IVF: If at First You Don't Succeed, Try Again, New Study Finds

Two-thirds of women undergoing IVF need up to 6 attempts, a new British study found, which calls into question doctors' practices of giving up after 3 or 4 failed attempts.

An embryologist at the La Jolla IVF Lab in La Jolla, California, March 24, 2009.
Bloomberg

Two-thirds of women undergoing in vitro fertilization treatment need up to six attempts to have a successful pregnancy, though the odds are still reasonable up to the ninth cycle, according to a new British study that made international headlines this week.

The results call into question the policy of doctors and many insurance companies in the West to limit the number of unsuccessful IVF attempts to three or four, on the assumption that further treatments will likely fail as well.

The research, published in The Journal of the American Medical Association, was not exactly news to physicians in Israel, one of the only countries where the government will fund unlimited IVF treatments for women up to age 44, or until they have two children. Women who have gotten pregnant after 12, 15, or even 20 treatment cycles are far more common here than in countries where women must pay for additional, and expensive, treatment cycles out of their own pockets.

The British study defined an IVF “cycle” as the initiation of treatment with ovarian stimulation and all resulting separate fresh or frozen embryo transfers. Cumulative live birth rates were far higher for women under 40; only 31.5 percent of women aged 40-42 achieved a live birth by six cycles and the success rate dropped drastically for women over 42. The researchers conclude that the findings “support the efficacy of extending the number of IVF cycles beyond 3 or 4,” but point out that repeat IVF is not only costly, but also stressful.

Though senior Israeli fertility specialists were not surprised by the findings reported by scientists at the universities of Bristol and Glasgow, they noted that the large population studied – nearly 157,000 UK-based women who received almost 260,000 ovarian stimulation cycles over seven years – is significant because it gives hope to couples suffering from infertility.

“This definitely encourages women not to give up after a short series of treatments and shows that there is definitely a reason to keep trying,” says Prof. Benny Fish, the head of the reproductive medicine and IVF department at Beilinson Hospital in Petah Tikva. “One of the most common arguments was that after four to five treatment cycles the chances of success drop dramatically. This study shows that even at the sixth cycle there is still a 17 percent chance of success.”

According to Prof. Ronit Haimov-Kochman, the coordinator of the Israel Fertility Association’s ethics committee and a fertility specialist at Hadassah University Hospital in Ein Karem, Jerusalem, the research was not relevant to Israel because of its liberal IVF policy.

“In the big world where people pay out of pocket for this treatment, people tend to do one or two cycles and then stop, so this article will encourage them to continue. In Israel people don’t give up,” she said.

The knowledge accumulated in Israel has shown even more dramatic results than the British study. Israeli studies published in recent years have demonstrated reasonable success rates in women who underwent between 12 and 20 cycles of IVF. However, Prof. Shahar Kol, director of the Rambam Medical Center IVF unit, suggested keeping things in proportion.

“The general statistics are liable to go wrong and do an injustice to some women,” he said. “Success is best seen among women under 40 with a particularly good ovarian response.”