In Vitro Fertilization (IVF) Success Rates
Our IVF Pregnancy Rates & Outcomes
Ahead of the CDC and SART statistics that report on live birth rates, here are CHR’s cumulative 2017 IVF success rates (IVF pregnancy rates), along with notable characteristics of our patients who underwent IVF cycles.
Age Distribution of IVF Patients
It is now for quite some years that CHR has been serving the by far oldest patient population of any IVF center in the U.S. that is reporting annual outcomes to either the Centers for Disease Control and Prevention (CDC) and the Society for Assisted Reproductive Technology (SART). Over the last 10 years, CHR’s average patient age has been slowly but progressively increasing. The increase observed between 2016 and 2017 was, however, unexpected: Within that one year, the median age of CHR’s patients increased by one full year, jumping from age 42 to age 43, as the figure demonstrates.
In fact, an almost unbelievable 59% of all patients were over age 40. 35% were above age 45, while 21% were between 41 and 43. This is likely because only very few IVF centers in the U.S., Canada and overseas offer IVF with use of own eggs to patients above age 44. Women at ages 42-43, on the other hand, are increasingly able to receive fertility treatments elsewhere and, therefore, proportionally declined at CHR in numbers in comparison to earlier years.
Only a few years ago, women entering IVF cycles with their own eggs above age 45 were a rarity even at CHR. Now, women over 45 starting autologous (own-egg) IVF cycles are an almost daily event. Our (and likely the world’s) so-far the oldest patients achieving pregnancies with use of their own eggs were just a few weeks shy of age 48 at the time of embryo transfer. While we are still striving to cross age 48, we are now quite routinely treating even older women. Our so-far oldest patient who produced transferrable embryos with her own eggs was almost 52 years old.
Functional Ovarian Reserve of IVF Patients
The year 2017, however, not only demonstrated a greater influx of older patients. We, in parallel, witnessed a significant worsening of functional ovarian reserve in comparison to 2016. This was documented by significant increases in mean FSH and significant declines in mean AMH values of patients. While not all CHR patients are in their 40s, even our younger patients usually come to CHR only after they had multiple failed IVF cycles elsewhere and/or were refused further treatment with use of their own eggs because of high FSH and low AMH levels indicating severely diminished ovarian reserve.
IVF Pregnancy Rates for Autologous Fresh IVF Cycles
Table 1 below summarizes CHR’s 2017 autologous fresh IVF cycles (cycles using the patients' own eggs) stratified for age. Because CHR’s patient population is so severely adversely selected by age as well as functional ovarian reserve, 15% of started IVF cycles did not reach embryo transfer during this study year and, therefore, had no chance of pregnancy or live birth. In such an adversely selected patient population, the number of embryos available for transfer becomes a crucial predictor of pregnancy and live birth chances. This is why we are presenting the statistics for only patients who reached embryo transfer (i.e., had at least 1 embryo available for transfer). Here reported outcomes, therefore, must be further reduced by 15% to see IVF cycle outcomes with reference point cycle start (i.e., by “intent to treat”).
|Age Group||Pregnancy Rates|
Why IVF Cycle Cancellations Are Relatively Rare at CHR
Considering how adversely selected CHR’s patients were during 2017, the relatively small number of cancelled cycles was somewhat of a surprise and significantly lower than in preceding years. There are, likely, a number of reasons for this observation, though it will take another 1-2 years of similar experiences to be certain about these explanations:
CHR physicians, in principle, do not cancel IVF cycles when patients do not develop a certain minimum number of follicles, though this is a standard practice at many IVF centers. We recommend egg retrieval even with only one follicle. The reason is that almost all CHR patients are already on maximal stimulation and, therefore, have little potential to “do better” in subsequent IVF cycles. The only patients with cancelled cycles, therefore, are women who do not respond to stimulation at all, have zero oocytes retrieved, no fertilization or no embryos that develop to cleavage stage (day-3).
Furthermore, in poor prognosis patients, CHR never cultures embryos to blastocyst stage. Even in poor prognosis patients, embryos are more likely to reach cleavage stage and be transferred then. We believe that in these lower cancellation rates we see effects of CHR’s newly introduced Highly Individualized Egg Retrieval (HIER) program.
