Before joining infertility club, I assumed that fancy fertility treatments were effective. Especially IVF. I figured if anyone was spending that much money, odds must be in their favor. I was naive.

After my miscarriage, I read lots of personal anecdotes on forums and groups, then looked at the data. I remember the notion washing over me slowly, then hitting like a ton of bricks: IVF is not really that effective. If your issue is recurrent loss, it’s ineffective.

IVF Has No Guarantees

IVF’s Low Success Rates

IVF success statistics are fuzzy, and vary based on demographics (like age) and procedure details (own eggs, donor eggs, etc…).

SART (the Society for Assisted Reproductive Technology) gathers data about IVF and its most recent statistics assessed over 270,000 total cycles ( preliminary 2018 numbers listed here). Live births per egg retrieval cycle (including all embryo transfers) based on age and using the woman’s own eggs:

  • women under age 35: 47.6%
  • women ages 35 to 37: 34%
  • women ages 38 to 40: 21.7%
  • women ages 41 to 42: 10.4%
  • women aged over 42: 3.1%
  • average across all age groups:~ 23%

One IVF treatment cycle includes a single egg retrieval phase and all the resulting embryo transfers – could be 0, or more than 9, depending on how successful the first phase of IVF was. Cycles usually require multiple transfers to get an embryo that ‘sticks’.

One full cycle may take months to complete. Repeated transfers can be costly, as each one requires medication and monitoring.

For some couples, their first IVF cycle goes to plan: they produce good eggs and sperm, embryos are formed and survive, one of the transfers successfully implants, they carry a pregnancy to term and deliver a healthy baby. For others…

Do it again? Repeated IVF Cycles

Often, more than one full cycle of IVF is required to achieve a live birth. Actually, that’s a polite understatement and I need to clarify.

As a rule, IVF success requires multiple cycles. And it is not uncommon for this process to take years. Some authorities say a couple should be prepared for 3 full cycles to see clinical effectiveness.

More recently, a study published in 2015 reviewing UK IVF statistics from 2003 – 2010 notes that:

the cumulative prognosis-adjusted live-birth rate after 6 cycles was 65.3%, with variations by age and treatment type. These findings support the efficacy of extending the number of IVF cycles beyond 3 or 4.

The Reproductive Resource Center in Kansas City quotes the study’s author, Professor Scott Nelson, a fertility expert at Glasgow Royal Infirmary:

“Fertility treatments are being stopped prematurely. We need to stop thinking of IVF as a single shot at having a family, and think of several cycles as the standard.”

The study concludes that women under age 35 are the most likely to benefit from a six-cycle regimen, while older women have overall poorer results and may experience diminishing returns.

It makes sense that repeated IVF cycles would increase success rates- just odds alone. Plus, repeated cycles give doctors the chance to fine-tune the stimulation and transfer protocol based on the couple’s unique response to treatment (adjust dosage here, shift dates there, etc…).

IVF: Add-ons and Extras

Often, standard IVF is not enough. A protocol that results in a “take home baby” can involve many additional layers of treatment. Add-on services, surgical procedures and extra medications are all on the menu. Some of these are invasive, others costly, many are cutting-edge and not yet rigorously studied.

Add-ons include:

  • Elective freeze-all cycles
  • Embryo glue
  • Assisted hatching
  • Artificial egg activation
  • Time-lapse embryo monitoring
  • Pre-implantation genetic testing
  • Ovarian PRP (platelet rich plasma)
  • PRP, hCG, or Neupogen uterine wash
  • ERA testing

Extra surgical procedures include:

  • Hysteroscopy
  • Laparoscopy
  • Endometrial scratching
  • Ovarian drilling
  • Variocelectomy
  • Vasectomy reversal

Additional medications include:

  • hCG Boosters
  • Metformin
  • Antibiotics
  • Prednisone
  • Antihistamines
  • Blood Thinners (Lovenox, Aspirin)
  • Vaginal Viagra
  • LDN (Low Dose Naltrexone)
  • Plaquenil
  • Prograf
  • HGH (Human Growth Hormone)
  • Neupogen
  • Intralipids
  • IVIG
  • LIT
  • Humira

Donor Eggs, Sperm, and Embryos

For many couples, IVF starts with their own eggs and sperm, but eventual success may involve the use of donor eggs, sperm or embryos. This donor material can be costly, and there can be a wait list of months or years.

Donor eggs, sperm or embryos result in a child which is not (entirely or sometimes even partially) biologically related to the parents. For many families embarking on an IVF journey, this is not the ideal envisioned. These are serious compromises, sometimes made from a place of desperation.

Sadly, some couples ‘fail’ IVF and other ART (assisted reproductive technology) procedures – even with repeated cycles, bells and whistles, donor material — literally nothing seems to work. IVF and its peripheral offerings do not successfully address their particular reproductive obstacles. This is not always attributable to age.

