The most important factor that determines chances of success with IVF treatment is the prognosis of the patients (female and male) undergoing IVF. While this may seem obvious, it is unfortunately often overlooked when selecting the most effective and safe IVF protocol. The reason for this is that there is not one uniformly agreed upon criteria which is used to determine patient prognosis.
Here we describe patient factors associated with each treatment prognosis group and the type of treatments which may benefit each group.
Favorable Prognosis
(live birth rate 40-65% per IVF cycle)
- Female age <= 35 years
- Previous live birth after an IVF cycle
- Excess high-quality embryos available for cryopreservation
- Euploid embryos
- Use of donated eggs (from a donor < 35 years of age)
Intermediate Prognosis
(live birth rate 10-40% per IVF cycle)
- Female age > 35 but <= 40
- Capable of producing >3 oocytes with conventional stimulation
- No severe male or uterine factor infertility
- Previously failed <= 3 cycles with embryo transfer (either fresh or frozen)
- Special situations ofter associated with intermediate to poor prognosis depending on severity
- Women with uterine factor infertility (ie. due to Asherman’s adhesions)
- Sperm is surgically retrieved from the testicle for use in IVF (ie. men with azoospermia)
Poor Prognosis
(live birth rate 5-10% per IVF cycle)
Bologna Criteria (two of the following three criteria):
- Female > 40 years of age
- <= 3 oocytes
- AMH level < 1.1 ng/ml
- Previously failed > 3 cycles with embryo transfer (either fresh or frozen)
- Significant uterine factor infertility
Very Poor Prognosis
(live birth rate 1-5% per IVF cycle)
- Female >= 43 but < 46 years of age
- Multiple prior failed IVF cycles
- History of poor egg/embryo quality
- Severe uterine factor
“Futile” Prognosis
(live birth rate <1% per IVF cycle)
- Female >= 46 years of age
- Multiple prior failed IVF cycles
- History of poor egg/embryo quality
- Severe uterine factor
Patients who have a favorable prognosis have high chances of success with IVF treatment and are ideal candidates for elective single embryo transfer at blastocyst stage. Favorable prognosis patients may opt for conventional stimulation protocols which offer the highest live birth rates or for mild stimulation protocols which offer somewhat lower but still excellent live birth rates at a lower cost by utilizing lower medication doses.
Conversely, patients who have a poor prognosis generally do better with the transfer of multiple embryos at cleavage stage because they produce relatively few, low-quality embryos which may not survive to blastocyst stage even in the best laboratory. Some poor prognosis patients, who do not respond to fertility medications, may be good candidates for mild stimulation and natural cycle protocols. Poor prognosis patients may also consider the use of donor eggs, which generally yield a very high live birth rates.
However, most patients undergoing IVF do not fall into either the favorable or poor prognosis categories. In such intermediate prognosis patients, a detailed discussion of risks and benefits of various IVF strategies (fresh vs. frozen embryo transfer) (cleavage vs. blastocyst stage transfer) (single vs. multiple embryo transfer) and various add-on procedures (ICSI, AZH, PGT-A) is very helpful to individualize a treatment approach.
The prognosis can often be improved if the underlying cause of infertility is identified and appropriately treated before starting IVF. Correcting hormonal imbalances can often significantly improve fertility and the overall prognosis of IVF working. It is recommended for men with significant problems affecting sperm to see a fertility-trained urologist, who may be able to identify and treat an underlying medical cause. Women with significant uterine factor infertility may benefit from a combination of surgery and hormonal treatment. In the most severe cases thought a gestational carrier may be the best option.
Neway encourages a comprehensive evaluation by one of our board-certified reproductive endocrinology and infertility doctors who can determine your prognosis and recommend an individualized fertility treatment protocol.
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