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Largest In Vitro Study is Deceiving, Chicago Doctors Say

by K. Aleisha Fetters and Sheila Dichoso,  Medill Reports,  Feb 4, 2009

Chicago fertility experts claim the largest in vitro fertilization study to date misleads patients, especially older women, seeking treatment.

"The study gave the wrong impression about what the effects of in vitro fertilization are in older patients," said Dr. Randy Morris, reproductive endocrinologist at the Reproductive Genetics Institute in Chicago.

Women believe the study suggests in vitro will not help them if they're over 40, but the study's results actually show that while it cannot restore the fertility of their youth, the procedure can increase their chances of conceiving at any age.

In an analysis of the live-birth rate of more than 6,000 patients at a Massachusetts fertility clinic, researchers from Boston IVF and Beth Israel Deaconness Medical Center found that in women ages 35 and younger who were treated with up to six cycles of in vitro fertilization therapy, the live-birth rate ranged from 65 to 86 percent. However, women ages 40 and older had half the chance, with a rate ranging from 23 to 42 percent.

In vitro therapy increased patients’ pregnancy rates to those of fertile women their age. While it increased women older than 40's fertility, it could only establish rates equal to naturally fertile 40 year olds, which are lower than those of younger women. "It didn’t turn back the clock,” said senior study author Dr. Alan Penzias, reproductive endocrinologist at Boston IVF and Beth Israel Deaconess Medical Center in Boston.

Since the study was released Morris said patients have been calling his office distraught, understanding it to have found in vitro therapy ineffective for women older than 40. He believes the researchers have not adequately represented their findings as not helping these women.

"The public lives on abstracts and sound bites,” Morris said. “And quite often they can get the wrong message.”

Another Chicago doctor said not only does the study give the wrong impression, it gives patients – and even doctors – wrong information.

“I find this study to be of very little use to how I would counsel my patients. Patients need a good estimate of live birth success per in vitro fertilization attempt, not cumulative pregnancy over six cycle attempts," said Dr. Akas Jain, reproductive endocrinologist at the Advanced Fertility Center of Chicago.

However, results per IVF cycle can be inaccurate because success rates will differ between first-time patients and patients who did not become pregnant in previous IVF attempts, according to the study's news release.

In the Boston study researchers calculated, for the first time, in vitro fertility rates after all six treatment cycles, a previously uncalculated rate. It found that after six cycle attempts, women had the same pregnancy success rates as fertile women their age.

“Patients want to know how likely they are, when all is said and done, to become pregnant,” Penzias said. He called many past in vitro fertility rates “cherry picked” and said those rates gave women false expectations by focusing on individual treatment cycles.

“Until now doctors were really operating in the dark. These results help give women a realistic expectation of whether or not they will become pregnant,” Penzias said.

Besides age, Jain said other factors can affect patients’ success rates.

“The in vitro fertility process can be stressful and emotionally taxing on patients,” Jain said. “It is very important they understand everything it entails and know what to expect.”

The largest factor affecting many women’s in vitro cycles, though, is the price.

More than 125,000 in vitro attempts are performed each year in the United States, with an average cost of $12,400 per cycle. Successful treatments typically require six cycles of treatments, according to the American Society for Reproductive Medicine.

For each procedure, a woman undergoes several weeks of hormone injections to stimulate her ovaries and sometimes she must have her eggs extracted to be fertilized in the lab to produce viable embryos. If such embryos are obtained, then they are inserted into the mother's uterus through the cervix one to six days later.

The average live delivery rate for in vitro fertilization in 2005, the most recent year for which statistics are available, was 31.6 percent per retrieval, according to the American Society for Reproductive Medicine.

However, Jain said success rates vary greatly between clinics, and that the Boston IVF results don’t apply to all women seeking in vitro treatment.

In Chicago in vitro live birth rates can vary by as much as 45 percent, depending on treatment methods and protocols of individual clinics, he said.

Despite fluctuations between clinics, Penzias said the study will better inform women of their chances. “Giving women information is power,” Penzias said. “They can use this information proactively and make active choices rather than just discovering passively that it’s too late to become pregnant."

Chicago doctors insist older women shouldn’t be discouraged. Jain even predicts an increase in older women seeking fertility care.

“Can you make a 40-year-old woman like a 30 year old? No. Will in vitro give you a better chance of pregnancy? Yes,” Morris said.


Are you over 40 and trying to get pregnant? Are you encouraged or discouraged by this study's results?

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