IVF Pregnancy Rates & Outcomes
CHR is pleased to offer 2012 IVF pregnancy outcomes. Though, once again, our center's IVF pregnancy rates were more than excellent, the degree of excellence does not even become fully apparent until the adverse selection of patients undergoing IVF cycles at CHR is considered. The pie chart in Figure 1 on the right demonstrates, for example, how adversely selected CHR's patients were in regards to age: only approximately 30% of patients were under age 35. This means that over two-thirds of all our patients were above age 35. Indeed, almost half were between 41 and 50 years old in 2012.
Fresh IVF Cycles
The Table above, and Figure 2 on the left summarize CHR's 2012 clinical IVF pregnancy rates by age. A few peculiarities deserve explanation: For example, one may wonder why younger women, under age 30 years, have poorer pregnancy rates than women between 30 and 40 years. This, however, is an almost expected finding at our center: Women who seek out fertility treatments at such young ages are usually more severely affected by infertility. Especially at centers like CHR, where patients seek treatment usually only after having failed treatments elsewhere (often more than once), presenting young patients almost always have very severe fertility problems.
At CHR, this usually means that these young patients suffer from severe premature ovarian aging (POA), sometimes also called occult primary ovarian insufficiency (OPOI). Indeed, during 2012, CHR served a larger number of young women with severe POA than ever before, many with undetectable AMH levels and FSH levels approaching menopausal levels. Considering this fact, here presented 2012 pregnancy rates are nothing but astonishing.
POA is, indeed, the most frequent diagnosis at CHR in women under age 40. Approximately 90% of women under treatment suffer from POA, either based on abnormally low age-specific AMH, abnormally high age-specific FSH levels, or both. Besides very advanced age, POA is the second major reason why CHR's patients, likely, represent the most adversely selected patient population of any IVF center in the U.S., if not the entire world. Again, considering this degree of adverse patient selection, CHR's age-specific cycle outcomes have to be considered nothing but spectacular.
Some further explanations: Here reported pregnancy rates are "clinical" pregnancy rates, meaning that we do not count the so-called chemical pregnancies as pregnancies. We only count pregnancies seen and confirmed by ultrasound. Here reported pregnancy rates are calculated per embryo transfer. This means that to be included in these statistics, a patient had to have at least one embryo available for transfer.
This, of course, raises the question: how many patients did not have at least one embryo for transfer? Here again, CHR's numbers are quite remarkable. Among the patients who went through full stimulation, even with approximately 20% also undergoing preimplantation genetic diagnosis (PGD), only 19.8% ended up with no embryo for transfer.
Clinical pregnancy rates per number of embryos transferred
Here is another very important statistics: As shown in the table above, CHR recorded 15.6% clinical pregnancy rates in patients with 4 or more embryos transferred. Considering that CHR, up to age 38, practically never transfers more than 2 embryos and up to age 40 never more than 3, this is, again, quite a remarkable number. All patients who received 4 or more embryos were above age 41, and in such patients a clinical pregnancy rate of 15.6% is remarkable. Within each number of embryo transferred, younger patients, of course, will do better than older patients, though the range of difference narrows as women age.
A brief explanation as to why CHR presents pregnancy rates by embryos transferred: If a woman at retrieval produces no eggs, she, of course, has no chance of pregnancy. The same applies to when a woman with PGD only has chromosomally abnormal embryos that cannot be transferred. Both of these risks, of course, increase with advancing female age and/or increasing severity of DFOR. In such patients, age, paradoxically, becomes less important. Instead, the number of embryos available for transfer becomes more important. It is for that reason that CHR above, for the first time, reports clinical pregnancy rates by the number of embryos transferred.
Frozen-Thawed Cycles (FETs)
Donor-Recipient (Egg Donation) Cycles
|Fresh Non-Donor PGD||41.2|
|Donor Egg PGD||66.7|
A few remarkable comparisons to 2011
In comparison to 2011, CHR's clinical activities expanded markedly in the older age group. Indeed, the data very well demonstrate the continuing "graying" of CHR's patient population as IVF cycles in the oldest age groups increased the most.
- CHR provided IVF treatments to 24% more women over age 40
- CHR provided IVF treatments to 25% more women over age 42
- CHR performed 76% more egg donor IVF cycles
- CHR performed 11% more fresh IVF cycles
Conclusions and Cautions
2012 was, thus, another remarkable year for CHR' clinical program. In presenting the above data, we, however, also want to point out once more that statistical data have to be interpreted with extreme caution in medicine. No two patients are ever 100% alike, and looking at outcome data, based on patient age alone, especially for older women, is not always the best way to asses individual patient's pregnancy chances.
Such statistical outcome data represent mean values, a very appropriate way of presenting data when the range of outcomes is relatively narrow. In women with significantly diminished functional ovarian reserve (DFOR), whether due to POA or older age, the range of outcomes, however, becomes much wider and, most importantly, with significant risk involves the ZERO range (i.e. no pregnancy chance). For example, if a woman at retrieval produces no eggs, she, of course, has no chance of pregnancy. The same applies to when a woman with PGD only has chromosomally abnormal embryos that cannot be transferred. Both of these risks, of course, increase with advancing female age and/or increasing severity of DFOR.
In such patients, age, paradoxically, becomes less important. Instead, the number of embryos available for transfer becomes more important. It is for that reason that CHR above, for the first time, reports clinical pregnancy rates by the number of embryos transferred.
Last Updated: February 8, 2013