In Vitro Fertilization (IVF) Success Rates
CHR’s 2019 IVF Pregnancy Rates and Outcomes
Ahead of the CDC and SART statistics that report on live birth rates after IVF, here are CHR’s 2019 IVF pregnancy rates (IVF success rates), along with notable characteristics of our patients who underwent IVF cycles. We start with the patient characteristics, then summarize our patients’ pregnancy rates.
Age Distribution of IVF Patients
It is now for quite some years that CHR has been serving the oldest patient population of any IVF center in the U.S. by far. This is clearly seen in the outcome statistics reported by most of the U.S. IVF centers annually to the Centers for Disease Control and Prevention (CDC) and/or the Society for Assisted Reproductive Technology (SART). Over the last 10 years, CHR’s average patient age has been slowly but steadily increasing. From 2016 to 2017 alone, the median age of CHR’s patients increased by one full year from age 42 to age 43, where it has been staying since.
Age Distribution of Patients Undergoing IVF with Their Own Eggs at CHR, 2019
As the pie chart above demonstrates, by 2019, over 80% of all CHR patients pursuing IVF with use of their own eggs (autologous eggs) at CHR were above age 40. More than half were over 43, with women over 44 representing an ever-larger share of our IVF patients. This is not only unmatched by any other IVF center in the U.S. but, likely, unprecedented anywhere in the world. In fact hardly any IVF centers in the world offers IVF with use of own eggs to patients above age 42-43.
Just a few years ago, women above age 45 were a rarity even at CHR. Nowadays, however, women at those ages starting autologous IVF cycles represent daily events. Our center’s (and likely the world’s) two oldest patients achieving pregnancies with use of their own eggs were just a few weeks shy of 48 at the time of egg retrieval and embryo transfer. While we are still striving to successfully cross over to the other side of age 48 and achieve a healthy live birth, we are now quite routinely treating women with their own eggs even exceeding that age. Our oldest patient so far who produced transferrable embryos with her own eggs in IVF was almost 52 years old.
One more crucially important point regarding CHR’s patient ages: Though about 20% of our patients in 2019 were below age 40, it is also important to understand that those were not “normal” younger women because, practically all of these patients were younger women with low functional ovarian reserve (indicated by abnormally high FSH and low AMH), also called premature ovarian aging (POA) or occult primary ovarian insufficiency (oPOI). Young women with POA/oPOI require similar fertility treatments to women in their 40s and, unfortunately, in many IVF centers, they receive standard protocols without regard to their ovarian reserve status. We, therefore, would be able to obtain even better results in such patients if they presented to CHR before age 40 and before many failed IVF cycles elsewhere.
IVF Pregnancy Rates for Autologous Fresh IVF Cycles
Table 1 below summarizes CHR’s 2019 outcomes of autologous fresh IVF cycles (those using the patients' own eggs) stratified by age.
|Table 1: 2019 Fresh Autologous IVF Cycle Pregnancy Rates|
|Age Group||Pregnancy Rates|
Because CHR’s patient population is so severely adversely selected by age and functional ovarian reserve, varying percentages of patients who initiated IVF cycles (mostly depending on ages of women) did not reach embryo transfer in 2019, either because their ovaries were not able to produce eggs and/or they had no transferrable embryos. (CHR transfers only embryos with realistic pregnancy chances, so as not to cause unnecessary strain on our patients, financially and emotionally.) As CHR’s and other centers’ published studies in such an adversely selected patient populations have demonstrated, the number of embryos available for transfer in each IVF cycle becomes a crucially important predictor of pregnancy and live birth chances in that particular cycle.
In principle, for most of our patients, two IVF outcome parameters are crucial in understanding each patient’s IVF prognosis:
- (i) In a patient population with poor prognoses, the relative likelihood of not having even one embryo available for transfer is quite high, meaning that a 0 % pregnancy chance may be within the possible outcome range in more of our patients than at most other IVF centers. For this reason, we believe the informed consent process must include pregnancy rates with reference point cycle start (“intent to treat”) as well as with reference point embryo transfer (i.e., pregnancy chance for a patient provided that at least 1 transferrable embryo is available).
