Assisted fertilization

How many cycles of assisted reproduction are needed to be able to get pregnant?

How many cycles of assisted reproduction are needed to be able to get pregnant?

When a couple is about to face MAP treatment they will surely have many questions in mind, one above all: “How many cycles of assisted fertilization are needed to be able to get pregnant?”. The desire to succeed on the first attempt is really great but, statistics in hand, the data that is often repeated is that IVF fails in 70% of cases. An IUI in about 90%.

These are numbers that at first glance can be frightening. Apart from rare exceptions, when you decide to embark on a PMA course, you need to take into account (in all senses) more than one treatment to increase the chances of obtaining the desired result.

There are various factors that intervene in the success or otherwise of the treatment: the problem that requires the couple to resort to assisted fertilization, the age (especially of the woman) , whether or not to resort to gamete donation . Without forgetting the quality/experience of the center to which the couple turns.

In short, all these factors do not allow us to make precise estimates.

Certainly great strides have been made since 1978, when Luise Brown was born, the first child born thanks to in vitro fertilization.

Since then, the history of reproductive medicine has been radically changed. Luise’s birth was the beginning of a new way of becoming a family.

Nowadays, in vitro fertilization (IVF) is a much more advanced and common procedure.   In 2018, IVF led to 73,831 successful pregnancies and a total of 81,478 live births in the US, according to the  US CDC .

In Italy, the National PMA Register has currently published the data for 2017   which are as follows:

  • 78,366 couples treated with first, second and third level medically assisted procreation techniques
  • 97,888 treatment cycles started
  • 18,871 pregnancies achieved
  • 12,490 parts obtained
  • 13,973 live births representing 3.0% of the total births in Italy in 2017 (458,151 live births, Source: ISTAT)

The number of couples who resort to PMA is increasing every year, and this could in part be linked to the fact that the average age at which a woman is looking for her first child has risen considerably in recent years. We know that a woman’s fertility decreases after the age of 35-36 and the higher the average age of looking for the first child, the more the probability of getting pregnant naturally decreases.

Which treatment?

IVF treatments vary according to many personal factors: health, age, specific fertility issues…

For example, simplifying, a woman who has closed tubes cannot do intrauterine insemination but will necessarily have to resort to in vitro fertilization. A couple in which the male has very few sperm cells will have to resort to ICSI.

In vitro fertilization requires the stimulation of follicular growth , the retrieval of mature oocytes from the ovaries (pick-up) , in vitro fertilization in the laboratory and finally the transfer of the obtained embryos into the uterus .

Some structures support the transfer of one embryo at a time (a procedure that is increasingly widespread and used to avoid the risk of multiple pregnancies which often lead to complications), while others transfer more embryos (2 or 3) to increase the possibility that at least one embryo will implant and results in pregnancy.

It is important to remember that, just like natural conception,  IVF can also take several cycles to be successful.

A 2015 study published in JAMA found that success rates nearly tripled when women continued IVF for more than six cycles , from 20% to 60%.

An intrauterine insemination treatment has a 10% success rate with a cumulative rate of approximately 25% within 6 attempts.

The success of PMA is linked to many factors. The chances may increase if lifestyle changes such as changes in diet, exercise, are combined with the treatment. Some supplement treatments with acupuncture and other alternative medicine techniques, although a 2018 study by Western Sydney University and published in Science Daily gave unsatisfactory results. The study looked at 848 Australian women aged between 18 and 42. Some underwent acupuncture, others a “sham acupuncture”. The researchers found a “nonsignificant difference” in birth rates between the two groups of women

Will assisted reproduction treatment work?

This is a million dollar question, and no one can answer it with absolute certainty. As IVF procedures increase in precision and doctors gain experience, the odds are, of course, better. But it’s still a gamble. And also expensive if it is addressed in private centers.

While the rates vary, couples who receive IVF treatments have about a 20% to 30% birth rate, not much different from the success rate of those who conceive without medical assistance. The study published in JAMA concluded that the live birth rate for the first cycle is 29.5%. This success rate remained above 20 percent up to and including the fourth cycle.

Some additional considerations

IVF has risks, just like any invasive medical procedure. Stress, ectopic pregnancies, and multiple births are just a few of the possible side effects also listed by  Mayo Clinic , and while they’re not common, they’re worth considering carefully before moving forward.

Sites like Period Fertile with its ART forum   and social media are a great place to find other families going through a similar journey.

They are virtual places where women share their stories and support each other. If you choose to embark on this journey, these groups can be an important source of support along the way that may prove more complicated than expected.

Dr Kathryn Barlow

Kathryn Barlow is an OB/GYN doctor, which is the medical specialty that deals with the care of women's reproductive health, including pregnancy and childbirth.

Obstetricians provide care to women during pregnancy, labor, and delivery, while gynecologists focus on the health of the female reproductive system, including the ovaries, uterus, vagina, and breasts. OB/GYN doctors are trained to provide medical and surgical care for a wide range of conditions related to women's reproductive health.

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