Age and IVF Pregnancy Rates
Considering that virtually almost all of CHR’s patients, even at younger ages, have low functional ovarian reserve (abnormally high FSH and/or abnormally low AMH), pregnancy rates at younger ages were remarkably excellent. Absence of pregnancies in age groups 42 -43 are, likely, a statistical artefact due to smaller patient numbers in these age groups than in preceding years, as already noted above. We again point at the age group of 44 and above, which included patients up to age 52, and still exceeded “futile” pregnancy rates as defined by the American Society for Reproductive Medicine (ASRM).
Here reported pregnancy rates in this group of women at very advanced ages, however, require further explanation. Above age 43, the number of available embryos for transfer becomes a very important predictor of pregnancy and live birth chances. We’ve reported in a number of medical journal articles that this oldest patient population (as well as younger women with extremely low functional ovarian reserve due to POA) needed at least three embryos to reach a “reasonable” pregnancy chance with IVF, which we define as a chance in the low double digits. Only a relatively small minority of women in this extreme age group meet this requirement. Therefore, the large majority who produce only 1-2 embryos for transfer greatly dilute total pregnancy rates for this age group as a whole. In other words, if you are able to produce more than three transferrable embryos after age 43 in an IVF cycle, your success rate is likely higher than the rate for the entire age group. New York’s Cornell group recently made the same point, but considered 4 embryos a minimum for better IVF pregnancy chances.
This means that women at these ages must be counseled properly with correct information: They must understand that their pregnancy chances will be in the low single digits with one embryo for transfer. With two embryos, they will be in the higher single digits; with three or more embryos, their pregnancy chances will reach double digits. Pregnancy rates in this age group, overall, will be quite low, and their live birth rates will be further reduced by an approximately 50% miscarriage rate.
These poor prognoses, of course, must be weighed against much better pregnancy and live birth chances with young donor eggs (presented in Table 2 below). Patients who, however, prefer using their own eggs must also understand that they will reach better pregnancy and live birth chances only by working toward a decent cumulative pregnancy chance from multiple cycle attempts. CHR, therefore, offers such patients a 4 IVF cycle package, with almost 50% cost savings over standard per-cycle costs.
Frozen-thawed and donor egg recipient cycles
|Type of Cycle||Pregnancy Rates|
|Donor – Fresh||53.3%|
|Donor – Frozen Oocyte||20.0%|
|All Donor Cycles||34.6%|
Table 2 summarizes clinical pregnancy rates from fresh donor egg cycles as well as from frozen-thawed cycles with embryos from autologous and donor egg cycles. The numbers in 2017 again were quite exceptional. Especially surprising were not only the excellent outcomes from frozen-thawed autologous embryos but the mere fact that there even were frozen embryos for transfer, considering CHR’s patient population.
CHR does not “bank” embryos because we strongly feel that every cryopreservation reduces pregnancy potential to a minor degree, and especially poor prognosis patients cannot afford any further “voluntary” reductions in already very low pregnancy chances. Therefore, practically all FET cycles involve extra embryos (i.e., more embryos than we were willing to transfer in a fresh cycle). That CHR’s patient population still created such “extra” embryos is quite remarkable and, likely, at least partially also a consequence of the center’s new HIER program.
Summary of 2017 IVF Pregnancy Rates
Considering the incredible increase in adverse selection in CHR’s patients in 2017 based on age and poor functional ovarian reserve, CHR’s outcomes must be considered beyond exceptional. If they were viewed without an explaining commentary, they would be considered to reflect outcomes of a good IVF center. That they were achieved in the oldest IVF patient population of any IVF center in the U.S. and younger women with, likely, the lowest functional ovarian reserve, and that over 90% of CHR’s patients before reaching out to CHR already had failed IVF cycles at other centers, make these results, however, rather exceptional. CHR is looking forward to 2018 fully expecting even more challenges, as the center’s patients will, undoubtedly, continue to get older and more challenging.
Norbert Gleicher, MD, leads CHR’s clinical and research efforts as Medical Director and Chief Scientist. A world-renowned reproductive endocrinologist, Dr. Gleicher has published hundreds of peer-reviewed papers and lectured globally while keeping an active clinical career focused on ovarian aging, immunological issues and other difficult cases of infertility.
Last Updated: October 4, 2018