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Women who fail to become pregnant after undergoing in vitro fertilization treatment often grapple with the decision of whether to try IVF again. It’s a difficult one to make: The procedure carries hefty financial, physical and emotional costs, and there are no guarantees it will work.

Now a team of Stanford University School of Medicine researchers has developed a model to predict the outcomes of a subsequent round of IVF for those women who have already gone through a cycle. The researchers found that their test, which relies on taking clinical data from prior, failed treatments to provide more personalized predictions, is 1,000 times more accurate than the age-based guidelines currently used to counsel patients.

“Our findings show that the first IVF cycle can provide quantitative, customized prediction of the live birth probability in a subsequent cycle,” the researchers wrote in their paper. “This concept is radically different from the current paradigm, in which age is a major predictor.”

The paper, published online July 19 in the Proceedings of the National Academy of Sciences, was led by Mylene Yao, MD, assistant professor of obstetrics and gynecology. It follows previous work from Yao about another method she and her colleagues had devised that provides more accurate predictions about whether a woman undergoing IVF treatment will become pregnant. The newer test not only integrates more data into its methodology, but also its success was measured with a different outcome: live birth instead of pregnancy.

Yao said she’d like to see the new test widely available for clinical use, and she and co-author Wing Wong, PhD, professor of statistics and of health research and policy, have founded a company, Univfy, to develop and market prognostic tests to support clinical decision-making in infertility. Stanford holds the patent on this test.

Each year, close to 100,000 IVF cycles are performed using a woman’s fresh eggs, and around 29 percent of the treatments result in live births. Physicians typically use age-based data, with adjustments based on other clinical factors, to counsel patients on the probability of success. But given all the factors at play — including the number and quality of eggs and the total number of embryos implanted — age may be misleading as a prognostic factor.

Consider this scenario: A 38-year-old patient is told that women in her age bracket have a 33 percent chance of becoming pregnant from IVF. But because she has a lower-than-usual number of eggs, her physician says her chances are actually less than 33 percent. “The problem is that the patient will ask, ‘How much less?’” said Yao. And currently, the answer is at best an educated guess from the doctor.

Co-author Lynn Westphal, MD, an associate professor of obstetrics and gynecology who treats patients in Stanford’s Reproductive Endocrinology and Infertility Center, said a woman’s decision to repeat IVF is influenced by several factors, including financial considerations and her chances of becoming pregnant. “Many patients, even if they have insurance coverage, will drop out — either because they don’t understand what their odds are or they find it’s a very emotionally challenging experience to go through,” she said.

Westphal said improvements in the ability to predict a patient’s chances of IVF success would make counseling more meaningful. “The more information, the better,” she said.

It was the goal of Yao, Westphal and their colleagues to develop a way to provide patients with more personalized predictions. They took data from 1,676 IVF cycles performed at Stanford Hospital & Clinics between 2003 and 2006 and identified 52 factors — such as patient age, levels of certain hormones, number and quality of eggs and individual characteristics of each embryo — that influence a woman’s chance of having a baby. They then developed a computer model that sorted patients into subsets defined by similar clinical characteristics (so-called “deep phenotyping”) to predict live-birth probabilities in a subsequent round of IVF.

When testing their model with data from a separate set of more than 600 IVF treatments performed in 2007-08, the researchers determined that the model’s predictions were significantly different than the age-based predictions in 60 percent of patients. Interestingly, out of this group, more than half were assigned greater odds of having a baby than what age-related data indicated.

What’s more, in further verifying the accuracy of their new method, Yao and her colleagues determined that their model predicted outcomes with 1,000 times more accuracy than the age-based guidelines widely used in clinics.

Their findings, the researchers said in the paper, indicated that “the current age-based paradigm may provide misleading live birth outcome probabilities for a large portion of patients.”

Yao noted that because it’s critical to have data from previous treatment, this model wouldn’t be able to predict chances of success for those embarking upon their first IVF. But she said having personalized, accurate prognostic information would be invaluable in assisting women’s decisions to keep going or not. “For some of the patients, we may be able to reassure them and help them move forward and do another cycle if they have good odds,” agreed Westphal. “For other patients, if they’re in a poor category, we’ll help them move on to consider better options.”

Source: The first author of the paper is Prajna Banerjee, PhD, a postdoctoral scholar in obstetrics and gynecology. Other Stanford co-authors include Bokyung Choi; Lora Shahine, MD; Sunny Jun, MD; Kathleen O’Leary; and Ruth Lathi, MD. Funding came from the National Institutes of Health and the Coulter Foundation Translational Research Program at Stanford University.

More information about Stanford’s Department of Obstetrics and Gynecology, which also supported the work, is available at http://obgyn.stanford.edu/.

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There are only 15 states with insurance mandates that cover the diagnosis and treatment of infertility.  Theses mandates are unique in each state and different insurance guidelines may exist.  When IVF treatments are not covered by insurance patients must pay out of pocket for this procedure.  On average one IVF cycle costs around $10,000. These costs can add another dimension to an infertility diagnosis and can affect your entire family building journey.

Although IVF is considered a very successful treatment, a patient might have to go through multiple IVF cycles to take home a baby… adding to the cost of treatment with no assurance of a positive outcome. This might deter patients from undergoing IVF treatments to fulfill their dream of having a baby.

There are ways you can maximize your medical treatment with minimal financial risk:
• Create a financial plan;
• Communicate with your partner about financial options and expectations;
• Research financing options as there are programs that offer financing.

Research Arc, which a program that offers financing.  There is a network of clinics that offers the ARC Refund Guarantee™ program which will help you manage your infertility. Some clinics even have a guarantee of success or a % of your money back.  There are criteria to meet these programs but they are usually within reason.

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So you’ve gone through the entire IVF cycle, jabbing yourself with needles several times a day. Dragging yourself to your doctor’s office for what seems to be a dozen visits and blood draws.  You survived the egg retrieval and are still a bit sore and bloated.  You’ve anxiously awaited word from the clinic for the fertilization report the next morning. but now you’re past that. Now it is time to go to the clinic for your embryo transfer. Then it hits you, more than it has in the past, that you have to decide how many embryos you are actually going to have transferred.  You’ve thought about it before, even had discussions with your doctor, but suddenly the risk of getting pregnant with twins or triplets or not getting pregnant with a single embryo transfer seems much less of an abstract risk.  You ask yourself, “Am I making the right decision?” What is the “right” decision? What is the magic number?

The good news is that in the United States the decision of how many embryos to transfer is left to the patient and her doctor.  That’s not so in many European countries…however the costs are less in other countries.  The risks and expense of pregnancies with multiples is used as a rationale for limiting, by law, the number for embryos that may be transferred in other countries.

Since they have gotten better at IVF the number of high order multiple (HOM) pregnancies have decreased.  Before the success rate was only 15-20% so doctors would often transfer three, four or five embryos in the hopes that one would stick.  This resulted in not many getting pregnant but the ones that did had multiples.

So back to the original question….there is not one number that is right for every patient, and this should be an individualized decision.  There are guidelines however which states the greater your chance of pregnancy the fewer embryos you should have transferred.  Three main factors are: 1) age, 2) stage of embryo development, and 3) prognosis. The guidelines are strongly encouraging transferring only one embryo in those felt to have the highest chances for success.

So I wish I could be more specific in my answer but the bottom line is discuss your success rates with your Dr. and multiple pregnancy rates for that specific clinic. Sometimes it will be more clear and other times it will be more difficult.

Good luck to you all!

Source : Resolve.org Dr. Frederick Larsen

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