Rescripted_Dear Infertility_S6_Ep4: Audio automatically transcribed by Sonix

Rescripted_Dear Infertility_S6_Ep4: this mp3 audio file was automatically transcribed by Sonix with the best speech-to-text algorithms. This transcript may contain errors.

Kristyn Hodgdon:
Hi, I'm Kristyn Hodgdon, an IVF mom, proud fertility and women's health advocate, and co-founder of Rescripted. Welcome to Dear Infertility, the first-ever podcast that doubles as an advice column for all things fertility and women's health. This season, join me, along with Dr. Nicole Yoder, a fertility specialist at Spring Fertility in New York City as we explore what to do when you're trying to conceive and feel like nothing is working. From when to seek the help of a fertility specialist, to what questions to ask when IVF fails. We'll address all things fertility troubleshooting so you can become your own best reproductive health advocate. Now let's dive in.

Kristyn Hodgdon:
Hi everyone, and welcome back to Dear Infertility. I'm your host, Kristen, and I'm here with Dr. Nicole Yoder of Spring Fertility in New York City. Hi, Dr. Yoder.

Nicole Yoder:
Hi, everyone.

Kristyn Hodgdon:
Welcome back. Super excited today to talk about IVF success rate. What are the IVF success rates based on age? Just jumping right in.

Nicole Yoder:
Yeah.

Kristyn Hodgdon:
I think it's important to note that IVF in the media is always portrayed as 'do IVF and you'll get twins'.

Nicole Yoder:
Yeah. Yeah, that is definitely like what's advertised out there.

Kristyn Hodgdon:
Yeah. And I'm a testament over the past two years that it doesn't always work. It has really great success rates, but it doesn't always work. And I think it doesn't do it justice to the experience when it's just, oh yeah, just do IVF. Like just yeah, no big deal.

Nicole Yoder:
Oh, just do this. You'll be fine. You'll get pregnant. Yeah. It's not quite like that.

Kristyn Hodgdon:
Exactly. So yeah, I guess let's first kind of talk about like what IVF is and how it sort of aids typical human reproduction because I think that helps paint the picture of what.

Nicole Yoder:
IVF stands for in-vitro fertilization for anyone who is new to all of this. And basically, the concept of IVF is that we are going to stimulate the ovaries to produce as many eggs as we can at one time, do an egg retrieval. So take the eggs outside of the body, combine them with sperm in a lab, and then let them become embryos in that lab. So it's taking reproduction, altering it with medications, and doing a lot of it under the microscope. But you hit the nail on the head when you said, what are IVF success rates by age? That is largely the biggest determinant of success rates is the age of the person with the ovaries in a very unjust way in my opinion, but that is the reality of it. And success rates depend on primarily age but also some other factors. So ovarian reserve, endometriosis, sperm issues all of those also factor into the overall success rates. But the biggest driver of success for that first round of IVF is going to be the age of the egg.

Kristyn Hodgdon:
Okay. And when we talk about success rates, are we talking about like embryos created or are we talking about live births?

Nicole Yoder:
Usually, when you see a recorded it's going to be live births per one IVF cycle, including all of the transfers that came.

Kristyn Hodgdon:
From that cycle. Okay.

Nicole Yoder:
Yeah. And that's a good point, is that the ultimate success rate of people who do IVF can be higher than that first round. So sometimes you do multiple rounds, sometimes you do one round. You get some embryos, none of them work and you do it again. And ultimately you can be successful. But when we talk about success rates and how it's usually reported, it's by first IVF cycle and the transfers that came from that cycle.

Kristyn Hodgdon:
Okay. So under 35 what's the typical success rate per IVF cycle?

Nicole Yoder:
So 35 and under 35 typically is going to be somewhere like 50 to 55% success rate as a blanket statement. That'll depend a little bit lab to lab, person to person. But if you just look at a general number to throw out there, probably about 50 to 55% success rate, okay.

Kristyn Hodgdon:
And then what about over 35?

Nicole Yoder:
So over 35 if you're in that 35 to 37 age range going down slightly. So maybe like 45% success rate 38 to 40. Then again, another slight dip where you're looking at more around like 30% success rate. And then above 40, you're really getting into 20%, and above 42 really probably 10% or less.

Kristyn Hodgdon:
Okay. And I'm curious to know how do conditions like PCOS affect success rates. Is it on the front end of like embryo creation and quality, or is it transfer success rates?

