How Many Times Should You Try IVF Before Giving Up?

18 Dec
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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.

286 Comments

  • Jandd says:

    Hello, I am a 36 year old soon to be 37, and my husband id 40. We just had our second unsuccesful IVF treatment. The first time they transferred one day 5 blastocyst, and this time two morula day five. None of the other fertilized eggs (six both times) made it to freeze stage. I have had around 10-14 follicles each time, and end up with 10 mature and six that fertilize in both circumstances. I have been told my AMH was low before we started IVF with another doctor and my husband has less than 3 million sperm, with 50 % mobility and mortality. The dr’s don’t say much and we have no support financially and the insurance pays next to nothing. I know it is hard to say and everyone is different, I just don’t know if we should continue to try. We naturally conceived two years ago and miscarried around 7 weeks. I was doing only acupuncture and my own god given will. Which is diminishing as well. I am concerned if I have a low egg reserve each time I do the IVF it decreases the eggs at a higher rate of speed, and will limit any chance quicker.

    • Jandd says:

      I have been reading more on your website, which is amazing btw, thank you so much for shirring and helping so many women. I wanted to add that I also have hoshimotos and have told my dr’s and even asked if i should increase taking my synthroid but they said no.

      • Geoffrey Sher says:

        Thank you!

        Between 2% and 5% of women of the childbearing age have reduced thyroid hormone activity (hypothyroidism). Women with hypothyroidism often manifest with reproductive failure i.e. infertility, unexplained (often repeated) IVF failure, or recurrent pregnancy loss. The condition is 5-10 times more common in women than in men.
        In most cases hypothyroidism is caused by damage to the thyroid gland resulting from of thyroid autoimmunity caused by damage done to the thyroid gland by antithyroglobulin and antimicrosomal auto-antibodies. The increased prevalence of hypothyroidism and TAI in women is likely the result of a combination of genetic factors, estrogen-related effects and chromosome X abnormalities.
        While being the main cause of hypothyroidism TAI can be present without any coexisting evidence of hypothyroidism. Regardless of whether there is hormonal or clinical evidence of hypothyroidism or whether the hormone deficiency has been corrected through thyroid hormone supplementation, women with TAI commonly present with reproductive failure
        We have reported on the fact that in approximately 50% of women with TAI (regardless of the absence or presence of clinical hypothyroidism) activated Natural Killer cells (NKa) will be detected in the blood and such women often present with reproductive failure.

        Since 50% of women with TAI do NOT have reproductive failure it is probably NOT the antithyroid antibodies themselves that cause reproductive failure. Rather this is more likely due to coexisting increased NKa that by damaging the early “root system” of the implanting embryo that causes the problem.

        In some cases of TAI-induced reproductive failure, the pregnancy is lost prior to diagnosis by a blood or urine beta hCG test or before ultrasound confirmation. In other cases the pregnancy is lost a little later as a clinical miscarriage.

        We were among the first to demonstrate and report on the association between NKa and reproductive failure in women. We also showed in such cases that, aside from the need to adequately supplement with thyroid hormone replacement in cases where there is hypothyroidism, the administration of intralipid (IL) therapy in combination with steroids such as dexamethasone or prednisone starting at least 4-7 days prior to ovulation or egg retrieval results markedly improves IVF birth rates. Women with TAI who do NOT have NKa+ do not manifest with reproductive failure and do not require or benefit from IVIG or IL +steroid therapy.

        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. “Immunologic Implantation Dysfunction” (posted on May, 10th and on May 16th respectively.

        5. “Thyroid Autoimmune Disease and IVF”

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

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

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

        9. “IVF success: Factors that influence outcome”

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

        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.

        • Jandd says:

          Thank you, yes I watched the video before. I also read the articles. I am just confused as to what to do. Gambling isn’t my think. I will order your book and try to find out more info. Thank you again.

    • Geoffrey Sher says:

      I sympathize with your difficulty in deciding what to do for all the reasons given. However, given your age, your diminished ovarian reserve and your husband’s sperm issue, IVF with ICSI is the only option. This having been said, if you go that route, y the protocol for ovarian stimulation will have to be reviewed. You need a robust, FSHr-dominant long pituitary down-regulation protocol for ovarian stimulation. I would use an agonist/antagonist conversion protocol (LA10-E2V) and in addition I would suggest “Embryo Banking with Staggered IVF”.

      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 “ (Parts 1 & 2 (posted March, 2012)

      6. “IVF success: Factors that influence outcome”

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

      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.

  • ki says:

    We were successful with ivf with transfer of 2 5 day blastocytes. Found out pregnant on week 4 and then ultrasound on week 5 to confirm twins. Went back 2 weeks later to discover that hearts were barely fluttering. Dr didn’t even give me a bpm. I’m guessing that’s really bad since he discussed next ivf round with us. We go back Friday to confirm that they did not make it. Completely torn up. Should we try again? Out of 14 eggs, 11 fertilized and only 2 made it to 5 day blastocyte. He said no others were able to freeze. I wonder if we should call it at 3 day next time.

    • Geoffrey Sher says:

      Might I respectfully suggest that you defer making a decision until you have more concrete information.

      Geoff Sher

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