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IUI & IVF Success Rates

Many patients think that the IVF success rate is 70-80% or even more. Of course, this is not true. The success rates are affected by many factors, including the infertility causes and the specific techniques used for resolving the problem.

Intrauterine Insemination

IUI success rates may reach approximately 15-18%. IUI is not a panacea for infertility but can successincrease the chance of fertilization compared to sexual intercourse. Taking into consideration that IUI is an inexpensive option, easy to perform, can be repeatedly performed (e.g. monthly) and is not traumatic for the woman, IUI pregnancy rates are satisfying.

Usually, three IUI cycles are recommended to achieve the highest possible success rates.

In Vitro Fertilization (IVF)

IVF for most couples initiates an expensive, stressful and lengthy journey that requires medical team-successintervention. Furthermore, many couples believe that IVF offers exceptionally high success rates and that their baby dream will definitely come true.

Generally, IVF success rates range between 45-48%, considering that there are legal constraints on the maximum allowable number of embryos transferred during embryo transfer.

What do these success rates really mean?

First, this percentage refers to women under the age of 35. At around age 35, success rates start to decline annually to reach a percentage of about 12% at age 40 and drop even more up to 1-3% at age 44.

success_failureIt is important to note that the percentages mentioned above, as well as those mentioned below, refer to women on average regardless of their hormone profile, anatomic abnormalities, previous failed cycles and husband’s sperm quality. Every couple has its own success rates that are impossible to define accurately. For this reason, evaluation is not always approximate but still estimated according to the percentages already mentioned.

Moreover, the overall success rate for women (under the age of 35) undergoing three consecutive treatment cycles is approximately 70%.

A source of confusion regarding success rates is their ambiguous meaning. A female patient of 34 years has an IVF success rate of around 45%. What does this really mean?

Pregnancy success rates may refer to a positive pregnancy test (including biochemical pregnancy) or to the detection of foetal heart beat via ultrasound, a few weeks after completing a treatment cycle (clinical pregnancy). However, during the first weeks of pregnancy, a significant percentage of conceptions spontaneously abort and never reach the heart beat at the beginning stage. It is therefore obvious that biochemical pregnancy success rates are significantly higher compared to clinical pregnancy success rates.

It becomes even more complicated when considering the IVF live birth success rates (take home baby rate). Among pregnant women, the miscarriage rate is about 15%. The rate of miscarriage drops as the pregnancy is progressing well, but is still different for every woman and increases exponentially with maternal age due to the high frequency of chromosomal abnormalities.

Moreover, the miscarriage rate for women undergoing IVF treatment is about 20%. This is due to the fact that these women encounter pregnancy complications more often and are categorized as high risk pregnancies. Thus, IVF live birth success rates are even lower.

Also, we need to consider those women undergoing IVF treatment that never reaches to the stage of embryo transfer. Even though they start ovarian stimulation their cycle is cancelled due to:

>  poor or no response to medical ovarian stimulation,

>  no oocytes are collected after egg retrieval (empty follicle syndrome),

>  spermatozoa fail to fertilize the oocytes and no embryos are available (failed fertilization) and

>  embryo transfer is not possible due to anatomic abnormalities.

The above mentioned cases do not occur simultaneously, but one per case. However, each one of these unfortunate events reduces the success rates. If success rates include all women initiating an IVF treatment, then percentages are considerably lower compared to those including only women that successfully reached the embryo transfer stage.  The latter group of women has overcome the risk of dropping out of IVF treatment.

Embryo quality plays also an important role. Normal embryo morphology increases success rates.

The equation becomes more complicated if we take into account (ICSI), blastocyst culture, oocyte in vitro maturation (IVM), natural cycles, preimplantation genetic diagnosis (PGD), using cryopreserved oocytes, sperm or embryos, assisted hatching and ovarian stimulation protocols (short, long, ultra long and ultra-short), agonist or antagonist and recombinant or human gonadotropin administration.

In conclusion, success rates are different for each couple undergoing IVF treatment. Statistics have been used to our benefit in many sciences (economics, politics) and whoever (either the fertility specialist or the patient) refers to statistics should be very careful.  The fertility specialist is responsible for avoiding to create unrealistic expectations. On the other hand, the couple has the right to know its own realistic per-cycle success rate, irrespective of international IVF pregnancy rates that do not coincide with the couple’s personalized predicted success rate and the clinic-specific statistics report.

However, international IVF statistics reports are not useless. On the contrary, all IVF data provided by statistics are valid as they are extracted from a wide study population. It is important though to distinguish between overall success rates, clinic-specific success rates and personalized success rates depending on each couple’s medical record.

In conclusion, the infertile couple should understand that Assisted Reproductive Technologies are not a panacea for overcoming infertility and cannot promise that a woman will get pregnant, even more taking a healthy baby home. However, IVF is the most reliable and safe way of experiencing parenthood. In experienced hands, success rates are promising and every year is increasing, following scientific progress.

We hope that in the near future IVF treatment options will be more promising compared to the present status. Our goal is to achieve a 50% success rate in the majority of treatments, motivating couples to initiate IVF treatment and making it a less stressful and less expensive experience.

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