Nicole Yoder:
So PCOS can actually when you're doing IVF. It can have some advantages in that you typically going to have more follicles, more eggs retrieved. So that gives you then the potential to have more embryos created from one cycle. So PCOS is can be very frustrating for people trying on their own certainly has implications for fertility. The silver lining of it is that usually, people are getting a higher number of eggs per IVF cycle.

Kristyn Hodgdon:
Yeah. And then is there a quality issue typically or not really.

Nicole Yoder:
That is I would say that's a rather controversial topic. Some people will say if you have like very classic, like super classic symptoms of PCOS is definitely a spectrum that there can be some quality issue just because the hormonal environment that those eggs are in is not quite normal, but would say on average, we don't see dramatic changes in egg quality due to people with. So I typically do not counsel people that. Because you have PCOS. Your eggs are not going to be as good for the most part. They do behave just as well as people without PCOS when you're doing IVF and retrieving them in the lab.

Kristyn Hodgdon:
And then what about endometriosis?

Nicole Yoder:
Well, endometriosis is a little different. Endometriosis that's a condition where people have endometrial tissue that is implanting outside of the uterus in the pelvis. So it can be on the ovaries, can be on the pelvic sidewall on the fallopian tubes. That tends to have a decrease in egg quality for reasons that we don't fully understand, but partially what we think is that it's due to this autoimmune response that's altered and just chronic inflammation in the reproductive tract. So people with endometriosis do tend to have a little bit of a decrease in egg quality. Embryo quality implantation can be an issue. So endometriosis is a diagnosis. There's some quality issues.

Kristyn Hodgdon:
Interesting. I know that it's hard to diagnose like it can take up to ten years to diagnose. Do patients often come in knowing they have endometriosis, or is it more finding it out after things haven't maybe worked out?

Nicole Yoder:
Yeah. So there's a split. Some people come in and they know they have endometriosis, and that's why they're coming into our office to begin with. But I think most people actually don't know or have not been diagnosed. When you have periods, like all you know is your period and you might just think, oh, everyone's periods are super painful, super like intolerable, but it's actually not normal, quote-unquote normal. So it's hard to know when all you experienced is your own period. So a lot of people don't even flag that as something that might be wrong, or they've mentioned it and it just hasn't been diagnosed or hasn't been fully addressed. So a lot of people don't know before they come in. They've been trying for a while and we do a scan maybe, and we're like, oh my gosh, it looks like you might have endometriosis. So sometimes it can be a surprise for people.

Kristyn Hodgdon:
And do you typically - does that influence the protocol for IVF at all?

Nicole Yoder:
Yeah, it certainly can influence the approach that we take. So you can use certain medications that can help decrease inflammation down, regulate the system a little bit to sort of decrease that inflammation as best we can. If we do see that the endometriosis appears to be having a lot of effects on the quality. So it is something that we like to keep in mind when we're making protocols for people.

Kristyn Hodgdon:
Okay, that makes sense. And with PCOS you would give lower doses of medication, correct?

Nicole Yoder:
Yes. Yes. Absolutely. Absolutely. So people with PCOS definitely have the potential to have a very robust response, which can lead to hyperstimulation. So we're very mindful about the dosing in those cases, keeping the doses lower, maybe monitoring a little bit more frequently to make sure things aren't escalating too quickly, and then giving certain medications for the trigger as well that help decrease that risk of hyperstimulation after the retrieval.

Kristyn Hodgdon:
Okay. I want to talk a little bit about what I guess I like to call the IVF funnel, which is.

Nicole Yoder:
Yeah.

Kristyn Hodgdon:
I think if you're counseled properly prior to an IVF cycle, you know this. But I found it out in hindsight like I just wasn't anticipating the drop off from number of eggs retrieved to number of embryos created. And I think a lot of people are blindsided by that. So can you speak to that a little bit?

Nicole Yoder:
Yeah, absolutely. It is. It's a good way to phrase it is the IVF funnel. So it starts even from the follicle count that we see at the beginning of the cycle. You know, when we come in to start a cycle we'll count the follicles. We're like great. There's going to throw out some numbers like say there's like 20 follicles. We see we're like good number to start with. Let's go. Then you go through the stimulation and you get to the egg retrieval. And maybe we retrieve 18 because not all of those are going to respond to meds. Maybe not all have a healthy egg inside. So that's your first cutoff is number that are retrieved. The next thing that you get a cut off on or how many mature eggs were there. So if we look at the maturity we know probably not all of them will be mature at the same time. So now maybe you're down to. So even before we do fertilization, you're already at some sort of cutoff. The next step is we're going to fertilize those eggs. And typically I'd say 75 to 80% are going to fertilize normally. So maybe you had 16 mature. We get 14 that fertilize. Now we're down to 14 contenders that are still going. The next thing we do is we're going to take a peek at day three, see how they're growing. And we know not all of them are going to make it to day three.

