Study: Sixth Time May Be Charm For In Vitro

If in vitro fertilization fails two times, some couples might conclude they are never going to have a baby. They shouldn't give up so quickly, according to a new study published in The New England Journal of Medicine.

In the largest study ever to try to clarify the accuracy of in vitro fertilization (IVF), researchers at Beth Israel Deaconess Medical Center, Harvard Medical School and Boston IVF found that additional attempts dramatically increased the success rate. A woman younger than 35, for example, had a 65 to 86 percent chance of giving birth after six IVF cycles.

IVF is an expensive treatment, ranging anywhere from $7,000 to $15,000 per cycle. It's also complicated; women take hormones to stimulate ovulation; doctors then mix the eggs and sperm in a petri dish, creating embryos that are inserted into the woman's uterus. These embryos must attach to the wall of the uterus for a pregnancy to result.

As couples consider this, the first question they usually ask is how likely they are to have a baby, explains Dr. Alan Penzias, a reproductive endocrinologist at Boston IVF and professor at Harvard Medical School.

"Unfortunately," he adds, "most of the work that's been done before, and even the individual statistics, haven't been able to answer that question. And now we can."

Previously, fertility specialists could only predict the odds of having a baby after each individual cycle of IVF. That rate was about 40 percent for a patient under 35. But that didn't help patients decide how many cycles merited the investment.

In the latest study, Penzias and colleagues analyzed more than 6,000 patients undergoing over 14,000 cycles of IVF. They found that after three IVF cycles, the cumulative live-birth rate was 45 to 53 percent; after six IVF cycles, the cumulative life-birth rate was 51 to 71 percent for all age groups. What this means is that after six cycles, in vitro fertilization gives women the same probability of having a baby as their counterparts without fertility problems.

For women younger than 35, the odds were particularly good.

"With this new information," Penzias says, "I can sit across today from a 32-year-old patient and tell her that if she goes through up to six IVF cycles, she has somewhere between a 65 and 86 percent chance of having a baby at the end of therapy."

Penzias says the results of his study should confirm the old adage, "try and try again."

Take the situation of Rebecca Chung, a 36-year-old mother of one. Her infertility problems are typical: Her husband's sperm count is low, and she doesn't ovulate regularly. She's now hoping to have another child through IVF.

"When [my daughter] was about 2 years old, we decided it was time to try for a sibling, and thus began our roller coaster for the last 2 and a half years. We had a bunch of close calls; I got pregnant several times, but never with the happy result of a sibling for my daughter."

In one sense, Chung says, she's lucky. She lives in Massachusetts, a state that mandates insurance coverage of IVF; most states don't. Currently in her sixth IVF cycle, however, she's on the verge of giving up.

"We're actually on our last try right now; if that doesn't work, and of course I hope it does ... we'll probably consider adoption," she says.

But at 36, Penzias says Chung is still young and her chances are good that IVF will eventually work.

If she were older, however, the assessment might be different. According to the new study, women over 40 had half the chance of having a baby as women under 35. While IVF can boost their odds to those of fertile women in the same age group, it cannot "reverse the biological clock," Penzias says.

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