IVF’s Last Stop: Gestational Carrier Surrogacy

At the end of a long infertility journey, after failing to get pregnant using IVF, some couples will combine it with gestational carrier surrogacy in hopes of taking home a baby. This is the last option before adoption.

Surrogacy is being normalized, but the option is fraught with serious moral, ethical and biological questions. Some have pointed out:

  • The laws describing surrogacy fall under property law.
  • There are serious class concerns. The process often involves the use (exploitation?) of a poor(er) women’s body to fulfill the needs (wants?) of a wealthier family.
  • Gestational carriers are sometimes sourced more cheaply in other countries—whole agencies are forming to facilitate this trade.
  • The fiercest critics refer to surrogacy as a form of human trafficking.

If it were studied, I speculate that babies created via surrogacy experience significant emotional and physical suffering as a result of separation, and that gestational carriers do, too. The 9-month period of gestation forges a biologically proven mother-baby bond.

  • The gestational carrier is the only mother that baby knows while in the womb. Baby is synced to her heartbeat and voice. Even if the carrier isn’t the biological mother (it’s often someone else’s egg/embryo), a maternal-fetal connection is undeniable.
  • The baby is separated from its surrogate mother, often shortly after birth.
  • Mama-baby physically and emotionally need each other in the 4th trimester and beyond – no one else will do.

Gestational carrier pregnancies are some of the most complicated, biologically and legally. Babies born this way could have three biological parents – an egg donor mother, an sperm donor father, a gestational carrier (surrogate) mother. Add to that a legal mother and father who are potentially of no biological relation.

Finally, hiring a gestational carrier is expensive. The figures vary, but $100,000 is the most repeated average cost. That increases if the process requires donor material and/or multiple IVF cycles over a period of time.

All of this to say, if families can find ways to reproduce that do not require surrogacy’s murky ethics, so much the better.

IVF’s Lack of Transparency

IVF: What are the Odds?

Even after serious research, couples considering IVF may have difficultly answering these important questions:

  • What are my chances of a take home baby?
  • What is this process likely to cost?
  • How long can I expect this to take?

I’ve shared stats, but to be honest, the data is confusing. It varies!

It varies country to country, year to year. It varies based on age, based on whose eggs are being used. It varies according to the the dozen plus variables of the cycle and reproductive issues that might be at play. It varies based on individual clinic protocols, which are not always transparent.

When planning something as expensive and intense as IVF – clarity about odds is imperative to making an informed decision. Due to obvious conflicts of interest, a couple’s clinic shouldn’t be the only one weighing in. Some outside research is definitely in order. There are many articles written by women who’ve been through the wringer, warning IVF newcomers about the industry’s fog and mirrors.

Skewed Statistics? Acceptance-Exclusion Criteria

Did you know, many IVF clinics use exclusion to inflate their numbers? Of course, IVF clinics are businesses in competition with one another. They are compared and ranked based on success rates and statistics. If every couple seeking IVF were allowed to go through the process, the statistics would be worse than what SART reports.

Some clinics do a great deal of pre-admission testing to screen for the patients most likely to have IVF success. They look at factors like advanced age, high BMI, sub-optimal lab findings and medical conditions. As a result, clinics exclude many less promising candidates entirely.

When comparing IVF clinics, it pays to get details about their acceptance-exclusion criteria. Otherwise you may be comparing apple and oranges.

It’s worth noting that some clinics, like CNY Fertility, have an open acceptance policy, yet manage to maintain competitive stats. Remember, though, open-admission clinics are the exception, not the rule.

IVF’s Negative Health Consequences

Does IVF Produce Healthy Children?

Evidence suggests that children born as a result of IVF are more likely to be delivered pre-term and to have complications after birth. They also have a slightly higher mortality rate in their first weeks of life than children not conceived via IVF.

Since the technology is relatively new (first successful IVF procedure was in 1978), the long-term data is not well studied. But, pregnancy complications are known to be more common in IVF, including: twins, multiples and high-order multiples, ectopic pregnancy, ovarian hyper stimulation syndrome, premature delivery, and low birth weight. Any pregnancy complication can influence the lifelong health of the child.

There is a chicken or the egg question, as to whether IVF related “health risks are associated with intrinsic maternal or paternal factors related to subfertility or to the ART treatments per se.”

“Fresh embryo transfer is associated with a higher risk of small for gestational age babies (SGA), low birthweight and preterm birth (PTB), while frozen embryo transfer is associated with large-for-gestational age babies and pre-eclampsia. ICSI may be associated with a higher risk of birth defects and transferral of the poor semen quality to male progeny, while oocyte donation is associated with increased risk of SGA and pre-eclampsia.”

