Is IVF working well for you?: What are the signs of a “good” IVF cycle?

Submitted by FertilityLab Sun 08/19/2012

If you get pregnant from IVF, obviously your IVF cycle went well. But if you aren’t getting pregnant, how can you tell if your cycle went as well as could be expected or whether your IVF results are such that you should reevaluate whether IVF is likely to work for you? I found a very good blog post called “What impacts Embryo Donation Success Rates?” which does a very good job of explaining the criteria that embryo donation centers look for to decide whether embryos are likely to be of high enough quality to implant in a recipient and make them pregnant. These same criteria are predictive as to whether you are likely to become pregnant in your own IVF cycles. The table below is copied from the Embryo Donation International Blog post “What impacts Embryo Donation Success Rates?” written by Craig R. Sweet, MD, Reproductive Endocrinologist and Corey Burke, Laboratory Supervisor. If you are interested in embryo donation as either a donor or recipient, Dr. Sweet’s embryo donation site has a lot of info for both donor and recipient. Very Important!
Preferred Less Optimal
Did the fresh cycle in which the embryos were frozen result in a pregnancy & delivery?
Successful pregnancy and delivery Fresh transfer resulted in miscarriage or no pregnancy
Number of embryos available in a given donated set
Four or more Three or fewer
Past implantation rates of both fresh and frozen embryo transfers
High implantation rates Low implantation rates
Quality of the embryos frozen
High quality (Blastocyst) Medium quality Age of the women when the eggs were provided to create embryos Less than 35 years old
35 years of age or older Overall health of the embryo recipient
Healthy With treated or untreated medical issues
Important Preferred
Less Optimal Stage of growth when the embryos were frozen
Day 5, blastocyst stage Day 3, 8-cell stage Technique used to freeze/thaw or vitrify/warm the embryos
Vitrification Slow freeze Overall frozen embryo transfer pregnancy rates for facility freezing the embryos
30% or more Less than 30% Overall frozen embryo transfer pregnancy rates for facility thawing the embryos
High at 30% or more Less than 30% Ejaculated vs. surgically aspirated sperm used for fertilization
Ejaculated sperm Surgically aspiration sperm
Somewhat Important Preferred Less Optimal Was preimplantation genetic testing of the embryos done? Yes No Some of the criteria are only applicable to identification of the highest quality embryos for donation. For
instance, having PGD done makes the embryo more valuable to the recipient because at least some genetic worries are removed, depending on the testing. Other criteria are more pertinent as general guidelines for determining whether your cycle is going well. Getting back to the IVF patient currently in cycle, you know that your cycle is going well or is working efficiently for you if : Excess embryos are produced. Four or more
appropriately progressing embryos are produced in excess of the one or two that are transferred. In other words, having excess embryos to freeze is a good sign that you are likely to get pregnant. High quality blastocysts. Whatever the embryo scoring system, if most of your embryos are getting the equivalent of “A’s” and “B’s”, IVF is working well for you. Maternal age: if you are under 35 years old, IVF is more likely to be successful for you. Obviously, we can’t become younger or stop aging but timing IVF earlier rather than later in our treatment protocol is beneficial if we are older. Progression and Freezing Method. If your embryos are frozen at blastocyst stage using vitrification, you are more likely to have IVF working well for you. Why? Because it tells us something both about your embryos (they are healthy enough to get to blastocyst stage) and something about your lab (it is progressive and skilled enough to use the more advanced methods of day 5 culture and vitrification). Both of these bode well for the patient and are predictive of better pregnancy rates compared to embryos that come from programs that routinely transfer on day 3 (is it because they are incapable of growing embryos longer?) and still use older slow freeze methods (slow freezing is associated with poorer embryo integrity post-thaw). Post-thaw embryo survival rates should be 90% or better in good programs. Thawed blastocysts should look healthy, be capable of re-expanding and have rare damaged cells. FET pregnancy rate. The overall pregnancy rate using cryopreserved embryos is important because if your lab produced a frozen embryo transfer rate of less than 30%, it is performing below the national average compared to other clinics and the pregnancy rates are likely to be lower as a result. Ejaculated sperm tend to produce better embryos than surgically recovered sperm. There is no evidence that surgical recovery damages sperm but surgically recovered sperm tends to be poorer quality because the reason for surgical recovery may be due to underlying medical reasons that negatively impact sperm quality. For example, low sperm numbers due to problems with testicular function may require a testicular sperm extraction (TESE) procedure and the testicular function problems by themselves reduce sperm quality. Generally speaking, men who easily produce a normal ejaculate are more likely to be healthy and make better sperm. It is important to understand that there are cases of patients who are successful with only one or two viable embryos produced in a cycle but the “odds” of pregnancy are reduced for them. If you are one of those patients who consistently produce only one or two embryos per IVF cycle, you may want to move on past IVF sooner rather than later. IVF simply isn’t working very well for you. Sometimes programs encourage patients to stick with IVF too long because neither doctor nor patient want to “give up”. But it is important to know that other avenues for parenthood (such as adoption) may also become less feasible as you age because adoption programs have age cut-offs and may become financially out-of-reach as you spend most of your resources on IVF cycles which produce few embryos.

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