How Many Times Should You Try IVF Before Giving Up?

18 Dec
4 how many times
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Button - Ask Dr Sher MedBecause of the emotional, physical, and financial toll exacted by IVF, it is preferable that a couple undertake the process with the mindset that they will be in it for more than one attempt. If a couple can only afford one treatment cycle, IVF may not be the right course of action. Recall that on average, with conventional IVF, there is only about one chance in three that it will result in a live birth, and there is a tremendous letdown if it fails. It is thus unreasonable to undergo IVF with the attitude that “if it doesn’t work the first time, we’re giving up.” In vitro fertilization is a gamble even in the best of circumstances.

Statistically speaking, a woman under 40 years of age, using her own eggs, having selected a good IVF program is likely to have a better than 70% chance of having a baby within three completed attempts – provided that she has adequate ovarian reserve, (the ability to producing several follicles/eggs in response to gonadotropin stimulation), has a fertile male partner (or sperm donor sperm) with access to motile sperm, and has a normal and receptive uterus capable of developing an “adequate” uterine lining. Women of 39-43 years of age who meet the same criteria, will likely have about half that chance (35%- 40%).

When the most “competent” embryos are selected for transfer using a new genetic process (introduced into the clinical arena by SIRM in 2005), known as comparative genomic hybridization (CGH), the birth rate per single, completed IVF cycle is likely to exceed 60% (regardless of the age of the egg provider) and, more than 85% within three such attempts.

Unfortunately, there will inevitably always be some women/couples who in spite of best effort at conventional IVF will unfortunately remain childless. In my considered opinion, it rarely advisable to undergo more than three IVF attempts using the same approach each time. There is of course one important caveat: in women where the reason for repeated IVF failure is finally uncovered, it would indeed be justifiable (assuming there are sufficient emotional, physical and financial resources) to continue trying, using a defined and new approach that addresses the reason for prior failures. Simply stated, “the time to stop trying is when there is no remediable explanation for repeated failure to achieve a viable pregnancy”.

One very interesting case comes to mind. It happened a few years back when I consulted with a 42 year old Australian patient (she happened to also be a physician) who had undergone 22 prior failed attempts at IVF elsewhere. After determining that the reason for prior failures (at least in part) was due to a hitherto unrecognized immunologic implantation dysfunction (IID), I took her through yet another IVF attempt using selective immunotherapy. She conceived (using her own eggs) and went on to have a healthy baby boy. This case serves to point out that the time to stop doing IVF should not always be based on the number of prior failed attempts alone.

When conventional IVF (with or without egg donation and/or CGH embryo selection) fails to yield a successful outcome, other options such as ovum donation, IVF surrogacy, or adoption should be considered.

Although it is the right of any healthy women who has a uterus and is capable of producing even one follicle/egg to have the right to decide on doing IVF using her own eggs, given the very low success rate after 43 years of age (less than 10% per attempt and under 25% within 3 tries) it is my opinion that women over 43 years should be advised to rather do egg donor IVF. Here, regardless of the age of the embryo recipient, the IVF birth rate after a single attempt is about 60% – and better than 80% within three IVF attempts.

Couples who choose to undergo IVF should be encouraged to view the entire procedure with guarded optimism, but nevertheless must be emotionally prepared to deal with the ever‑present possibility of failure. It is important for IVF patients to be made to realize from the outset that an inability to become pregnant should never be considered a reflection on them as individuals.

302 Comments

  • Ray says:

    Dr. Sher – my wife and I just failed our third IVF round, all in the last 10 months. My wife turned 39 last week, we have one 4 year old naturally conceived. My wife has a DOR diagnosis with a 17 FSH last October, 6.7 FSH in February this year, and 10 in September this year. AMH 0.9 last year and 1.9 in September. First round IVF was estrogen priming antagonist, had 13 follicles but only 1 egg retrieved due to “empty follicles.” Day 3 transfer for Grade 1 embryo failed. Second round same EPP antagonist, had 8 follicles, 5 eggs retrieved after 20,000 hcg trigger, all fertilized and one good quality blast transferred, negative test and nothing to freeze. Third round lupron stop with added ganirelix later in cycle (so essentially the agonist/antagonist conversion protocol), 9 follicles, 9 eggs retrieved but only 5 mature and 4 fertilized. Two grade 1 and 2 embryos transferred on day 3 but no pregnancy (our doctor gave us a 30-35% chance at time of transfer). All three cycles used 450 follistim and 150 menopur per day. Our RE is now saying we have a very low chance to conceive with our own eggs due to three failures (5-7 percent chance if we do another round). We don’t get the sense they have varied ideas on protocol options and he is convinced it is an egg quality issue, our clinic says they have tested all possible implantation issues. We are a bit surprised by the dramatic drop in success rate they are now giving us, as we did not think our response was particularly bad given the DOR diagnosis. Do success rates drop dramatically after 3 failed rounds even if embryo transfers are reached in each cycle? Any suggestions for a revised protocol if we decide to try one last cycle? We want honesty here so not just looking for an answer that makes us happy.

