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Don’t Be Too Discouraged by “Poor Prognosis”

Many couples come to CHR, a specialized fertility center in New York City, after being told that their chance of achieving a pregnancy with IVF is less than 1% if they wanted to get pregnant with their own eggs. Dr. Norbert Gleicher, CHR’s Medical Director, explains that even for patients with very low ovarian reserve, this “less than 1%” prognosis is often far too low an estimate, as long as patients can still produce a few embryos in an IVF cycle. At CHR, even women over 42 and 43 still have 5-7% chance of pregnancy if they have 2-3 embryos for transfer.

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We published in Fertility & Sterility, the official organ of the American Society for Reproductive Medicine, a rather unique paper where we summarized our experience with the “worst of the worst” patients. To our surprise, and certainly to the surprise of most of our colleagues, when we analyzed the data, a very significant group of patients did surprisingly well. What the study demonstrated is that the current policy, favored by most IVF centers around the world, that very poor prognosis patients should not even be given a chance of achieving pregnancies with their own eggs is really mistaken, because a significant portion of these patients will still have a surprisingly high pregnancy chance.

Obviously the pregnancy and delivery chances that can be achieved in such patients are limited, and can never be compared to the pregnancy chances that young donors’ eggs will give you. But in making the choice between a lower pregnancy chance with use of their eggs and much higher chances with young donor eggs, many patients understandably will choose the lower pregnancy chances with their own eggs. Therefore, it’s important to understand what these chances are. Here at CHR, our recommendations to patients are data driven.

In this paper in Fertility & Sterility that I just referred to, our remarkable findings can be summarized: Among the very poor prognosis patients, meaning patients with very high FSH levels or very low AMH levels, there will obviously be a group of patients whose ovaries no longer respond to stimulation. These patients will not produce eggs and will not produce embryos. Those patients, however, will recognize very early in the treatment process that there is no response, and their expenses will be limited.

The majority of patients, however, will respond, and produce eggs and embryos. Here, the data were actually fascinating.

If you are under age 35, even only one embryo in our program will still give you an approximately 33% live birth rate. If you are between 35 and 37, that same one embryo will give you about 15% live birth rate. As you get older, the number drops pretty precipitously, and once you reach age 43 and above, one embryo does not give you any live birth chances. When you further look at this table, you see, however, that if you are 43 or above, if you at that point succeed to produce 3 embryos, you still have a 7.4% live birth rate.

Many, if not most, IVF centers, will not treat patients over 42 or 43. In many Scandinavian countries and Europe, insurance coverage stops at around age 40 or 41. Therefore our colleagues have little experience in treating older patients. It’s not surprising then that very common myth that is presented to older patients is that their IVF pregnancy chances above age 42 is at best 1-2%. That is categorically incorrect, as this table demonstrates.

By having these data, we can be very specific in explaining to our patients what their chances are. By doing so we believe we are giving them the opportunity to make a very educated decision in deciding between using their own eggs or young donor eggs.