Nicole Yoder:
So maybe at day three, we have, I don't know, 1112 that are still growing, still look good. So now you started that 20. We're already down to 12. And then the number that finally make it to be an embryo. We expect that to be about 50% of the fertilized ones. So maybe you end up with eight or 6 to 8 embryos. So you've already gone from, oh we started with 20. Great. I'm going to have 20 babies to oh, maybe there's only six now. And then the final step, if you do testing to see if they're genetically normal, then you're going to get the results of which ones are normal and abnormal. And this is going to depend on your age, the age of the egg specifically. And if you are 38 it's going to be about 50-50. So now we had six embryos and now we have three normal ones. And then finally the final step of this funnel is about 65% of normal embryos will turn into a live birth. So. It's a pretty cruel funnel. There's a lot of steps that those little eggs have to get through to make it to a real live, walking, talking baby. But it's really good thing to have your expectations managed and understand that at the outset, just so that you're on the same page. And none of it comes as a huge shock.

Kristyn Hodgdon:
Yeah, no, it can be surprising, but what is sort of an indicator that egg quality might be an issue? How do you tell the difference between a normal drop off and or a normal funnel, and when there might be like a larger issue at hand?

Nicole Yoder:
Yeah. So the numbers that I just gave you are like the standard of what we expect. Now when people are getting maybe we see it initially with number of eggs retrieved is lower than we're expecting. Maybe it's maturity is lower than we expect. And then sometimes it's in the most of the time, I'd say it's in the embryo development where we see how they're developing the tips is off to like, oh, maybe there's an egg quality issue, or sometimes it can tip us off to a sperm quality issue. So there are definitely like drop-offs that we expect to have happen. But when you're falling way below, that's when we start to say, oh, maybe this is a quality issue because this is not quite meeting what we expect that standard to be.

Kristyn Hodgdon:
And how many egg retrievals does it typically take? Or what's the average to achieve a live birth? Is that in the success rates that you mentioned earlier?

Nicole Yoder:
That, again is going to go back to your age. So if you're doing IVF in your 20s very feasible that you do one egg retrieval and you get enough embryos to work with and you end up with a live birth from that and you're one and done type person. People who are in their 40s typically are doing more than one cycle on average. Some people get lucky on that first try, but a lot of times people in their 40s are doing maybe two, three, four plus egg retrievals in order to get to a healthy embryo that makes it to a live birth. Unfortunately, all goes back to that age issue again.

Kristyn Hodgdon:
Yeah, absolutely. When do you know it's time to maybe move on from your own eggs?

Nicole Yoder:
Yeah. And that is a really personal decision and really depends on what we're seeing happen, both with the egg retrieval and in the lab as well. Now sometimes you just don't get a normal embryo and you just but you make embryos, you have eggs retrieve, you make embryos, but they just haven't been chromosomally normal yet.

Kristyn Hodgdon:
Yeah.

Nicole Yoder:
In those cases, people say, okay, we'll try again. But if we're seeing a lot of repeated like patterns of maybe unexpected number of eggs retrieved, like the development is really poor. You never make embryos. Or maybe they just don't go anywhere. After a certain number of tries. You're going to start having that discussion of are we doing more harm than good by proceeding. So it's always a tricky conversation for everybody. That number is going to be a little bit different. But you are correct. There is a point where we look at the big picture and say, we're probably not doing you any favors by doing more cycles with your own eggs, and it may be time to consider moving on to donor eggs.

Kristyn Hodgdon:
Yeah, yeah. And that's the limit is different for everyone.

Nicole Yoder:
It has a lot to do with not only biology but emotionally. How do you feel like psychologically, how do you feel about like donor eggs and unfortunately like financially, all of those all of these things work into that conversation?

Kristyn Hodgdon:
Yeah. I love this question because when I was going through my egg retrieval, I had no idea how important the lab was. So how important is the fertility clinics expertise, but also the importance of the IVF lab? Because I was like, wait, my doctor doesn't actually touch my embryos. It's like all the embryos.

