Thursday, September 11, 2014

Why has our IVF success rate increased so dramatically ?

We have noticed that a much larger proportion of our patients has been getting pregnant these last few months. This is obviously an occasion for celebration, and our patients are very happy, but this also raises the question – why has our success rate jumped so much ?

This is a simple question – but finding the answer is an extremely complicated exercise. This is true for all biological systems , because they have so many moving parts ! This is especially true in an IVF lab, where we don’t have the luxury of being able to carry out controlled trials. It’s often hard to figure out which particular change resulted in a change in success rates – and this is true, both when success rates rise – as well as then they drop !

When success rates drop , patients and doctors are extremely worried , and the staff needs to do a lot of troubleshooting and quality control analysis, in order to find out what's going wrong . They need to tweak stuff, in order to fix the problem. This is hard to do in a system which is malfunctioning , and these changes sometimes make matters worse , because we are operating in the dark. This is why so many new IVF clinics shut down without achieving even a single pregnancy.

When you have a robust system which has a good success rates , and you find your success rate has jumped up, you cannot just pat yourself on your back. We want to continue to have these high success rates in the future as well, which is why we try to carefully analyze what changes have been made, so we can continue using them for all our patients in the future.

We are very conservative , and try to minimize making changes in our practice . We have had the same embryologist, the same clinicians and have been using the same culture medium and catheters for many years. This is why it’s very hard to pinpoint what the change has been ? Has it been because we changed our incubator settings and increased the CO2 percentage from 6% to 6.5% ? Or is it because I have changed by embryo transfer technique by being much more deliberate when transferring embryos and doing this in slow motion ? Could such a minor change really have such a dramatic impact ?

It's hard to pinpoint the answer, but we hope that if we continue doing what we have been doing in the last few months , we will continue getting the same extremely high success rates in the future as well.

Incidentally, this is a problem which plagues IVF clinics all over the world . No matter how much we standardize our protocols, there are always a few months when everything goes swimmingly well, and everyone seems to get pregnant. Conversely, there will be months when for no explicable reason, the success rates go down . IVF has still not matured to the point where it has become a 100% repeatable technique – but we are slowly and surely headed in that direction !

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