IVF: Preparing to increase your chance of success
How successful is IVF?
We often hear the good IVF stories but we rarely hear about the IVF journeys that don’t end with a baby. Our limited exposure to the unsuccessful side of IVF has created an assumption that pregnancy through IVF is a given, or highly likely at worst.
It can be really tricky to get a good grasp on just how successful IVF actually is because the statistics and presentation of information can be rather confusing. Different IVF clinics use different ways of quantifying their data meaning that the same set of data can appear to give quite a different result. For example, the use of ‘live birth rate’ vs ‘cumulative live birth rate’. Here in Australia, the ACCC has worked hard to regulate the representation of data after statistics were found to be misleading and lacking transparency in a 2016 investigation.
THE ANZARD REPORT
ANZARD data
Australia New Zealand Assisted Reproduction Database (ANZARD) is the database for all IVF clinics in Australia and New Zealand and is not associated with any one particular clinic.
Important statistics from the 2018 report:
From 2014 to 2018 the IVF success rate in the first cycle was between 32.7% and 34%. Essentially, stable at 1 in 3 women.
There is a 30% drop out rate during or after the first cycle. Georgina Chambers who heads ANZARD was quoted as saying that this is “because of physical and emotional demands of treatment, a poor chance of success with continued treatment, and financial cost”.
54% of women who start the IVF journey, will finish with a baby
This means, that if 3 women start IVF together,
One will become pregnant in her first round
One will drop out of IVF
One will go on to subsequent rounds, and have a 50% chance of having a baby within 8 rounds
IVF is a scientific miracle, but unfortunately it’s not a guaranteed path to pregnancy.
Are you a candidate? Factors to consider;
If you are thinking about IVF there are a few factors that might play a role in pushing your decision;
Age of both partners; There are no set rules, chronological age does not necessarily mean you can’t become pregnant naturally but it is statistically likely to take longer, time you might be better to spend working through an IVF process. This conundrum is tricky, but I will say that IVF doesn’t have to be the immediate or first option.
Number of ovulations you have tried to conceive; It’s tempting to think of this as ‘how long’ it has been, but how many good attempts is more helpful. For most couples, this is somewhere around 12 good goes, for couples who are a little older, it might be a little shorter, but each case is different
Immediate candidates determined through testing; Couples or people who will not become pregnant without IVF, like women with blocked fallopian tubes, men with very poor sperm analysis, women doing it solo and same sex couples.
A professional opinion; You are a candidate if your IVF doctor can confidently state that you have a better chance of conceiving with IVF than if you continued to try conceive naturally.
Preparing for IVF
Your preparation should cover three aspects;
Your team
You need a fantastic IVF doctor. I suggest an initial consultation with two different doctors. Two different doctors will have two different approaches, comparison helps you decide what you really want in your IVF approach. You can read more about choosing your IVF doctor.
Preconception care. Allied health play a great role here. This is the person or people who look after your reproduction components and play a role in your emotional well being. More on this below.
Nurture and support crew. The people who look after YOU. The shoulders to cry on or the person who holds your hand, someone who helps with your injections, or drives when you can’t. These might be people you already have in your sphere, people you pay, or people you search out.
Your mindset
Unpopular opinion: Positive thinking is not the be-all and end-all. You don’t have to be positive and happy all the time. IVF is incredibly hard. Levels of emotional stress are extraordinarily high, with up to 56% of women going through IVF having symptoms of depression and 76% symptoms of anxiety. Of course there is space for mindfulness, but be kind to yourself. If you are going through IVF, you already are an optimist.
In terms of how IVF is approached, your mindset can be important - switching the thought process from going through a round of IVF, to the idea of entering the process of IVF can take the pressure off and may allow a realistic expectation.
Your preconception care
For most couples trying to conceive, a great preconception care plan should be adhered to about 80% of the time. When you are prepping for IVF, the stakes are higher so preconception care should be taken even more seriously. Want some scientifically proven ways to support IVF? I’ve written a whole evidence based series with live links to references. Preconception care is hugely important and hugely undervalued.
Navigating add-ons
Once you’re in the IVF space, you’re not necessarily handing over the reins for someone else to manage. In fact, going through IVF necessitates you being your own advocate, particularly in the world of IVF add-ons.
What is an IVF add-on?
An IVF add-on (aka IVF-adjunct) is a supplementary procedure sold to patients, that is not essential to the IVF process. There are a whole lot of add-ons with varying degrees of scientific backing. Investigation has lead to the suggestion that the increased use of these add-ons have been linked with the industrialisation of IVF and driven by the commoditisation of IVF.
Here in Australia, IVF regulation is fragmented which may have led to the use of these unregulated procedures.
For comparison, in the UK the market is more regulated due to the passing of the HFEA – Human Fertility and Embryo Act, passed in 1990. The HFA has developed a traffic light system, essentially to simplify what current research has found about the different add-ons.
THE HFEA TRAFFIC LIGHT SYSTEM
Green; effective at improving live birth rates and is shown to be safe for patients to use.
Amber; conflicting evidence to show that an add-on can improve live birth rates, or that the add-on is safe for patients to use. This means that the evidence is not conclusive and further research is required. The add-on should not be recommended for routine use.
Red; there is no evidence to show the add-on could improve live birth rates, and could be unsafe.
Embryo scratching is a good example; during an endometrial scratch, a catheter is used to superficially damage the uterine lining to create inflammation with the aim of supporting implantation. A NZ study, the largest investigation of this add-on, looked at 1,364 women, comparing those who had an endometrial scratch with those who didn’t. 180 babies were born in the group with an endometrial scratch and 176 in the control group, a difference not statistically high enough to claim any degree of success. This procedure costs about $700 and as recently as 2016 was used in Australia by about 80% of IVF doctors. It has an amber rating - does not increase live birth, but is not dangerous.
How do I advocate for myself?
All your fertility appointments with your IVF specialist should be be approached as a collaboration. Two people working together toward the same goal, in a way that both parties are comfortable with (FYI, this applies with any practitioner you are working with - psychologist, nutritionist, acupuncturist, osteopath, naturopath)
Ask lots of questions: how does this work? Does this increase my chance of success? What is the basis for your suggestion? What are the risks? What are the complications? What is the cost? What does the scientific literature say?
Work with what you believe in, what appears valid and has been justified to a level acceptable to you. If your IVF doctor is able to explain why a particular add-on is right for you despite it not having solid evidence or a green on the HFEA traffic light system, then go all in. A good example is the genetic testing of embryos. This has a RED classification as per HFEA; it does not improve live birth rates and it adds a level of risk, raises the risk of big ethical decisions, but it does decrease chance of miscarriage and may be appropriate for certain patients.
It is apparent that IVF technology is both a science and an art, however I’m not convinced that every add on that I’ve seen used, has been justified.
The take away
Increasing your chance of IVF success is about understanding, gaining information, investigation, building the right team and a little hard work. If you are embarking on your IVF process or in the thick of it, I genuinely wish you all the success in the world
Jenna.