Nicole Yoder:
To answer your question, the lab is everything. Yeah. So I have to say that the whole clinic is important in every piece of it plays into it. But the lab, you can have the best eggs, the best doctor, the best protocol, best retrieval, everything. You'll be top-notch. If the lab cannot turn those eggs into embryos, none of that matters.

Kristyn Hodgdon:
Yeah.

Nicole Yoder:
So really, you want to make sure that the lab is solid, that the lab has good success rates that they are experiencing know what they're doing because the lab can really make or break all of these cycles.

Kristyn Hodgdon:
Yeah. I usually recommend the SART report.

Nicole Yoder:
Yeah.

Kristyn Hodgdon:
And can you tell us a little bit about that and that it has all of the information that we spoke about earlier like the success rates in each age range per cycle, correct?

Nicole Yoder:
Yeah, it does. So SART is it's SART. So society for Assisted Reproductive Technology Start is basically a good resource for patients to be able to go to look at success rates of various clinics. Not everybody participates in it, but if they do, you're able to go on the website and just generally see like how their outcomes have been and it will break it down by age range. So also good to look at those different age ranges, see how they see how they're doing. But it's just a way for people to get a little bit of a glimpse to how the lab is performing or how the overall success rates are doing. And along the same lines, your clinic should be able to answer those questions for you, too.

Kristyn Hodgdon:
Yeah.

Nicole Yoder:
If you want to know what are success rates, they should be able to tell you that, and they should be able to provide you with information about that to reassure you that the lab is doing well. They can take eggs, they can turn them into embryos, and they have good success rates.

Kristyn Hodgdon:
Absolutely. So the million-dollar question: are there any lifestyle modifications that you typically recommend to patients to help improve IVF success rates?

Nicole Yoder:
Yeah. So. Unfortunately, I don't have anything that might be like mind-blowing or any like secret sauce. It's a lot of things that you might think upfront, but the number one lifestyle modification that we know definitely has implications for outcomes is smoking.

Kristyn Hodgdon:
Yeah.

Nicole Yoder:
Fortunately, the smoking rates are not as high as they used to be, but smoking is absolutely the number one thing that we know definitely has negative outcomes on egg quality and IVF success rates. So any form of smoking, if you do it, quit. It's going to help you with your fertility and your overall health. Beyond that healthy diet. So limiting red meat I'd say two three servings or less, eating lots of healthy fruits and vegetables, but at the same time making sure they're not like fruits and vegetables that have been exposed to lots of pesticides. Washing all of those things to the best of your ability, and moderate exercise. All of these things. When you think about what's good for your fertility, you think what's good for your cardiovascular health is also good for your reproductive health. So all those things that cardio cardiologist is going to tell you, I'm going to tell you the same thing.

Kristyn Hodgdon:
Yeah. It's interesting. We've been having a lot of conversations about just the sheer amount of information on the internet and social media, and do you have patients coming to you constantly, like asking, should I do this or should I do that, or will this?

Nicole Yoder:
Yeah. And that's the tricky thing about the internet is you can literally if you Google something or you look something up, you're going to find somebody who's talking about it and saying whatever they believe about it, not necessarily backed in like data or science or anything. But there's a lot out there on the internet about things that work, things that don't work. And there are several people who are happy to sell you all sorts of supplements that definitely have not been tested, definitely are not regulated. And I do feel like a lot of them are taking advantage of kind of a vulnerable population.

Kristyn Hodgdon:
Yeah. I saw something recently that said if wellness is stressing you out, it's no longer wellness.

Nicole Yoder:
That is a very good slogan. Yes.

Kristyn Hodgdon:
Yeah. Because I was finding myself like I'm taking a break from treatments right now, but it's like then I was almost getting consumed by, oh, should I be doing this? Or should I be doing that for my fertility and for getting my period back and all of the above? Just to end on that note of sometimes less is more, right? It's like, yeah, what will?

Nicole Yoder:
You have to take care of your like, whole self. And if you're going into a rabbit hole in any aspect of it, it usually is not going to be ultimately good for you.

Kristyn Hodgdon:
Absolutely. Thank you so much, Dr. Yoder. This episode was great and I learned so much. So until.

Nicole Yoder:
Next time.

Kristyn Hodgdon:
If this podcast means something to you, be sure to hit follow or subscribe. This helps you because you'll never miss an episode, and it helps us because you'll never miss an episode. For everything you need to know about fertility and women's health, head to rescripted.com or follow us on social @HelloRescripted.

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