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IVF: How Many Times Should I Try?

Dr. Geoffrey Sher Recommends

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Procreation, an inalienable right and one of the most insatiable of human needs, allows us as humans the opportunity to live on through our children. It is probably the subconscious drive to perpetuate our genetics and thereby leave definitive proof of our existence, that underlies the desire to reproduce. This urge morphs into desperation in many couples who are unable to conceive, becoming increasingly more acute when, with advancing age, they become more aware of their own mortality.

Although IVF offers hope to many infertile couples who might otherwise have no way of conceiving, it is not a panacea. In addition, every IVF procedure exacts an emotional, physical, and financial toll. No one gets through the process unscathed. Those considering IVF should learn what they can reasonably expect from it before committing to the procedure. Only once realistic expectations have been attained is the patient/couple ready to decide whether IVF is truly for them and when/whether/how and where to proceed with treatment

The ideal candidate/couple for IVF fits the following profile:

The woman is under 40
She has at least one ovary capable of responding normally to fertility drugs (normal ovarian reserve).
The uterus and the endometrial lining are normal and capable of sustaining a healthy pregnancy
She has been pregnant in the past, thereby proving that her eggs can fertilize. -She has access (through her partner or a designated donor) to healthy sperm.

These criteria are however, by no means absolute. In many cases, one or more of the following factors can be addressed to improve odds:

Egg quality can be optimized (for the woman’s age) through revision of the protocol used for ovarian stimulation, and by better timing administration of the human chorionic gonadotropin (hCG) trigger shot
Sperm function can be enhanced through selective medical or surgical interventions
Surface lesions inside the uterus can be surgically corrected
Immunologic implantation problems can be addressed through selective immunotherapy
A deficient uterine lining can be improved with sildenafil (Viagra) and/or hormonal treatment.

There are, however, two detrimental factors that cannot be altered. The first is that with advancing age there will inevitably be a progressive increase in the incidence of chromosomal egg abnormalities, which in turn result in a reduction in overall embryo “competence.” The second is that diminishing ovarian reserve as evidenced by a low antral follicle count, low antimullerian hormone and inhibin levels, raised follicle stimulating hormone (FSH) – all on the 3rd day of the cycle and a history of poor ovarian response to stimulation with fertility drugs lead to fewer eggs being available.

Here is a practical example. Let’s say a woman is 34 years old and her partner has normal sperm function. Following stimulation with fertility drugs, she develops a good number of mature follicles, she has a normal uterine cavity and upon optimal ovarian stimulation develops an excellent endometrial lining.Such a woman would, in an optimal IVF setting, have about a 45% chance of having a baby following a single cycle of IVF treatment. However, a woman of 41years who aside from her age fulfills the exact same criteria as her younger counterpart, would because of the adverse effect of the biological clock on egg and embryo quality have a less than half the chance of having an IVF baby.]

It follows that couples contemplating IVF should initially develop expectations based on an evaluation of those criteria that have the potential to impact outcome, and then temper their expectations with the realization that while some, adverse factors can be overcome through individualized management, not all can be.

There are some conditions that might not be reversible without resorting to other options such as egg donation and gestational surrogacy. These include:

Advanced age over 43 years
Severely diminished ovarian reserve
Intractably damaged uterine lining due to prior intrauterine inflammation (endometritis), multiple surface lesions and post-surgical scarring
Certain types of immunologic implantation dysfunction such as complete alloimmune (DQ alpha/HLA) matching of both partners

So what does this all boil down to? It means that each couple and their physician need to assess all the variables that can affect IVF outcome. Then, given their own unique set of circumstances and the capability of their chosen IVF program, the couple should develop realistic expectations. In most cases, through availing themselves to all medical fertility options, the vast majority of couples/individuals will over a few attempts, succeed.

But in the final analysis, there is a time to stop trying. Independent of the number of prior failed attempts, and aside from obvious limitations brought about by financial, emotional and physical constraints, the time to give up on IVF arrives when there is no potential remedy for the cause of failure.

Tags: Age and Fertility, Biological Clock, Diminished Ovarian Reserve, embryo competence, embryo implantation, Immunologic Infertility, In Vitro Fertilization (IVF), IVF Authority, Viagra

12 Responses to “IVF: How Many Times Should I Try?”

Sprudeln says:

March 17, 2010 at 2:34 am

We were dealing with severe MFI and it took us 5 rounds to acheive a successful pregnancy. It also took friends of ours with other issues 5 tries.

I think everyone should go into IVF well aware that it could very well take more than 1 or 2 cycles.

Reply
Geoffrey Sher, MD says:

March 17, 2010 at 1:18 pm

Thanks for your contribution.

Geoff Sher

Reply
Lorrie S says:

March 19, 2010 at 10:00 am

I am now 43 years old. I respond very well and have always had more than 10 eggs retreived with every cycle & well over 60% fertilization success each time. We're moving onto our 4th IVF cycle. My first didn't work. Second was a chemical and third I miscarried at almost 7 weeks. This will be our final IVF cycle due to insurance coverage, not by choice. If this should not work I will be devastated. I would love to have many more cycles to try, but out of pocket is not an option for us financially.

