In Vitro Fertilization - IVF - Success Rates
The Jones Institute has the first and therefore the oldest program in the United States, with the first IVF baby born in this country. Her birth date was December 28, 1981. By January 2016, 4,480 babies were born with assistance from our ART programs (IVF, ICSI, cryopreserved embryos, PGD and PGS).
The main factors affecting IVF outcome are:
- age of the woman ( and consequently, her ovarian reserve )
- normalcy of the uterus
- semen quality
- success or failure of fertilization and cleavage in vitro
- number of embryos transferred and cryopreserved (therefore augmenting the total reproductive potential of a given IVF cycle).
In addition, success rates increase as the number of IVF stimulation attempts increase, probably ranging to a maximum of three to four stimulation cycles. Overall, pregnancy results are similar for the main infertility diagnosis, including tubal factor (post tubal ligation, corrected hydrosalpinges, pelvic adhesions), endometriosis, male factor, and unexplained infertility. Women of advanced maternal age and/or with a diminished ovarian reserve, typically have a poorer prognosis. Occasionally cases with uterine abnormalities history (congenital anomalies, post-surgical correction of myomas, severe intrauterine adhesions) may also have a compromised chance of conception, depending on the severity of the pathology.
Furthermore, it is of utmost importance to eliminate or decrease two potential severe risks of IVF treatment: these are ovarian hyperstimulation syndrome (OHSS) and incidence of multiple gestations. The Jones Institute IVF program has applied protocols that are individualized to decrease the risk of OHSS and has made major efforts to reduce the incidence of undesirable high-order multiple pregnancies. This has been achieved by using state-of-the-art ovarian stimulation protocols, optimized laboratory conditions, and decreasing the number of embryos transferred.
The Jones Institute recommends the transfer of two embryos or a single elective embryo transfer as appropriate given the patient's clinical scenario. Embryos are cultured in vitro for transfer on day 3 (cleavage stage), or on day 5 (blastocyst stage) also as appropriate and in an individualized fashion. Extra embryos are frozen on day 3 or 5 (vitrification), and therefore the total reproductive potential may be increased in those cases (i.e., the chance of pregnancy increases if fresh and subsequently frozen embryos are transferred, all originating from a single stimulated cycle).
Average statistics may not apply to an individual patient or couple within an age or treatment group. Success rates vary depending on many factors including the causes of infertility, the adequacy of ovarian reserve ( as measured by cycle day - 3 serum FSH, LH, estradiol levels, AMH serum levels, and antral follicular count by transvaginal ultrasonography), and the number, maturity, and quality of eggs retrieved.
It is important to understand the philosophy with which the Jones Institute approaches the management and treatment of infertility. Here our goal is to help couples achieve their dreams of having children. The Jones Institute does not pre-select patients; in other words, we do not exclude couples due to the presence of factors that may negatively impact their success rates. For example, one third of our female patients are "low responders (they are more than 37 years of age and/or have an abnormal assessment of ovarian reserve). In addition, another third of our patients had one or more failed IVF cycles elsewhere. These two factors are typically considered to compromise success; nonetheless, we have been able to achieve pregnancies in many of these cases. As a consequence, the Jones Institute offers all couples the possibility of enrollment and participation in an IVF attempt to have their own genetic children. In addition all alternatives to IVF including lower cost methods such as fertility treatment with hormones for ovulation stimulation/induction with or without IUI are offered to the patient first, if appropriate.
Patients with low ovarian reserve and/or advanced maternal age will discuss their prognosis with the attending physician and a decision to undergo IVF or move directly to oocyte donation will be made. Therefore, either initially, or after failed IVF, these patients are directed to egg donation, a program that offers them a higher chance of conception. The table below shows the total IVF experience at the Jones Institute. The data apply in a combined fashion and represents women using their own eggs as well as donor egg cycles.
Total IVF Experience at the Jones Institute (1981-January 2016 )
|Number of Fresh IVF Cycles||13,747|
|Number of Cryopreserved Embryo Transfer Cycles||3,402|
|Number of Delivered Babies||4,480|
Sixty percent of deliveries were singleton; 35% were twin pregnancies. The year 2011 was the last time we had a triplet pregnancy, and 1998 was the last time we had a quadruple gestation. This has been the result of the application of the above-mentioned laboratory and transfer policies, and not due to the use of selection reduction (termination) of multiple gestations. It has been the policy of our program to transfer two embryos, with recommendation of an elective single embryo transfer to those patients with good prognosis.
Comparison of Success Rates between IVF Programs
Patients are cautioned regarding making comparisons of success rates between IVF clinics based on the clinic - specific data reports released by the Society of Assisted Reproductive Technology (SART) and the Centers for Disease Control (CDC). Although SART issues a statement that the data should not be used for comparison, the fact is that they are unfortunately (and incorrectly) many times used by patients and clinics alike for that purpose. There are many variables that influence IVF success rates and many variables exist among individual clinics that make comparisons almost impossible based on the released data. Outcome of previous years for all patients and all age subgroups for IVF and oocyte donation cycles performed at the Jones Institute (as well as national averages) can be obtained from the CDC reports (Centers for Disease Control, USA) and from SART websites.