Thursday, June 18, 2015

Why are our IVF success rates improving ?

We have noticed that a larger number of our patients have been getting pregnant of late. No doubt, this is an occasion for celebration, and our patients are very happy; however, this also raises the question – why has our success rate jumped so much?

The Simple Question?

This seemingly simple question has a very complex answer. This is because all biological systems are complex as they have innumerable moving parts. This aspect is even more relevant in an IVF Lab, where we don’t really have the luxury of being able to carry out any controlled trials. It’s often difficult figure out exactly which change resulted in a change in success rates- This holds true even when there is a drop in success rates.

Analyzing the Changes

When success rates dip, patients and doctors get 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 that is malfunctioning; sometimes, these changes also 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 that has good success rates, and you find there has been a rise in this; 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 which changes have been made, so we can continue using them for all our patients in the future.

The Conservative Approach

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 my 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.

A Common Problem

Incidentally, this problem plagues IVF clinics across the world. Regardless of 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 dip. 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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