Reply
Geoffrey Sher, MD says:

March 19, 2010 at 10:31 am

Read my october 8th 2009 blog on IVF Failure-Success…Factors that affect outcome.

Good luck!

Geoff Sher

Reply
The Mystical and Practical Lawyer says:

March 29, 2010 at 11:48 am

Dr. Sher: Thank you for your informative and specific blog. I have read each topic that pertains to my husband and I. I am 33 (PCOS) and my husband is 35 (MFI). We just failed a third IVF with no change in protocol on the horizon. We have low fertilization (1st 1/11, 2nd 4/13, 3rd 7/14). No BFPs, nothing. My current RE says that it is the MFI but I am not so sure because of my severe PCOS. Is there a different protocol for PCOS? Should I be concerned that a RN "IVF Coordinator" is handling my dosage? Is it time to give up or move on to donors? We live two hours north of NYC. Should we come see the folks at your clinic in Manhattan?

Reply
Geoffrey Sher, MD says:

March 29, 2010 at 12:43 pm

I do not believe you need an egg donor. Yes PCOS requires a very individualized aproach to get good eggs, but it can be done.

Perhaps we should talk.

Geoff Sher

Reply
Sandy says:

May 16, 2011 at 7:52 pm

Hi,
i hv just failed my 2nd ivf…1st ivf – 5/14 matured (20 eggs collected) with lucrin follow by puregon and 2nd ivf – 1/3 matured (22 eggs collected) with Lucrin, Gonal F and Luveris concurrent.

Age 39…Endo and mild adeno …Hubby 40 (no prob)

What happen to me Dr? shld i try 3rd attempt of so, what protocol this time i shld be taking?

sanyong71@gmail.com

Reply
Geoffrey Sher, MD says:

May 17, 2011 at 11:04 am

I really need to know much more3 to advise properly.

Why don't you call 800-780-7437 and set up a telephone consultation (free) to discuss further.

Geoff Sher

Reply
Sadie says:

December 14, 2012 at 4:58 am

Dr. Sher,

I had the result of my first IVF today, It was negative.
I am 42 and 3 month. My doctor suggested as next step to take DHEA for 3 months before trying again the same protocol, Antagonist.
I had 2 eggs removed grade A, 2 fertilized, 2 transferred at 4 cell, 48hrs later. poor response to HUMOG 450mg treatment. should I make this treatment with DHEA 75mlg ? do you think it could change something or am I wasting precious 3 months ? my sisters leave in the USA, NY and I might consider to change clinic for the second try to give my self the best chances due to lack of time
thank you for you response
Sadie from Indonesia

Reply
- Geoffrey Sher says:
  
  December 14, 2012 at 10:07 am
  
  Respectfully Sadie, I do not recommend DHEA, especially not to “older” women and those with diminished ovarian reserve. It is an androgen (male hormone) which can metabolize to testosterone in the ovary. Too much of the latter can even be harmful to egg/embryo quality.
  
  Please go to the home page of this blog (www.IVFauthority.com ). When you get to the look for a “search bar” in the upper right hand corner. Type in the following subjects into the bar and it will take you to all the relevant articles I posted there.
  
   “An Individualized Approach to Ovarian stimulation” (posted on November 22nd, 2010)
   “Ovarian Stimulation in IVF: Why is it important to down-regulate LH?”
   “Agonist/Antagonist Conversion Protocol”
   “Immunologic Implantation Dysfunction” (posted on May, 10th and on May 16th respectively.
   “Embryo Implantation………” (Part-1 and Part- 2—-Posted August 2012)
   “Traveling for IVF from Out of State/Country– The Process at SIRM-Las Vegas” (posted on March, 21st 2012)
   “A personalized, stepwise approach to IVF at SIRM”; Parts 1 & 2 (posted March, 2012)
   “IVF success: Factors that influence outcome”
   “Staggered IVF”
   “Embryo Banking”
   “Egg Donation”
  
  Consider calling 702-699-7437 to arrange a telephone or Skype consultation (f so we can discuss your case in detail.. While an audiovisual (Skype) interaction is much more personable and preferable than a discussion by telephone, either will suffice.
  
  Geoff Sher
  
  Reply
Sadie says:

December 15, 2012 at 5:23 am

thank for your response about DHEA.I will contact the phone number you have suggested to have a Skype with your team. Can I however ask you what you think about the mini IVF for holder women? and do I have to wait 3 months to start a new cycle?
thank you so much for your time.
regards
Sadie

Do I have to wait 3 months before a new IVF cycle ?

Reply
- Geoffrey Sher says:
  
  December 15, 2012 at 8:34 pm
  
  I am NOT a protagonist of Micro-IVF for women over 39Y and/or those who have diminished ovarian reserve. The results are poor.
  
  I do not think you need to wait 3 months nto do another cycle.
  
  let’s talk through Skype.
  
  Geoff Sher
  
  Reply

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