How Many Times Should You Try IVF Before Giving Up?

18 Dec
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When to stop trying IVF

Because 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.

350 Comments

  • Jamie says:

    Hi Dr. Sher,

    My husband and I just underwent our first round of IVF…a very disappointing and emotionally trying failure. I’m having a hard time finding much information on cases like ours and I’m curious if you could offer your input on whether or not you think it’s worth a try to go for another round. I’m perfectly healthy and although I had some mild OHSS which delayed our transfer, my Doctor retrieved 34 eggs, 32 of which were mature. Our issue is with male factor infertility. My husband is a carrier of CF and suffers from CBAVD so sperm was surgically retrieved for ICSI. Out of all those eggs, our numbers quickly dropped and we only ended up with two embryos for our FET. One had a great rating and the other was fair so we transferred both. For my first beta, I was told that my HCG was at 81 and I was pregnant yet 48 hours later, my second beta had dropped in half and I was told it was a chemical pregnancy. Should we bother to try again? I have read about others with this kind of MFI being successful but our experience has made me think that the sperm quality is just too low to justify the expense of going through it all again. My Doctor says it’s medically possible and while I understand that, in our case, does it just seem like a waste?

    • Geoffrey Sher says:

      Thank you for connecting! I am updating my entire blog, so kindly-go to http://goo.gl/4hvjoP and re-post your question/comment there, and I will respond promptly. Henceforth I will be responding on that site.

      Thank you.

      Geoff Sher

    • Thomas says:

      Try again1!!!!!!!

      • Geoffrey Sher says:

        geoffreys@sherinstitute.com
        68.96.198.165 In reply to PK.

        My website has changed. The new site is at http://www.sherIVF.com where I host and populate new and updated blog articles . The blog can also be accessed directly by going to http://goo.gl/4hvjoP. I now only respond to posts on this new site.

        To find and follow updated and new blog articles and to post questions or comments, please use this new venue. I promise to respond promptly.

        In the interim, please re-post this question or comment on my new website-blog.

        Geoff Sher

  • Lauren says:

    Hi there, I have completed 2 rounds of ivf unsuccessfully. We initially were dealing with MFI but our first ivf attempt resulted in only 2 eggs retrieved from at least 6 mature follicles- transferred a 4 cell and 8 cell on day 3 = BFN. We tried a more aggressive approach with meds on my second ivf attempt (I also took dhea and coQ10) before starting the 2nd cycle and everything was looking great. I had 11 follicles looking great in size with 3 on the cusp. I woke up after the retrieval to be told only 3 eggs could be retrieved. We pushed to let the embryos grow till day 5 to see if they were strong enough to survive. 1 made it to an early blast stage- transferred on day 5 = BFN. Supposedly the doctor could not get the eggs out of me (again)? I am 31 and have been told I am healthy and would have a good chance of conceiving naturally (if we had a high sperm count) but I do not seem to respond well to ivf meds. We were told we would get the same results if we tried a 3rd round of ivf (leaving us at 20%) chance but would have an 80% chance if we were to go the donor route. Is there a name for this diagnosis? Having a great response in terms of follicle count and size but the doctor NOT being able to physically get the eggs out of me?

    • Geoffrey Sher says:

      Thank you for connecting! I am updating my entire blog, so kindly-go to http://goo.gl/4hvjoP and re-post your question/comment there, and I will respond promptly. Henceforth I will be responding on that site.

      Thank you.

      Geoff Sher

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