Increased IVF success with cumulative treatment
Posted on 15.10.15
We believe in giving patients a realistic expectation of IVF success. With delivery rates now around 30% in most countries, and a positive outcome more likely after two or three cycles, we explain the statistics behind IVF success and the benefits of opting for a three-cycle package.
The road infertile couples take to having a family of their own can be described as a magical mystery tour as they follow the twists and turns towards parenthood. They are faced with bewildering challenges, complicated treatments, difficult decisions, worrying costs and, of course, possible disappointments along the way.
Understanding the statistics
The simple fact is that not all couples will successfully reach the end of the road. Some will give up, while others will face treatments which simply don’t work for them. Delivery rates after IVF are now around 30% in most countries of the world, including Britain, which means that for every single cycle of treatment undertaken by an infertile couple, two out of three will not work.
The Human Fertility and Embryology Authority (HFEA), Britain’s regulator of fertility clinics, provides a whole section of its website on how to interpret the statistics of ‘success.' It shows how percentage rates can be different if reported as pregnancy rates or live birth rates, or according to the age of the patient. For instance, it’s an indisputable fact that women of an older maternal age have lower success rates than those under 35.
The delivery of a healthy baby is often more successfully reached after two or three cycles of IVF treatment
Similarly, women who have already been unsuccessful in one or more cycles of IVF will usually have lower success rates than those having a first attempt. But the records nevertheless show that the endpoint of the fertility journey – the delivery of a healthy baby – is often more successfully reached after two or three cycles of treatment than after one. That’s why delivery rates after several cycles of treatment are always higher than after one, suggesting that the fertility journey is more accurately reflected in a package of treatments than in one single treatment cycle.
In such cases IVF specialists may evaluate success as a ‘cumulative’ delivery rate – that is, the chance of a live birth after several cycles of treatment, not one. And cumulative delivery rates are always higher than single-cycle rates. For instance, a huge study of all live birth rates following IVF in Australia showed in 2013 that the chance of delivering a healthy baby was 21.1% after the first cycle, 31.1% after two cycles, 36% after three cycles, 38.6% after four cycles, and 40% after five cycles.
It was in recognition of these trends – evident in most clinics of the world – which a few years ago prompted the LWC to introduce a three-cycle package of treatment, which set out quite clearly the eligibility of patients, the costs from the outset, and promise of a fee refund if the treatments were not successful.
The move met demands from the HFEA to provide patients with ‘clear and accurate information in the form of personalised costed treatment plans’, but also reflected a groundswell of changing opinion on the definition of ‘success’ in IVF.
The birth of a healthy baby is the only measure of success that matters in IVF
Defining IVF success
‘For the past 30 years success in IVF has been defined by fertilisation rates, pregnancy rates or implantation rates,’ said Dr Hemlata Thackare, fertility specialist at LWC Wales in Cardiff. ‘But patients don’t want pregnancy rates, they want a baby. The birth of a healthy baby is the only measure of success that matters in IVF. That’s what our patients want and they want it within an appreciable treatment time and within an acceptable budget. And that’s what we’re aiming to give them.’
The LWC scheme has been devised as a package of standard IVF treatment providing three IVF treatment cycles over a 12-month time frame. Eligible patients need to be non-obese, nonsmokers, with hormonal and gynaecological levels within a specific range. Patients with certain types of infertility – for example, as a result of polycystic ovary disease, or a history of recurrent miscarriages – are ineligible.
The treatment package includes all clinical and laboratory monitoring, egg retrieval and three fresh embryo transfers, and the first counselling and legal service consultations. Only the initial consultation and the cost of drugs for ovarian stimulation are extra.
An analysis of all three-cycle package treatments carried out at the LWC London in Harley Street since 2005 shows how successful a ‘cumulative’ approach to IVF can be, with delivery rates each year ranging between 49% and 75% per patient. In 2012, out of 81 patients who went into the programme, 28 became pregnant in the first cycle, 17 in the second, and five in the third. Overall pregnancy (not delivery) rate from the full programme was 61%. These are high levels of success, whose outcome is clearly enhanced by the additional two cycles available within the package.
There have been many authorities throughout the short history of IVF who have called for a new definition of ‘success’ in IVF. Most recently those calls have not just urged the recognition of delivery (and not pregnancy) rate, but also the safe delivery of a healthy singleton baby. Some have even argued that twins, and certainly triplets, can no longer be considered a ‘success’ in IVF.
But certainly, for those couples looking ahead to their fertility journey, with its twists and turns and ups and downs, it seems clear that the road will not come to an end with a pregnancy test, whether positive or not. All pregnancies are precious and deserve continuing care to delivery. And that surely is the point where the journey comes to an end.
To find out more about our three cycle packages, please call 020 7563 4310 or email firstname.lastname@example.org.
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