Children born as a result of IVF may not be as healthy and robust over their lifespan as children born to mothers who did not require IVF.

“Concerning long-term health risks, the current evidence is limited but suggests an increased risk of altered blood pressure and cardiovascular function in ART children.”

Regarding the important ‘chicken or the egg’ question, there is some data that reveals complications may have to do directly with ART

“…even in the same mother an ART singleton has a poorer outcome than the non-ART sibling; hence, factors related to the hormone stimulation and/or IVF methods per se also may play a part.”

Is IVF Safe for the Mother?

IVF is a high pressure endeavor for the woman undergoing the procedure and for her family: it involves significant financial costs, is physically demanding, emotionally stressful and time-consuming.

The high-dose hormone treatments directly affect a woman’s psychology and physiology:

  • Mood changes (irritability, depression, anxiety)
  • Digestive issues (diarrhea, constipation, nausea, vomiting, bloating)
  • Weight gain
  • Headaches
  • Hot flashes
  • Breast tenderness
  • Abdominal pain
  • Cramping
  • Fatigue
  • Insomnia
  • Injection site pain and bruising
  • Enlargement of the ovaries, and even ovarian hyper stimulation syndrome (OHSS) can result from the ovulation induction medications (like HCG)
  • Cancer is a possible long-term side effect, correlation/causation has not been clarified at this time

The Egg-retrieval and embryo transfer procedures have side effects and carry risks:

  • Egg-retrieval involves the use of an aspirating needle which creates multiple punctures to the vaginal wall and ovaries— soreness and spotting is typical. Damage the bowel or bladder, and bleeding or infection are possible.
  • Sedation or general anesthesia carry risks, side-effects include vomiting and dizziness.

IVF pregnancies tend to have more complicated obstetrical outcomes:

  • Ectopic pregnancies (where the egg implants outside the uterus) are more common with IVF. These pregnancies are not viable and can lead to the loss of a fallopian tube in some cases.
  • Miscarriage
  • Increased incidence of multiples
  • Hypertension
  • Gestational diabetes
  • Delivery complications: preeclampsia, preterm delivery, low birth weight baby, c-section, hemorrhage, anemia.

We need a better understanding of the long-term consequences of IVF’s high-dose hormones and invasive procedures, especially when undertaken repeatedly. The technology is new enough that long-term health data is only beginning to emerge, and it needs to be carefully studied.

IVF’s Financial Toll

IVF is expensive

Cost varies depending on the clinic and details of the cycle, but average total costs for one IVF cycle in the US (including medication) is $20,000.

Often clinics will quote less, but their figures do not account for the necessary medications or for any add-ons.

When looking at anything in the ballpark of $20,000 per cycle, the prospect of six full cycles is truly…daunting. That’s $120,000! Then, consider the success rate for six cycles is only 65% (for women <35).

It boggles the mind.

If the IVF industry were transparent about these facts, I wonder, how many couples would spring for it?

IVF Puts Families in Debt

The average IVF patient goes through two cycles, with the combined costs of IVF procedures and medications totaling between $40,000 and $60,000.

Figures vary, but 80-85% of IVF costs appear to be paid out of pocket.

Families spend a fortune on ART procedures, often going into inescapable debt.

This incredible out-of-pocket cost can create financial setbacks that cannot be recouped or recovered from. This can be devastating for families just becoming parents. And it is truly heartbreaking for those who spend their life savings and/or go into debt, but never get a ‘take-home’ baby.

All of this to say, if families can find ways to reproduce that DO NOT require IVF’s high cost, so much the better.

IVF is a Blessing…When Used Wisely

I realize this article does not paint a rosy picture of IVF. To clarify – I’m not against IVF. When it’s necessary. IVF may be the only or best option when the following conditions are present:

  • Un-treatable tubal factors
  • Seriously disordered ovulation
  • Scarce or immotile sperm
  • Grave genetic diseases in the family line

In those cases, IVF is necessary and I’m grateful it is available.

I’m not upset about the use of IVF, I’m upset about it’s overuse.

I’m upset that families are rushed to IVF prematurely, without being informed about their odds of success or the risks.

I’m upset that infertility diagnostics are insufficient. That so many root-cause conditions are going entirely undiagnosed and untreated.

I’m upset that people are dazzled by the incredible IVF technologies, but blind to the truth: IVF is an expensive procedure with serious side effects and risks. It’s clinical efficacy is low, especially when weighed with cost and risk. As such, IVF should be reserved for last resort, when every other treatable root-cause condition has been ruled out.

This is the second post in my series about infertility revelations and ah-ha moments:

  • Unexplained Infertility: Real Talk
  • Age: Not the primary factor in infertility
  • The real drivers of the infertility crisis
  • Effective tests and treatments for the true root causes of infertility