Women in their 30s and 40s who undergo multiple infertility treatments may be nearly as likely to deliver a baby as women who conceive naturally, according to new research that provides men and women with a more realistic view of their chances of becoming parents.
Until now, the success of in vitro fertilization and other assisted reproductive technology (ART) was based on live births following a single course of treatment, called a cycle. However, researchers for the first time have calculated cumulative success rates for women undergoing several treatment cycles. Among nearly 250,000 U.S. women treated with ART in 2004-2009, 57 percent achieved a live birth, they reported. In addition, 30 percent of all ART cycles were successful, they found.
"This study shows that if you keep at it …your chances of becoming pregnant continue to rise with continuing treatment," said lead researcher Barbara Luke, a professor of obstetrics, gynecology and reproductive biology at Michigan State University's College of Human Medicine in Lansing. "The takeaway message from this is you may need to look at infertility treatment over a course of cycles."
Luke noted that about 25 percent of women drop out after their first cycle for a variety of reasons that may include cost (about $7,000 to $15,000 out-of-pocket per treatment cycle) and stress. Many insurance plans will only cover a couple of cycles; Luke and her co-authors said they hoped their finding might encourage insurance companies to reconsider those limits.
Success depends on many factors, most importantly a woman's age and the quality of her embryos, which are related, Luke said. "As we age, our eggs age, and the quality of the embryo may be less. That's why using a donor egg, from a younger woman, greatly improves the live birth rate among older women."
Donor eggs give women "a 60 to 80 percent chance of live birth, regardless of your age," Luke and her colleagues reported in today's issue of the New England Journal of Medicine.
Choosing the donor egg route represents "a very personal decision," Luke suggested. Although it may seem cold to advise women in their 40s that their best chances of becoming pregnant lie with the eggs of younger women, she said they might want to think about egg donations "within families," with a younger sister donating to an older sister.
Luke and her co-authors found that for women under age 31 undergoing ART, the live birth rate is 42 percent for the first cycle; 57 to 62 percent for a second cycle; 63 to 75 percent by a third cycle and 66 to 83 percent in the fourth cycle. Among women 43 and over, the chances of a live birth with their own eggs are about 4 percent for the first cycle; 6 to 8 percent for the second; 7 to 11 percent for the third; and 7 to 15 percent for a fourth cycle.
For comparison, Luke and her co-authors noted that among the general population, the odds of a couple conceiving spontaneously are 45 percent at one month, 65 percent at 6 months, and 85 percent at 12 months.
"This study provides patients with important and encouraging information," said Dr. Glenn Schattman, president of the Society for Assisted Reproductive Technology, which compiled the patient data that Luke and her colleagues analyzed. "While tracking outcomes by cycle started or single embryo transfer is a valuable method for assessing quality, having cumulative data linked to individual patients better estimates the prospect for success when they start a treatment cycle."
"Having the data to demonstrate that medically assisted conception can nearly match rates of natural conception is an important milestone," said Dolores J. Lamb, president of the American Society for Reproductive Medicine, which represents more than 8,000 health professionals focused on reproductive biology.