- (ii) Among patients who have at least 1 embryo for transfer, CHR’s own studies, as well as those conducted at other centers, demonstrated that in older, poor-prognosis patients, again depending on age, at least 3-4 embryos must be available for transfer for these patients to be able to expect pregnancy chances in the double digits. With single or 2-embryo transfers, patients’ pregnancy chances will only be in single digits (see below for further detail).
In poor-prognosis patients, it is almost impossible to predict whether they can reach embryo transfer in a cycle. This means that outcome statistics based on cycle starts are clinically not very useful. Therefore, here, we are presenting statistics for only patients who reached embryo transfer (i.e., had at least 1 embryo available for transfer). Here reported outcomes, therefore, must be further reduced if you are looking for IVF cycle outcomes with reference point cycle start (i.e., by “intent to treat”). By how much will mostly depend on female age: From around 15% at age 40-41, to around 50% at ages 45-46 and even higher percentages above age 46.
Two additional considerations are important:
- (i) Pregnancies can be miscarried, and in pregnancies with patients’ own eggs, miscarriage rates increase with advancing female age from ca. 15% at age 40 to approximately 50% at age 45 and above. These miscarriage rates need to be factored in when translating these pregnancy rates to estimated live birth rates.
- (ii) Since pregnancy and live birth rates in poorer prognosis patients are low by definition, such patients are well advised to view their outcome chances based on the so-called cumulative pregnancy/live birth rate chances—meaning that most of these patients will need 2, 3, 4, or more IVF cycles to reach a realistic enough pregnancy chance. CHR, therefore, offers patients highly discounted multiple IVF cycle packages, designed specifically for patients with diminished ovarian reserve.
Why IVF Cycle Cancellations Are Relatively Rare at CHR
Many IVF centers cancel started cycles when patients’ ovaries do not respond well to stimulation medications, producing just a handful of eggs for retrieval. Considering how adversely selected CHR’s patients are, cancelled cycles are actually surprisingly uncommon. In the context of reading the pregnancy rate table above, CHR’s low cycle cancellation rate means that these pregnancy rates do not need much adjustment to account for cycles that are cancelled before embryo transfer.
These are a few potential explanations for CHR’s low cycle cancellation rate:
Though standard practice at many IVF centers, CHR physicians, in principle, do not cancel IVF cycles when patients do not develop a certain minimum number of follicles. In our patient population, we usually recommend egg retrieval even when just one follicle has developed. The principal reason is that almost all CHR patients are already on maximal ovarian stimulation and, as such, have little potential to “do better” in subsequent IVF cycles by simply increasing the medication dosages. The only patients with cancelled cycles are, therefore, women who do not respond to stimulation at all, have zero oocytes retrieved, have no fertilization or have no embryos that develop to cleavage stage (day-3 after fertilization).
Furthermore, in poor-prognosis patients, CHR never cultures embryos to blastocyst stage. Even poor-prognosis patients will have more embryos on days 2-3 (cleavage stage) than days 5-7 (blastocyst stage). Therefore, they will have better cumulative pregnancy chances if all embryos are transferred at cleavage, rather than blastocyst, stage. This was recently again well shown in a prospectively controlled and randomized study from Australia that demonstrated very clear advantages for day-3 transfers.
Our avoidance of embryo selection through PGT-A (preimplantation genetic testing for aneuploidy) also plays a role in not (unjustifiably in our opinion) reducing the number of embryos available for transfer (for more on PGT-A, please see below). We believe that in these lower cancellation rates we also see effects of CHR’s recently introduced Highly Individualized Egg Retrieval (HIER) program.
Age and IVF Pregnancy Rates
Considering that virtually all of CHR’s patients, even at younger ages, have low functional ovarian reserve (abnormally high FSH and/or abnormally low AMH), 2019 pregnancy rates at younger ages were remarkably excellent. Absence of pregnancies in the age group <30 is, likely, a statistical artefact due to the very small number of patients under 30 going through IVF cycles at CHR. We again point to the age group of 44 and above—despite including patients up to age 52, this group’s pregnancy rates still exceeded “futility” of fertility treatments as defined by the American Society for Reproductive Medicine (ASRM).
