If at first you don’t succeed, try again

A recent study in the Medical Journal of Australia has confirmed a previously released Harvard University study on the the chances of having a baby from multiple rounds of IVF or other types of assisted reproduction.

Prior to these results, patients interested in pursuing IVF were counseled on individual cycle success, but this new research is demonstrating that persistence can pay off!

The researchers followed over 56,000 women who completed eight cycles of treatment during 2009-2012, and followed them until 2014, or the first treatment-dependent live birth.

For women aged 40, success rates for live births increased from 10 percent to roughly 40 percent by the seventh cycle.

IVF is never a guarantee of a baby. But, this study and the one that preceded it certainly support the notion that the cusses of IVF is cumulative, and a woman’s chances increase with several IVF attempts.

According to the Australian study and its researcher Professor Michael Chapman, a 35-year-old can be fairly certain that she’s got a better than 70 percent chance of taking home a baby with current modern technology.

In the past, many women were told to expect either positive or negative ‘determination’ of their ability to conceive by the third or fourth cycle. This data on multiple cycles has helped to prove that IVF and Assisted Reproductive Technology (ART) is a numbers game.

The research supports a Washington University study finding that women with robust insurance for infertility treatment also have a higher success rate. This goes along the same lines. Insurance allows the patient to continue trying, and those efforts can often lead to eventual success.

So, if the couple did not conceive after the first IVF cycle, why would we still hope to achieve pregnancy  during the following treatment cycles? We have several reasons to believe so.

First, there is a lot of natural variation in the ovary, and every month, the new group of eggs is on the start line, ready to mature and develop. The more eggs we retrieve, the better, but it really takes one good golden egg to produce a baby. Maybe it is coming out next month.

Second, when we plan for an IVF cycle, we choose ovarian stimulation after thorough testing for ovarian reserve; however, sometimes the outcome is not as expected, and the stimulation needs to be modified for the next cycle to achieve better results. We “learn” from the performance of the particular patient and the couple.

Last, but not least, even though there is little data to prove it, we knew for years that there is a positive effect of the IVF stimulation for future treatments, even when the first cycle fails. For about 30-50 percent of the patients, the second and third IVF cycles lead to production of more and better eggs and embryos. We think the explanation is that if there are a lot of positive changes in the ovary during the initial IVF stimulation that potentially improve the eggs that will be realized during the next several month.

Remember that each individual is different, and that a thoughtful review of a number of factors, physical examination and other issues must be considered in determining how much is enough.

Our job as reproductive endocrinologists and infertility (REI) specialists is to evaluate each patient determine the best protocols and continually adjust as necessary throughout the process. Some people may have the physical advantage and the insurance to back them up but are more apt to investigate other family building options earlier on. This study, however, allows us to give them the data from which to make the best decision.

Dr. Elena Trukhacheva is a reproductive endocrinologist on staff at Advocate Good Samaritan Hospital in Downers Grove, Ill.