A year after we
starting trying to get pregnant, we started IVF. Before our first round, the
fertility doctor wanted to prepare us for the fact that we shouldn't expect
success on the first try, that it often takes them a couple of cycles to figure
out a woman's specific issue and tailor a protocol to it.
"But how many??"
I wanted to know. When you're spending that much money, it does not feel like
there's room for experimentation. He wouldn't give me an answer, but I pressed
him. "Three or four," he finally admitted. "After that, we can reevaluate."
Turned out I got
pregnant on my first try, and he was elated. Even though the pregnancy failed—no heartbeat—the team found it encouraging, this first step toward success.
(Me? Not so much).
I spent four
cycles at that clinic, and four more at another, and it was only at yet another one that I found success on my second try. But I wish I'd known more at the
beginning how long to give it. Here's what I would advise:
1.The First Cycle Is a Trial
they've tested your hormones, taken into account your age and specific health
issues like endometriosis or short menstrual cycles, fertility is the one field
that doctors don't know much until they try. (Can you imagine a brain surgeon
saying he needs to do an exploratory surgery first?) For many patients, the
first cycle is likely a trial run. It's unfair, but no one really knows how
you'll respond to the meds, how your eggs will develop or how they'll fertilize.
2.Never Follow the Same Protocol
After my first
cycle, the doctors were like, "Well, she got pregnant the first time, so let's
do the same thing and hope for the best!" Turns out that the second time, none
of my eggs fertilized, but they hadn't done ICSI (intra-cytoplasmic sperm
injection)—a more aggressive fertilization where they insert the sperm into
the egg rather than let them meet up in the petri dish—because it wasn't
needed on the first round. Lesson: After any failed round, ask your doctor what
she or he will do differently. Change your meds? Up your dosage? Stress to them how
you don't have time or money to waste on trial cycles.
It's good to know at the start what your plan is: A year of trying? Until your money runs out? Until the doctor says so?
3. Spend Only Three Cycles at
By the second round of IVF, your clinic should have enough
information about you to tailor a proper protocol. By the third, they should be
experts on you. "It's rarely advisable to undergo more than three IVF attempts
using the same approach each time," Dr. Geofffrey Sher writes on his blog at
Sher Fertility. "The time to stop trying is when there is no remediable
explanation for repeated failure to achieve a viable pregnancy."
4.But Is There Really a Number?
speaking, for a healthy woman under 40 with good ovarian reserve and a partner
with viable sperm, there's a 70% chance of having a baby through IVF with three
cycles. (For women over 40, it's half that.) But a number of studies have
suggested that over a certain number, about 6-7, the odds do not improve, and
Of course, there
are exceptions to every rule: Once an underlying cause is found for
infertility, or for failure of a healthy embryo to implant, you start the count
Dr. Sher tells a
story of a woman who had undergone 22 failed IVF cycles—but then he found a
reason for it, and the next cycle (her first with him), she had a baby.
IVF is not only a numbers game. There are other factors to take into
consideration aside from success rates—resources. How much time, money and
effort do you want to put into this? Sometimes, a couple has to stop because
their money runs out; sometimes they have to consider other options because the
emotional toll is too great.
It's good to know at the start what your plan is: A year trying? Until your
money runs out? Until the doctor says so?
These considerations are best discussed at the beginning—even though you
may change your mind along the way, at least you have a plan.