What is the Success Rate in IVF Treatment?

PREGNANCY RATIOS IN IVF TREATMENT

IVF treatment is the method with the highest pregnancy and live birth rate among the treatments applied to couples who have difficulty in getting pregnant. Moreover, although this method is applied to a more difficult patient group than other methods, it reveals this difference.

The difference of IVF treatment from other treatment methods is that fertilization is provided under laboratory conditions. In this method, other than the application differences that increase the success compared to other methods, more eggs can be obtained, more competent embryos can be selected by observing the stages of fertilization and embryo formation, and more than one embryo can be placed in the uterus according to the age of the woman, when necessary.In addition, the fact that different technologies can be added to this method according to the characteristics learned from the examination of the couple further increases the success by personalizing the treatment.Among the additional technologies in question there are many methods such as; the microinjection method especially in heavy male factor, using surgical methods such as TESE if no sperm is found in the ejaculate fluid, and freezing the obtained excess embryos and using them in the future.

As in all infertility treatments, the most important factor affecting the success of the IVF method is the age of the woman. This is such an important factor that we do not yet have the technology to eliminate the negative impact of advanced female age.

The reason for this is that the formation of eggs in the females is completed before birth and all the eggs formed are stored in the ovaries and there is no new egg formation for a lifetime. Naturally, over the years, both the number of eggs decreases and the quality of the eggs, whose waiting time is prolonged in the ovaries as the age progresses, is constantly decreasing. For this reason, the number of eggs that can be obtained from an aged woman decreases, and a significant decrease is observed in the quality of the eggs obtained.

The most important factor in the decrease in the number of eggs in women over time is not the loss of eggs due to ovulation every month, but the process of self-destruction (atresia), which is a natural process that starts before birth and continues until menopause in every woman.

In this way, the number of eggs in females decreases with advancing age.

On the other hand, the remaining small number of eggs until advanced age are exposed to negative metabolic processes longer than the eggs laid at earlier ages, and their ability to conceive decreases due to some defects in their structures.

This is not the case for men. Every day, the sperm produced from new stem cells are waiting freshly ready for use.

Therefore, the important factor in obtaining pregnancy is the age of the woman and it is more important than all other factors.

According to this, while the highest rates of pregnancy and live births are encountered in IVF are in the period until the early thirties, these rates decrease starting from the age of 35, and accelerates from the age of 38 and reach very low levels after the age of 40. Since the live birth rate per IVF trial at the age of 43 decreases to the level of 5% and it is observed as 1-2% at the age of 44 years and above, it can be mentioned that IVF application above the age of 43 is not a profitable practice for the patient.

The figure below shows the percentage of live births per trial in IVF applications in the United States, according to the age of women. Similar rates are also observed in the applications in Turkey.

Some other important factors that affect the success of IVF treatment can be mentioned as;

Endometriosis
Increased sperm DNA damage rate
Previous damage that prevents thickening of the endometrium (uterine lining)
Hydrosalpinx

There are researchers stating that pregnancy and live birth rates of patients with endometriosis are lower than other patients in In Vitro Fertilization treatment. It is claimed that the reason for this is the decrease in the number of eggs in the ovaries due to the damage caused by the chocolate cysts and the operations performed for this, and also the decrease in egg quality in patients with endometriosis compared to their age group.

The high rate of sperm DNA damage causes a decrease in both the rate of good embryo formation and the rates of pregnancy and live births. In addition, there is an increase in pregnancy loss (miscarriage) rates accordingly. This situation can be effectively eliminated by intake of antioxidants and, when necessary, the use of sperm obtained by TESE.

Adhesions in the inner lining of the uterus due to surgical operations previously performed in the uterus may prevent thickening of the uterine lining and the creation of a suitable bed for the baby to settle. With hysteroscopic operations, this situation can be corrected and the desired level of thickening in the uterine lining can be achieved, and higher pregnancy rates can be obtained in IVF applications.

Because of infections, surgeries, or endometriosis involving the abdominal and internal genital organs, one or both of the tubes may close at the ends facing the ovary and become fluid-filled bubble structures. Since the liquid in these ballooned tubes (hydrosalpinx) can leak into the uterus from the end of the tube attached to the open uterus, it can sweep out the embryo placed in the uterus in IVF applications.In this way, it can reduce the success rate in IVF applications to half of what it should be. For this, before IVF application, the end of a tube facing the uterus must be closed by laparoscopic surgery, or this tube, which is no longer functional and even harmful, must be removed.

The conditions mentioned above are the most important factors affecting the success of in vitro fertilization treatment. It is important to determine these situations before the application and to inform the couple about the situation and to plan the applications that will eliminate the negative factors when necessary before the IVF treatment.

Prof. Dr. ErdalAktan

Gynecology and Obstetrics Specialist

Chief Physicion of Tınaztepe Hospital IVF Center