Tuesday, June 09, 2015

What are My Chances of Getting Pregnant?

This is one of the commonest questions an IVF specialist is asked – especially by someone who is starting an IVF cycle, or someone who has just failed an IVF cycle. In one way, it’s an easy question to answer. IVF clinics keep statistical records of the pregnancy rates they achieve in the women that have been treated there; this means they 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 us, who is asking the question? Not all 40-year olds are the same. While some have good ovarian reserve and produce excellent quality embryos, others make embryos that are fragmented and which arrest in the lab.

A Matter of Good Quality Embryos

It’s incorrect to lump apples and oranges together when providing an answer, because it’s likely to be inaccurate. The truthful answer is more nuanced. It depends on the number of good quality embryos you make. In turn, this depends upon the egg quality. 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 proof of the pudding is in the eating. It’s only when we actually superovulate her during an IVF cycle will know how good her ovarian response is.

About Specifics

Even though this is accurate, patients aren’t happy with this answer. They want a specific number, and would prefer a doctor who says to 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. Instead of pushing the doctor to provide a figure (which is often fabricated), they need to ask themselves- What is the magic number at which I will decide not to go ahead with the IVF cycle? Let me explain.

The Magic Figure

Let’s presume the doctor says your chances are 30-40%. If you have decided that you 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 your decision. Of course, you may want to select a clinic which has a higher overall success rate, and these figures (which are statistical averages for all the patients the clinic treats, and do not apply to individuals) are available online.

Contrastingly, if she feels that if her chances of success are less than 10%, and 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.

The Overlap

It means that the patient should then decide what particular success rate will allow her to make a go/no go decision. She should then share this information with the doctor, so that he can answer the question a little more intelligently and honestly. Remember that it’s not just a matter of statistics - it's also a question of the patient’s personal preferences.  This is where there is an overlap in the clinic's overall success and the patient's decision-making process.

Thus, we will have some patients who will be more than happy to go ahead with the treatment even if their chances of success are less than 5%, because it’s better than zero! They want to give it their best shot, because they never want to regret not having tried. 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?

Need more information? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you better!

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