Our Monash IVF Group Chief Executive Officer, Mr James Thiedeman & Fertility Specialist Dr Helena Lim Yun Hsuen (KL Fertility Centre/ Monash IVF, KL) spoke to New Straits Times on Egg Freezing and the technology involved.
Category Archives: IVF Success Rates
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Fresh embryo transfer versus frozen embryo transfer
Recently, a few patients came in with some information from the internet with regards to frozen embryos transfers. These information suggested that Frozen embryo transfers has a higher pregnancy rates compared to fresh embryo transfers. Therefore, the patients requested to undergo the IVF cycle so that they can freeze all the embryos and have the embryos transfer back in later cycles.
This practice is not something new. With the vast improvement in freezing technology using a new technique called ‘vitrification’ or rapid freezing method, the survival rates of embryos after freezing and thawing is close to 95%. Therefore, in a reasonably good IVF cycle, apart from having 2 embryos to transfer back during the fresh cycle, majority of patients would have good number of embryos to be frozen which can be used during the next cycle. It is not unusual to find that if the patients did not manage to get pregnant during the fresh cycle, when they come back for frozen embryo cycle, the pregnancy rates are close to 80-90%. A recent study conducted at KL Fertility Centre which looked at success rates of fresh cycles and frozen cycles of all women under the age of 42 and the statistic showed a 1.4x higher pregnancy rates for frozen embryos transfers. There is also significant lower miscarriage rate whereby there is a 2.5x reduction of miscarriage.
This finding coincides with the recent paper published in Fertility & Sterility, one of the world leading medical journal in Fertility. This paper consists of a meta analysis of a few studies which looked at the pregnancy rates for Fresh embryo transfers versus Frozen embryo transfers and the result showed a significant higher pregnancy rate in Frozen embryo transfers and a lower miscarriage rate. The results favoring Frozen Embryos Transfers instead of fresh embryo transfer may be related to the adverse effects of Controlled Ovarian Hyperstimulation (the drugs we used to stimulate your eggs to grow) on endometrial receptivity (which is the term we used for how ready your womb to accept the embryo for implantation) , as well as the improved results that can be achieved with current cryopreservation methods (which is the rapid freezing method, or vitrification). (Rogue M at el. Fresh embryo transfer versus frozen embryo transfer in in-vitro fertilization cycles: a systematic review and meta-analysis. Fertil Steril. 2013 Jan;99(1):156-62)
So, for those who have not been successful during the fresh cycle, please be reassured that when you come back for your frozen cycle, there is a higher chance of getting pregnant. Please do not beat yourselves up and turn the disappointment of the failed fresh cycle into a long-term grief. If you keep moving on, you will get there!!!!
Cumulative Pregnancy Rates for IVF
I absolutely LOVE to give my patients the news they wanted to hear. ” Yes, Madam XYZ, your pregnancy test is positive”, and I live on the thrills of having them laugh with tears of delights and relief. However, on the flip side of the coin, I HATE to give them the news they dreaded most, which is when the test result is negative.
This is the reality of IVF, you win some battles, and you lose some. We rejoice with the patients’ victories and we weep for their defeats.
For those battles that we lost, what is the next step forward?
We talked about the overall success rates of ONE IVF a few days ago and we know for sure that if you have a good number of embryos from the result of ONE IVF, the chance of you getting pregnant with the subsequent Frozen embryo transfer is extremely likely, especially if you are under the age of 35. In fact, there is some evidence to suggest that Frozen embryo transfers yields a higher pregnancy rate compared to fresh embryos transfers
(Rogue M at al. Fresh embryo transfer versus frozen embryo transfer in in-vitro fertilization cycles: a systematic review and meta-analysis. Fertil Steril. 2013 Jan;99(1):156-62)
However, if you have no embryos frozen, what is your option?
This chart below showed a cumulative live IVF births from a study conducted in Australia.
This study looked at all the women under the age of 42, who are going through IVF.
The study revealed that the pregnancy rate is around 40% in this group of women after they completed their first cycle of IVF. For those women who did not get pregnant the first round and went on having the second round of IVF, there were another 20% who got pregnant after the second round. Therefore, by the 4th IVF cycle, around 80% of women would have achieved a live birth.
This statistic clearly shows that if you persevere and keep moving on, chances of you getting pregnant by the end of the 4th IVF is around 80%.
Therefore, it is not unusual for Fertility doctors to encourage our patients to keep moving on because the statistics had clearly show us the evidence.
The Reality of IVF
Many couples choose their Fertility doctors because of their preference towards a characteristic of the doctor, however, many more choose to undergo their IVF treatment under a doctor or a centre because of the perceived success rates of the doctor or a centre. A published survey in the UK revealed that success rate of a centre or a doctor is the key determining factor for the decision of going through IVF in a particular Fertility Centre.
Therefore, all IVF doctors and centres strive very hard to increase the success rates of their patients. We emphasize on the patients’ lifestyle and age, in hope to get them to come at a younger age and in a better state of body fitness, so that we can obtain better eggs and sperms and hence make better embryos. We improve our laboratory environment and technology to mimic the uterus environment to yield a better fertilization and growth rate. We pat our own shoulders when we produce good quality embryos. And then we transfer the good looking embryos into the uterus and we wait……
10-12 days later, we either rejoice with the patient for a positive result, or we put on a very sad and sorry face to deliver the bad news
So what happened in between the time after we put those embryos back into the uterus until the time we test for pregnancy? The answer to this is that nobody knows.
