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Should I Try IVF Again to Get Pregnant?
a blog by Mylene Yao, M.D., CEO and Co-Founder, Univfy, Inc., July 14, 2013
My last IVF didn’t work should I try IVF again? I had a child with IVF but it has been a few years; what are my chances of pregnancy with IVF now?
If you are asking these questions, the good news is that new tools exist to help you make decisions about your next IVF cycle with more confidence. From research originating at Stanford University and validated at other leading IVF clinics, we have developed a statistical model, based on data from thousands of IVF cycles, to predict your personalized chance of pregnancy with IVF.
My research colleague, Wing Wong, PhD, and I co-founded Univfy so that we could put this powerful information in the hands of patients and their doctors. We developed Univfy IVF Prediction Tests to predict your chance of pregnancy with your first IVF cycle (Univfy PreIVF) and additional IVF cycles (Univfy PredictIVF).
In a previous blog series, we discussed how statistical models can be used to predict your personal chance of pregnancy with your first IVF cycle based on personal medical factors, such as your age, body mass index (BMI), natural egg supply (ovarian reserve), data from your male partner’s semen analysis, and any other medical conditions. Predicting your chances of pregnancy with your next IVF cycle uses all this data and additional data from your previous IVF cycles.
We recognize that our fertility decreases as we age. Two women of the same age may have very different probabilities of success with their next IVF, based on their own unique mix of fertility factors. Chronological age is not the only factor that impacts your chances of pregnancy. For instance, even very young women may have a much reduced egg supply or ovarian reserve which negatively impacts fertility. On the other hand, we know some women have conceived in their 40’s with their own eggs. This discrepancy between chronological age and fertility is why maternal age should not be the only factor under consideration when deciding whether to try a first or subsequent IVF cycle.
Your ovarian reserve at any age can be estimated by blood tests such as Day 3 follicle stimulating hormone levels (Day 3 FSH) and levels of anti-mullerian hormone (AMH). These blood tests are typically ordered as part of the diagnostic work-up before starting an IVF cycle, and the results are used to recommend the optimal ovarian stimulation cycle type and stimulation medication (gonadotropin) starting dose for you. For instance, if your blood work shows a high Day 3 FSH and a low AMH level, you might require more gonadotropins to get an optimal number of eggs for IVF. Your doctor may also order an ultrasound imaging of your ovaries early in your cycle to count the number of antral or “starter” follicles that are available this month to respond to stimulation.
Single fertility factors identified from the research are not independent of each other but actually may modify the importance of other factors. For example, BMI and smoking habits impact your overall fertility, because they can affect ovarian factors. For instance, a young woman with an abnormally high BMI may have a lower probability of success with IVF than an older woman with a normal BMI. An abnormal BMI (too high or two low) can disrupt your cycles and cause problems with ovulation at any age.
Smoking is another factor that is known to negatively affect your overall fertility, at any age. Smoking and chronic health conditions can devalue your positive factors, so these other factors are also considered in the mix of fertility factors analyzed by both Univfy PreIVF and Univfy PredictIVF.
Your response to gonadotropin stimulation in past IVF cycles is used to predict your chances of success in your next IVF cycle (Univfy PredictIVF). For instance, if you needed low to moderate doses of gonadotropin to grow an optimal number of eggs for IVF, your prognosis for success is better than if you needed a very high dose to get relatively few eggs. Your previous response to ovarian stimulation is a factor that contributes 13% to your overall chance of pregnancy with IVF in your next cycle.
In the next post, we will talk about some of the other important data from you last cycle that can be used to predict how you will do in your next cycle.