    • Geoffrey Sher says:

      It sounds as if it is time to consider egg donation. However, your wife still does produce eggs and while there is certainly DOR, an AMH of 0.9 ng/ml is not critical. It seems to me that rthere could be a stimulation issue here and perhaps if this is addressed, “Embryo Banking” with Staggered IVF should considered. Perhaps we should discuss this via Skype.

      Please go to the home page of IVFauthority.com. When you get there look for a “search bar” in the upper right hand column. Then type in the following subjects into the bar, click and this will take you to all the relevant articles I posted there.
      1. “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)

      2. Ovarian Stimulation for IVF: The most important determinant of IVF Outcome” (Nov. 2103)

      3. “Agonist/Antagonist Conversion Protocol”

      4. “Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)

      5. A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)

      6. “IVF success: Factors that influence outcome”

      7. “Use of the Birth Control Pill in IVF”

      8.”Staggered IVF”

      9.“Embryo Banking”

      10.“Array CGH versus metaphase CGH in IVF patients….’

      11.“Egg Donation”

      Consider calling 800-780-7437 or 702-699-7437 to arrange a Skype with me so we can discuss your case in detail.

      Finally, perhaps you would be interested in accessing my new book (recently released). It is the 4th edition (and a re-write) of “In Vitro Fertilization, the ART of Making Babies”. The book is available through “Amazon.com” as a down-load or in book form. It can also be obtained from most bookstores.

      Geoff Sher

      P.S: Please go to http://www.youtube.com/watch?v=Vp3GYuqn2eM&feature=youtu.be
      To view a video-tutorial by Linda Vignapiano RN, Clinical Manager at SIRM-Las Vegas.

  • Evrill says:

    Hi,
    I had two IVFs and one IUI. All failed. The first IVF: two fertilized oocytes: grade A and grade B. The second IVF: not enough follicles, proceeded to IUI.
    I am 43 years old and in good health. The only reason given was my age. I am pondering on should I do another IVF or just give up. Devastated.

    • Geoffrey Sher says:

      If you do IVF again…using own eggs, then you need to carefully strategize the protocol used for ovarian stimulation. This is particularly important in older women and women who have diminished ovarian reserve. Also, given the relentless progression of the “biological clock” you need to be thinking very seriously about doing “Staggered IVF” and “Embryo Banking, in my opinion.

      Please go to the home page of this blog, http://www.IVFauthority.com . When you get there look for a “search bar” in the upper right hand column. Then type in the following subjects into the bar, click and this will take you to all the relevant articles I posted there.

      1. “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)

      2. Ovarian Stimulation for IVF: The most important determinant of IVF Outcome” (Nov. 2103)

      3. “Agonist/Antagonist Conversion Protocol”

      4. “Embryo Implantation………” (Part-1 and Part- 2—-Posted August 2012)

      5. “Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)

      6.“A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)

      7. “IVF success: Factors that influence outcome”

      8 “Use of the Birth Control Pill in IVF”

      9.”Staggered IVF”

      10.“Embryo Banking”

      11.“Array CGH versus metaphase CGH in IVF patients….’

      12.“Egg Donation”

      Consider calling 800-780-7437 or 702-699-7437 to arrange a Skype with me so we can discuss your case in detail.

      Finally, perhaps you would be interested in accessing my new book (recently released). It is the 4th edition (and a re-write) of “In Vitro Fertilization: The ART of Making Babies”. The book is available through “Amazon.com” as a down-load or in book form. It can also be obtained from most bookstores.

      Geoff Sher

      P.S: Please go to http://www.youtube.com/watch?v=Vp3GYuqn2eM&feature=youtu.be
      To view a video-tutorial by Linda Vignapiano RN, Clinical Manager at SIRM-Las Vegas.

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