The decision to embark on IVF is a big one, but what about the decision to stop...
It’s just as big as the beginning. When it enough, enough? And how do you know when to stop IVF? Here, Genea Deputy Medical Director Dr. Mark Livingstone answers all of your questions.
Does IVF always work for everyone?
I am afraid IVF does not work for everyone. The chance of successful pregnancy with an embryo transfer reduces as a woman becomes older, and by the time a woman is over the age of 45, it becomes virtually zero when using her own eggs. The issue is also not just becoming pregnant but the increased risk of miscarriage and chromosomally abnormal pregnancy as a woman ages.
We also know that the chance of pregnancy reduces with the number of unsuccessful IVF attempts. In other words, a woman embarking on her fifth egg collection has a lower chance of pregnancy than a woman embarking on her first egg collection as the woman on her fifth cycle has had four unsuccessful attempts, indicating a possible issue.
Is IVF suitable for anyone to try?
IVF is not always suitable for everyone to try. As the chance of successful pregnancy for a woman over the age of 45 is less than 1%, many people will decide not to embark on treatment. There may also be some medical or psychological reasons not to embark on assisted conception.
How long do you advise patients that the process may be?
I advise patients before commencing treatment that we tend to see people who will become pregnant doing so within four egg collections. I also talk about those who will not become pregnant within four egg collections. This of course does not include the frozen embryo transfers which may also be attempted.
Patients often describe IVF cycles as fresh and frozen embryo transfers combined but Fertility Specialists talk about the number of egg collections as the number of cycles. This process could be as short as six months or take a couple of years if there are lots of frozen embryo transfers in between each fresh cycle or if the patient experiences pregnancy losses.
Do you suggest taking a break between cycles, or is it beneficial to keep them rolling?
I do suggest taking a break between cycles, but I do not object if a patient wishes to go ahead with two stimulated cycles back to back. That said, I would not recommend three back to back cycles. We used to have one month break between a fresh egg collection and a frozen embryo transfer due to the concern that ovulation was not good in the cycle following a fresh egg collection but the opinion on this has now changed and you can embark on a frozen embryo transfer immediately following a fresh egg collection cycle.
What are some physical signs that it might be best to cease treatment?
Some of the physical signs it may be best to stop treatment are very low egg numbers coupled with very poor quality embryos and a significant number of treatment cycles. It is also important for a patient to consider the psychological impacts of multiple unsuccessful cycles of IVF which can include insomnia, inability to work, and stress on their relationship.
What about mental or emotional signs?
As I mentioned above, having a number of IVF cycles can affect both women and men mentally and emotionally. It’s important that people consider those elements of their wellbeing when deciding whether or not to continue with treatment. Both Genea’s Fertility Specialists and Fertility COunsellors can help patients assess the impact of these factors.
Is there any other reason you might suggest a patient stops IVF?
The main reasons I might suggest a patient stopping treatment are the ones I’ve listed above. If there are concerns from a financial perspective, then there are lower-cost options available that can be discussed.