGD) may assist us in picking embryos which have the highest chance of being chromosomally normal, thereby decreasing the incidence of miscarriages in patients over 40 while increasing the chances of delivering a normal baby.
4. I am 32 years of age I have been told that my eggs are of poor quality. I produced more than 20 eggs in my last IVF cycle and was hospitalized with severe abdominal pain and swelling. Can so many eggs all be bad?
   
   The single most serious complication that an IVF patient faces, apart from multiple pregnancy, is the risk of becoming seriously ill after being stimulated with injectable fertility medications. This condition is known as Ovarian Hyperstimulation Syndrome (OHSS) and reports suggest that 1 to 2% of patients who receive these medications may develop signs of hemoconcentration, weight gain, severe abdominal distension, ovarian enlargement and in severe cases even renal failure. The exact cause of this syndrome is still incompletely understood, although it is well known that the administration of Human Chorionic Gonadotropin (hCG) is the precipitating event which sets in motion the symptoms mentioned above and that OHSS is made worse by pregnancy!
   
   When there are more than 20 follicles developing and the estradiol level rises above 4000 pg/ml then there is a risk of moderate OHSS and with more than 30 follicles and estradiol greater than 6000 pg/ml there is an 80% chance of developing severe OHSS. In the past, the only way of avoiding severe OHSS was to withhold the administration of the hCG and cancel the IVF cycle. The patients most likely to develop OHSS are patients with menstrual cycles longer than 30 days or patients with irregular ovulation and menstruation. Age is also a factor, but OHSS can occur in patients over 40 years if more than 20 follicles are produced. We can therefore predict which patients are most likely to develop hyperstimulation based on menstrual history and we can also identify early during stimulation, which patients are producing more than 20 follicles.
   
   Prolonged Coasting is a simple procedure whereby the fertility medication is stopped at a very specific time, in patients that are at risk for OHSS. The correct time to discontinue the fertility medication is when approximately 30% of the follicles have reached 15 or 16 millimeters in diameter. The estradiol levels should be followed daily thereafter and they will continue to rise and when the estradiol level falls below 3000 pg/ml it is safe to administer hCG and proceed to egg retrieval.
   
   Embryo quality after coasting is better than the quality seen in non coasted patients and the pregnancy outcome in patients who require coasting is excellent. It is important to restrict fluid intake to one liter of a sports drink like Gatorade per day for approximately 10 days after the egg retrieval.
   
   Patients who are young and respond with more than 20 follicles can end up with poor quality eggs because of a poor stimulation. HCG may have been given too early for fear of OHSS, instead of initiating prolonged coasting, waiting for the estrogen level to drop, then doing a safe retrieval yielding good quality eggs. If you think that you are a high responder or have menstrual cycles that are irregular, make sure that your doctor is familiar with “prolonged coasting” it may prevent a cancelled cycle and also avoid causing ovarian hyperstimulation syndrome.
5. I have endometriosis, does this affect my fertility and can it affect success with IVF?
   
   Endometriosis is a condition where cells that usually remain confined to the cavity of the uterus, grow outside of the uterus usually on or in the ovaries and also on the surface of the pelvic cavity between the uterus and the rectum. Endometriosis can cause pelvic pain and may also decrease the chances of natural conception by about one-third. Patients who require IVF who have endometriosis still have the same chances of a successful outcome as patients of the same age without endometriosis as long as immunological factors that may accompany endometriosis are identified and treated appropriately.