Expert Insight: What are the odds of multiples, IVF success over 40?

A Choice Mom of a three-year-old on the discussion board who has shared her rollercoaster ride on attempting to conceive again — with many frustrating delays — is now deciding whether to stick with two more IUIs or an IVF, and if the latter, how many embryos she should transfer, given a concern of having multiples. She also has been frustrated with her doctor care, and doesn’t feel she has a good understanding of IVF success over 40.

Here’s what she asked:

“I do need to be better educated on stats. Again, I feel my RE has failed me here. All he would tell me is that for a 40-year-old there was a 50% chance of success, and that the odds of twins were 30%. Does that mean that of the 50% who will become pregnant over half of them will have twins? I’m not sure how to interpret that. It also doesn’t tell me how many embryos were transferred per cycle to arrive at these stats. And how many were doing IVF due to male factor infertility vs. high FSH vs. poor ovarian reserve vs. whatever else.

“I now seem to have 2 options:
1. Do 1-2 more Letrozole cycles before doing IVF as a last resort. Pros: No multiples risk, less expensive (unless it doesn’t work, in which case it is no cost savings and just eats up time). Cons: there is a risk I could ovulate while the clinic is closed for Christmas. They will be closed on days 22-28 of my cycle. The last 4 cycles I have ovulated on Days 20, 18, 24, and 21. It could work, but it could go wrong. Also, a lesser chance of success.

2. Go ahead and start the pill tomorrow for IVF. Pros: best (but far from guaranteed) chance of success. Cons: ++++$$, no guaranteed success, risk of multiples.

I consulted with a few fertility doctors in our Choice Mom-friendly network. Here’s what one of them, Dr. Vasiliki Moragianni of Fertility Solutions (Boston) has suggested:

“Please allow me to clarify some of the confusion with regards to IVF success rates. You can find national U.S. statistics in this very helpful website where all clinics are required to report their success rates (and can further narrow them down based on treatment type and diagnosis).

As you can see the success rate for a 40 year-old woman is unfortunately much lower than 50%. You are correct in thinking that the risk of multiple pregnancies depends on the treatment type, as well as the number of embryos being transferred.

Whenever you feel that you have reached a challenging point in your journey — try and consider the option of taking some time off. It certainly does not have to be months, but even a few weeks or one month might help you clarify a complicated situation and figure out what the best approach is for you.

Wishing you the best of luck!

Mikki’s note: For other articles on success rates and the age factor, consider these:

The age factor with IVF

Comparing IVF and IUI

Success rates over 40 

Moving to IVF after 40: personal stories

2012 ASRM research

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