Here reported pregnancy rates in this group of women at very advanced ages, however, require further explanation. Above age 43, the number of available embryos for transfer becomes a very important predictor of pregnancy and live birth chances. We’ve reported in a number of medical journal articles that this oldest patient population (as well as younger women with extremely low functional ovarian reserve due to POA) needed at least three embryos to reach a “reasonable” pregnancy chance with IVF, which we define as a pregnancy rate in the low double digits. Only a relatively small minority of women over age 43-44 can clear this bar. Therefore, the large majority of patients who produce only 1-2 embryos for transfer greatly dilute total pregnancy rates for this age group as a whole.
In other words, if you are able to produce more than three transferrable embryos after age 43 in an IVF cycle, your success rate is likely much higher than the rate for the entire age group, presented here. New York’s Cornell group also made the same point, but considered 4 embryos a minimum for better IVF pregnancy chances.
This means that women at these ages must be counseled properly with correct information: They must understand that their pregnancy chances will be in the low single digits with one embryo for transfer. With two embryos, they will be in the higher single digits; with three or more embryos, their pregnancy chances will reach double digits. Pregnancy rates in this age group, overall, will be quite low, and their live birth rates will be further reduced by an approximately 50% miscarriage rate.
These poor prognoses, of course, must be weighed against much better pregnancy and live birth chances with young donor eggs (presented in Table 3 below). This is not to say that CHR physicians ever refuse treatment with patients’ own eggs or push patients into egg donation cycles—that is contrary to our center’s philosophy of respecting patients’ fully informed autonomy. However, patients who prefer using their own eggs must also understand that they can attain better pregnancy and live birth chances only by working toward a decent cumulative pregnancy chance from multiple cycle attempts. CHR, therefore, offers such patients a unique 4 IVF cycle package, with almost 50% cost savings over standard per-cycle costs.
Pregnancy Rates for Frozen Embryo Transfer Cycles
Table 2 summarizes clinical pregnancy rates from frozen-thawed (FET) cycles with embryos from autologous (patients’ own) eggs. The numbers in 2019 again were excellent.
Even more remarkable than the pregnancy rates themselves is the fact that so many patients were actually able to produce enough “extra” embryos for additional FET cycles, despite their poor ovarian reserve.
CHR does not routinely “bank” embryos because we strongly feel that every cryopreservation reduces pregnancy potential. We know our patients cannot afford any further “voluntary” reductions in pregnancy chances. Therefore, practically all FET cycles involve extra embryos (i.e., more embryos than we were willing to transfer in a fresh cycle). That CHR’s patients still created such “extra” embryos is quite remarkable and, likely, at least partially also a consequence of the center’s still relatively new HIER program.
|Table 2: 2019 Frozen Embryo Transfer Cycle Pregnancy Rates|
Pregnancy Rates for Donor Egg Recipient Cycles
Table 3 presents outcomes for fresh donor egg cycles using third-party egg donors.
|Table 3: 2019 Third-Party Donor Cycle Pregnancy Rates|
|Type of Cycle||Pregnancy Rates|
|Fresh third-party egg donor||27.3%|
|Fresh transfers of third-party frozen donor eggs||40.0%|
|Transfers of frozen-thawed embryos from donor eggs||35.7%|
|All third-party donor egg cycles||35.6%|
Donor egg IVF cycles reported here included fresh “directed” donor cycles. Directed donors are usually family members who are usually older than egg donors in our egg donor program. Directed donors are not as highly selected as CHR’s own donors in terms of fertility and overall health. Therefore, pregnancy rates in those directed donor cycles are lower.
Moreover, increasing number of patients chose third-party donor eggs from frozen egg banks during 2019. Based on national data reported to the CDC, we previously reported in the literature that frozen donor eggs produced ca. 10% lower pregnancy rates than fresh donor eggs. Considering that CHR’s historical clinical pregnancy rates in young fresh third-party donors have been hovering around 50%, the 40.0% pregnancy rate in cycles using frozen eggs from egg banks appears appropriate.
It is in this context also important to note that an overwhelming number of donor egg cycles involve only single-embryo transfers since the very advanced age of most CHR patients does not allow for a risk of twin pregnancies. A 35.7% clinical pregnancy rates from frozen embryo transfers arising from third-party donors is also excellent, being approximately 14 percentage points higher than rates in autologous FET cycles and ca. 4.5 percentage points lower than fresh third-party frozen egg cycles.
