This is the commonest question the IVF specialist is asked – especially by someone who has failed an IVF cycle.
In one sense, it’s an easy question to answer. IVF clinics keep statistical records of the pregnancy rates we achieve in the women we treat, which means we can quote success rates in various groups of women ( for example, women under 35; women over 40; and so on.)
The trouble is that these figures apply to groups of women . How can we intelligently extrapolate these to the individual patient sitting in front of you and asking the question?
Thus, not all 40-year olds are the same. Some have good ovarian reserve and produce excellent quality embryos; while others make embryos which are fragmented and which arrest in the lab. It’s not fair to lump apples and oranges together when providing an answer, because it’s likely to be inaccurate and unreliable.
The truthful answer is more nuanced. It is – It depends upon how many good quality embryos you make – which in turn depends upon the egg quality.
Now while we do try to judge a patient’s ovarian reserve by checking her antral follicle count and measuring her AMH levels, these are fairly crude tests, with limited predictive ability. The final proof of the pudding is in the eating – and its’ only when we actually superovulate her during an IVF cycle will be know how good her ovarian response is.
While the pre-IVF tests will give us some idea, these tests have limitations, and it’s impossible to predict how a biological system will behave.
The final proof of the pudding is in the eating – and finally it’s the number of good-quality embryos we are able to make which determine the chances of IVF success.
However, patients are not happy with this answer, even though it is accurate. They want a specific number, and would prefer a doctor who tells them - Based on my extensive experience , your chances of getting pregnant in my clinic are better than 56% ! This is a load of rubbish, but patients love this kind of pseudo-accuracy .
These doctors are very good at massaging figures , that selectively present the success rate in patients who have the best prognosis. Because patients are not sophisticated enough to read between the lines, they are suitably impressed and are happy to sign up.
Patients need to learn to ask better questions. Rather than push doctors to provide a figure ( which is often fabricated), the question they need to answer for themselves is – what is the magic number at which I will decide not to go ahead with the IVF cycle. Let me explain.
Suppose the doctor says your chances are 30% or 40%, if the patient has decided she will go ahead with the treatment if the success rate is better than 20% per cycle, then the actual number the doctor quotes is unimportant, because it will not affect her decision. Of course, she may want to select a clinic which has a higher success rate overall , and these figures ( which are statistical averages for all the patients the clinic treats, and do not apply to individuals) are available online.
On the other hand, if she feels that if her chances of success are less than 10%, then she would rather not go ahead with the treatment cycle, because the slim chances do not justify her spending so much time, money and energy, then this is the key number she should focus on.
This means that the patient should then decide what particular success rate will allow her to make a go/no go decision ; and then share this information with the doctor,. so that he can answer the question a little more intelligently and honestly.
Remember that it’s just a question of statistics - it's also question of the individual patient’s personal preferences. This is where both the clinic's overall success and the patient's decision-making process overlap.
Thus , we will have some patients where even if their chances of success are less than 5%, they are happy to go ahead, because 5% is better than zero ! They want to give it their best shot, because they never want to regret afterwards that they didn’t try. However , this is the kind of soul-searching the patient needs to do , even before asking the doctor the question - What are my chances of getting pregnant ?
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