More IVF Tries Yield Better Live Birth Rates

Persistence pays off. That seems to be the message of a study published in The Journal of The American Medical Association (JAMA) at the end of last year. The researchers found that nearly 2 out of 3 women gave birth after undergoing 6 in vitro fertilization (IVF) cycles.¹

The study design. The study was a prospective study, which means researchers observed a group of individuals over a period of time to watch outcomes. This study followed nearly 157,000 women from the UK who received more than 257,000 IVF ovarian stimulation cycles between 2003 and 2010, and were followed until the middle of 2012. The researchers defined a cycle as an ovarian stimulation plus subsequent fresh or frozen embryo transfers using eggs produced by that stimulation.

At the start of the study, the women were 35 years old, on average, and the median duration of infertility was 4 years for all cycles.

According to the researchers, this was the first known study to link fresh and frozen embryo transfers to obtain estimates of live birth rates within each IVF cycle. The researchers measured not only the live birth rate per IVF cycle, but also the cumulative live birth rates across all cycles in all women. They also analyzed differences based on age and treatment type.

Overall results. These were the results for all women:

• For the 1^st cycle, a live birth rate of 29.5 percent
• For the 2^nd, 3^rd, and 4^th cycles, a live birth rate above 20 percent
• For the 6^th cycle, a live birth rate of 17.4 percent.

The number of eggs retrieved had no bearing on the live birth rates in subsequent cycles.

The cumulative live birth rate continued to increase slightly through the 9^th cycle, and it was at 65.3 percent by the 6^th cycle.

Age differences. Results did differ, depending upon age and treatment type. Women younger than 40 who used their own eggs achieved a live birth of 32.3 percent with the 1^st cycle. This remained above 20 percent through the 4^th cycle, with a 68.4 percent cumulative live birth rate by the 6^th cycle.

Women ages 40 to 42 had a live birth rate of 12.3 percent for the 1^st cycle. By the 6^th cycle, they achieved a cumulative live birth rate of 31.5 percent. All women older than 42 maintained a live birth rate less than 4 percent with each cycle. These age-related differences disappeared when women used donor eggs.

Rates of success were also lower for women who had partners with untreated infertility. However, treatment with intracytoplasmic sperm injection (ICSI) or sperm donation also erased these differences.

When to continue, when to stop? This study suggests that it’s better not to read too much into the outcome of any one cycle. In other words, it’s not a one-shot deal. Clearly age does make a difference. But for many women, not being successful during the first few cycles doesn’t mean future failure is a fait accompli.

In consultation with a fertility expert, each woman—or couple—must ultimately decide how many times to try IVF, then free themselves of guilt, no matter the choice they make.

Source

1. Smith A et al. JAMA.2015;314(2):2654–2662.

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