15 Is Magic Number?

Last February, I wrote that there's no magic to getting pregnant. That post was specific to "miraculous" fertility supplements. Well, now the news is full of "magic" again. This time, it's a Magic Number.

It's 15.

What kind of magic does the number 15 do for infertile couples?

A study that looked at 17 years worth of data concluded that 15 eggs retrieved in one IVF cycle renders the best chance of a live birth. Retrieving more eggs than that was linked to higher incidence of ovarian hyperstimulation syndrome.

The study authors failed to clarify that they were looking at conventional IVF cycles, not at cycles using very minimal or no ovulation stimulation medication. They did, however, tease out and present their findings related to the different ages within the study subjects. Specifically, the number 15 (eggs) did not make the live birth chances for women over 40 much better than otherwise. But as this article in the Globe and Mail suggests, a chance of live birth boosted by 4 percent might be inspiring to fertility patients older than 40.

I would remind patients that this is statistics, although well done. I worry about patients hearing these sorts of numbers and feeling stressed because theirs haven't "hit". As with so many aspects to treating infertility, your mileage may vary. We do everything possible to make each cycle safe *and* effective, and always, the outcome -- a healthy baby -- is our focus.

How Many IVF's Is Enough?

Yesterday I wrote about the importance of perseverance in fertility treatment. And in light of research that says "more IVF attempts equals greater chances of success" plus my concurring with Dr. Rosen's comment that likelihood of success per cycle decreases... here's my explanation of what sounds like conflicting stances:

There are so many facets that add up to IVF success or failure, we potentially learn something each time we use this technique for a patient. I use every tool I have -- the latest research findings, my years of experience in treating infertility, state-of-the-art equipment, highly skilled staff -- and still must approach each patient as a unique situation. Every body is different.

So any treatment cycle is an opportunity for us to find out more about how this body responds to various components of the IVF journey. When subsequent treatments are required, I take what we've learned, adjust the plan accordingly, and continue to observe the results carefully. Try again.

Decreasing success per cycle may not be related to the failure of the IVF technique itself, but to an organic sort of patient-screening dynamic.

For example, a patient chooses to undergo IVF. Her diagnostic workup reveals a potential reason for her infertility thus far, and we believe IVF can help resolve this issue. Her first IVF attempt does not result in a pregnancy, yet through that experience we learn something else about this patient's fertility factors. We decide on parts of the IVF process to change -- we may tweak the medication protocol, or use some additional technique or tool -- and we all try again. If we continue in this manner, the IVF process may wind up revealing even more causes of this patient's infertility with each treatment cycle. In most cases, after paying careful attention to a patient's IVF responses and adjusting the next cycle accordingly, success -- a healthy pregnancy -- is the outcome. For some, the result is coming to terms with the need to move forward, either with a different treatment technique or to adoption or to living child-free.

So in some situations, each procedure adjustment we make whittles away at the possible infertility causes until finally, we determine that IVF either is or is indeed not the answer for this patient. But there may have been no way to determine that fact if IVF had not been tried.

Of course, passing time is one of the biggest factors for decreasing success rates per cycle. Especially for women who are already in their 30's when they start fertility treatment, the natural biology of the female results in fewer chances for pregnancy as her body ages.

To some extent, medical treatment -- not just for infertility, but other conditions as well -- involves taking risks. My fellow practitioners and I always first balance the risk of harm to a patient versus the potential success of treatment. Each patient is different, not only in their body's responses to treatment, but in attitude and ability to move forward. Some are naturally more at ease taking risks, while others are more comfortable risking little. Helping patients make those choices is part of my job.

~ Sonja Kristiansen M.D.