As doctors we placed the embryos back, and nobody actually knows when and how the embryos get implanted, and what determines whether the embryos will get implanted or not.
This is the Holy Grill of the science and wonders of IVF
Many people had tried various things, complete bed rest, baby aspirin, steroids, hanging the legs up and etc etc etc.
Studies after studies failed to show any good recommendation on what we should do to improve the implantation rates. Some people believe that by performing a Pre-implantation Genetic diagnosis (PGD) can improve the implantation rates. There is some logic behind this: by selecting the normal chromosomal embryo to put back into the uterus, the chance of implantation increases. However, years had gone by with such a practice being implemented in some centers and there is only a marginal increment in pregnancy rates.
A recent study conducted at KL Fertility Centre (Monash IVF, KL) showed some interesting data.
We looked at all the women going through one IVF and divide them into 3 different groups by age.
Women who are under the age of 35 have 60% chance of getting pregnant during the fresh cycle when we put back the embryos into their uterus.
If they do not get pregnant during the first round and have good embryos which can be frozen and to be used in a later date, the chance of them getting pregnant by replacing 1-2 frozen embryos is around 60%.
By the time this group of women exhausted all their embryos which were produced by ONE IVF treatment, the likelihood of them having at least one baby is around 80%.
This translates that 4 out of 5 couples who are under the age of 35 will get pregnant with just ONE IVF attempt.
The success rate is about 60% in women between the age of 35-40 with the same trend observed.
Even for the group of women who are in the range of over 40 years of age, the success rate is close to 30%.
This certainly have a significant impact on the way we think….we now know that the chance of pregnancy is extremely good by just having ONE IVF without even having to subject the embryos to expensive and potentially hazardous pre-implantation genetic testing.
The key thing is to just keep moving on!!!!!
Success Rates of IVF
A published survey from the UK showed that the success rates of a particular Fertility Centre is a key factor for patients in deciding which Fertility Centre they choose.
Therefore, it is not unusual for patients to ask me what is the success rate of IVF in my centre. In places like UK, it is mandatory to submit the centre’s data to the authority (Human Fertilisation & Embryology Authority, HFEA) for publication and regulation. However, in Malaysia, these data are not readily available.
The data from most clinics in the UK suggested that most of the centres were about the same in terms of the success rates. According to the HFEA, an individual centre’s success rates can be affected by:
- the type of patients a clinic treats e.g., their age, diagnosis and length of infertility
- the type of treatment a clinic carries out
- a clinic’s treatment practices
A clinic that treats proportionately more patients with complicated diagnoses may have a lower average success rate than clinics that treat more patients with common fertility issues.
Clinics may have higher success rates for treatment if they treat women who are not infertile but who have no male partner and are using donated sperm in their treatment.
Quoted : http://www.hfea.gov.uk/fertility-clinics-success-rates.html#11
A comparison of KL Fertility centre’s data suggested the same trend:
The chart above showed that if you are under the age of 35 and attempts one IVF, your chance of getting pregnant by putting back 1 or 2 embryos during the same cycle is around 60%.
If you do not get pregnant during the fresh attempt and have enough good quality embryos frozen resulting from that particular IVF cycle, your chance of pregnancy by having a frozen embryo transfer is around 60% as well.
Hence, if you look at the pool of patients under the age of 35, taking into account of both fresh and frozen embryo transfer, the success rate is around 80%.
This translates that 4 out of 5 couples who are under the age of 35 will get pregnant with just an IVF attempt.
Therefore, if you have not been successful during the fresh embryo transfer cycle and have enough embryos frozen, you can be reassured that your chance of pregnancy is extremely likely during the frozen embryo transfer!!!
Age and IVF success rate
Many couples went through IVF in hope to have a child. Many view this treatment as the last resort to having a child. Therefore, it is not unusual for me to encounter couples who had exhausted ALL forms of treatment and landed in my clinic after many frustrating years. Some had come a bit too late….
Part of my job as an IVF specialist includes constantly being asked by patients on their chances of pregnancy by IVF.
This is definitely a relevant question. IVF is an expensive treatment and certainly after spending XYZ amount money on this treatment, you would like to know what is your chance of pregnancy.
In general, the chance of pregnancy depend on 3 most important factors: The woman’s age, the number of years of subfertility & whether there had been any pregnancies in the past.
Out of these three factors, the most important and relevant factor would be a woman’s age.
Studies had shown that after the age of 35, the chance of women getting pregnant naturally as well as through Fertility Treatment declined gradually. There is a further sharp declined after the age of 40.
I do not mean to press the panic button for all the women over the age of 35. However, I strongly feel that this is an important message which many Fertility Specialists like us had not been shouting loud enough to educate the general public.
Studies from Australia & US had shown that the success rate of an IVF is around 50% before the age of 35. The success rate drops thereafter and hit the range of 20-30% by the time the woman turns 40. The chance of pregnancy after the age of 44-45 is close to 0%.
The reason for a lower success rate after the age of 35 is a combination of the fact that age is associated with decrease number of follicles and quality of the eggs. For women, we are born with millions of eggs and the process of recruitment and activation of eggs started as we reached puberty. The number of eggs in our ovaries go down as we aged. By the time we each menopause, the eggs were completely depleted in our ovaries. Therefore, at the age of 35, we are expected to be producing less number of eggs. As we age, the quality of eggs also decrease and there is higher likelihood to produce eggs with abnormal chromosomes. Therefore, there is a higher risk of miscarriage and fetal anomalies.
Dr Helena Lim 