Pregnancy Rates in Preimplantation Genetic Testing Program
Table 4 summarizes CHR’s Preimplantation Genetic Testing program, separated for Preimplantation Genetic Testing for Monogenetic Diseases (PGT-M) and for Aneuploidy (PGT-A). Though CHR fully supports PGT-M, we do not support the utilization of PGT-A, except for sex selection purposes.
In many IVF centers, PGT-A is mostly used for the (in our opinion unproven) benefit of improving IVF outcomes, while in many patients actually achieving the opposite effect. Due to PGT-A’s negative effects on patients’ pregnancy chances, CHR does not support utilization of the procedure but will perform it if patients insist on PGT-A despite having received advice to the contrary. CHR, therefore, performs PGT-A only very rarely (in low single digits every year).
One thing in Table 4 that may make some readers wonder is the “PGT-A frozen embryo transfers of ‘abnormal’ embryos” line. CHR was the first IVF center in the world to start transferring the so-called chromosomally “abnormal” embryos after PGT-A in 2014 (and we reported the first normal births after such transfers in 2015). Because of the role CHR played in the questioning of the reliability of PGT-A, CHR receives from patients quite a large number of such allegedly chromosomally “abnormal” embryos for potential transfers. A large majority of embryo transfers performed at CHR after PGT-A are, therefore, done with embryos produced at other centers and with supposedly chromosomally “abnormal” embryos. In fact, we urge patients with supposedly “abnormal” embryos not to let their IVF centers discard them until consulting with a CHR physician.
In Table 4, transfers of “normal” and “abnormal” embryos are, therefore, listed separately, with many more transfers of “abnormal” embryos being performed at CHR than of “normal” embryos. The latter usually restricted to sex-selection cycles. As the table demonstrates, and as CHR also repeatedly reported in the literature, pregnancy rates after transfer of embryos by PGT-A reported as “abnormal,” are, indeed, surprisingly high at 40.0%.
|Table 4: 2019 Preimplantation Genetic Testing Cycle Pregnancy Rates|
|Type of Cycle||Pregnancy Rates|
|PGT-M fresh autologous cycles||40.0%|
|PGT-M fresh donor cycles||50.0%|
|PGT-M frozen embryo transfers from autologous eggs||35.7%|
|PGT-M frozen embryo transfers from donor eggs||50.0%|
|PGT-A frozen embryo transfers of “abnormal” embryos||40.0%|
|PGT-A frozen embryo transfers of normal embryos||0%|
Summary of 2019 IVF Pregnancy Rates at CHR
Considering the continuing increase in adverse selection in CHR’s patients in 2019 based on age and low functional ovarian reserve, CHR’s outcomes must be considered beyond exceptional. If they were viewed without an explaining commentary, they would be considered to reflect outcomes of an average IVF center. That these outcomes were, however, achieved in the oldest IVF patient population of any IVF center in the U.S. (and likely the world) and in younger women with, likely, the lowest functional ovarian reserve, is quite astonishing. In addition, over 90% of CHR’s patients, before reaching out to CHR, already have failed IVF cycles (usually multiple) at (frequently multiple) other IVF centers. CHR is looking forward to 2020, fully expecting even more challenges. As CHR’s reputation as the “fertility center of last resort” spreads around the world, we will see more and more patients with challenging and increasingly complicated cases of infertility.
Our motto has always been to fight for every egg and embryo—and, as we again demonstrated in association with the COVID-19 pandemic, when CHR was one of very few centers that remained open and continued to serve the center’s patients uninterrupted, we are more than ready to continue the fight for our patients, whoever they are, wherever they are coming from and whatever their problems may be.
Norbert Gleicher, MD, leads CHR’s clinical and research efforts as Medical Director and Chief Scientist. A world-renowned specialist in reproductive endocrinology, Dr. Gleicher has published hundreds of peer-reviewed papers and lectured globally while keeping an active clinical career focused on ovarian aging, immunological issues and other difficult cases of infertility.
Last Updated: July 14, 2020