Does IVF has 100% of pregnancy rate ?

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Question: My husband & I had tried conceiving through IVF but did not succeed. If we try IVF again, would my chances of getting pregnant lower than others? How do I increase my chance of success?
Dr Helena’s answer: The advent of IVF had greatly revolutionize the world of reproductive medicine. Millions of babies had been born, as the result of IVF. Without IVF, the birth of these babies would not had been possible due to various infertility issues
 
However, is IVF a magic bullet with 100% of pregnancy success rates? 
 
The answer is no, as we know, IVF’s success rate is not 100%.  
 
A few important factors associated with success rates of IVF is women’s age, the duration of Subfertility and whether there is any previous history of pregnancies. Some other factors includes the quality and quantity of eggs, sperm quality & lifestyle and habits 
 
For couples who didn’t succeed in getting pregnant during their first round of IVF, it is logically to wonder, whether they will ever get pregnant in their subsequent cycles of IVF
Generally the overall success rates of ONE IVF for a woman who is under the age of 35 is around 60-70%. We also know for a fact that a frozen embryo transfer has a higher pregnancy rate compares to a fresh embryo transfer.  For most women under 35, there is a good chance that she produces more than 2 good quality embryos each IVF cycle. most of the time, these excessive embryos can be frozen and can be used in the future. Technically speaking, ONE IVF cycle can potentially resulting more than one pregnancy, if the woman has lots of embryos and keep coming back to get them transfer into her uterus.
 
Coming back to the question, 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

However, if you have no embryos frozen, what is your option?

This chart below showed a cumulative live IVF births from a study conducted.

 

Cumulative Birth Rates

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%.

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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.

To improve your chance of pregnancy for the next IVF, it is important to improve the quality of your eggs and sperms by eating healthy and  improve lifestyle, quit habits which can potentially jeopardize your success rates such as smoking, alcohol and stress. Speak to your fertility doctor about what are the other options in your IVF treatment.

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Fresh embryo transfer versus frozen embryo transfer

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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!!!!