Setting realistic expectations effectually IVF success is important. In this guide, IVF warrior and Natalist Founder Halle Tecco walks through the IVF funnel and the process from egg retrieval to bringing a baby home.

By IVF warrior and women's health expert Halle Tecco, MPH, MBA

IVF has come a long way since the offset IVF babe was born in 1978. 30 years ago, your chances of bringing dwelling house a baby with each IVF try was five%. Today, that number is effectually 30%. While this is an impressive improvement, the fact is, less than i in three rounds of IVF volition lead to the nascency of a infant.

I am forever indebted to the doctors and scientists who have enabled me to become a parent through this incredible procedure. Just it has not been without heartbreak—including failed retrievals (ii), failed transfers (2), and miscarriages (v).

I wrote this guide considering I wish I had understood the "IVF Funnel" when I began my journeying. When I did my first egg retrieval at 33 and got 14 mature eggs, I was so excited! Little did I know that number of eggs retrieved ≠ number of babies . In that location are many steps in between, and anyone starting the long, hard, and expensive process of IVF deserves a adept understanding of their chances of having a baby.

Step 1: Mature eggs retrieved

Research shows that in that location'due south a strong association between the number of eggs retrieved at the egg retrieval and a alive birth. Your fertility doctor will have a skilful judge of how many eggs they volition likely retrieve based on your ovarian reserve and medication protocol.

In that location's a strong association between the number of eggs retrieved at the egg retrieval and a live birth.

Your ovarian reserve is determined through baseline hormone testing at the beginning of your menstrual cycle. These hormones include Follicle Stimulating Hormone (FSH), Estradiol, and Ant-Mullerian Hormone (AMH). They will also expect at antral follicle count, which is done via an invasive ultrasound that looks at the follicles in the ovary containing an egg (pro tip: yous can BYOL— bring your ain lube —for the ultrasound probe).

An average of ten to twenty eggs are usually retrieved for IVF, simply the number can be college or lower. You would think more eggs is always improve, but that's non the example. Researchers who analyzed thousands of IVF cycles found that the magic number of eggs that lead to a live nascence is xv. That is because women who produce too many eggs may have more immature or lower quality eggs. Keep in mind that quality matters as much as quantity, and there are a lot of steps between the egg retrieval and a live birth.

Step ii: Eggs that fertilize

Okay, at present that the eggs have been retrieved, the embryologist will fertilize them with the sperm (unless they are beingness frozen as eggs to be fertilized at a later date).

The fertilization procedure takes place overnight later the insemination of the eggs with sperm. Generally , lxx to 80 percent of the eggs retrieved volition fertilize. The average may be lower if sperm or if egg quality is a known problem. Some attrition at this stage is normal and expected.

Stride three: Embryos that make it to Day v (blastocyst)

Now the fertilized eggs will develop (or not) in the lab for the next five to six days. In "natural" or "spontaneous" conception, an egg is fertilized past sperm in the fallopian tube and an embryo is formed. The embryo usually reaches the uterine cavity about five to six days later equally a blastocyst made upward of about a hundred cells. In IVF , the fertilized egg turns into an embryo, which divides and multiplies its cells in the lab over this time. A blastocyst is the final stage of embryo development before the embryo is frozen or transferred. Embryos that survive to this stage of evolution take a college implantation potential one time transferred into the uterine cavity.

Stages of embryo development

Epitome from Remembryo

According to RMA , the greatest attrition rate comes from Day 3 to Day 5-6. But 30-50% of embryos growing on Mean solar day 3 make it to the Blastocyst stage.

Stride iv: Embryos that are chromosomally normal

Near clinics today will recommend the embryos be genetically tested, especially for individuals with a history of infertility and pregnancy loss. This tin help patients avoid a transfer of an embryo that is genetically aberrant and would not lead to a healthy pregnancy effect. Other benefits of pregenetic testing include increased implantation rates, decreased miscarriage rates, and shortened time to get pregnant. The number of embryos that are genetically normal is completely dependent on the age and genetic fabric of the egg and sperm.

At 35 years of age, well-nigh l% of a woman'southward eggs are chromosomally normal . By the time a woman reaches 40, only about 10-xv% of her eggs are chromosomally normal.

Step 5: Transferred embryos that implant

One time an embryo is transferred, the nail-biting wait for a hopeful BFP (big fatty positive pregnancy examination result) begins. Some clinics ask that you wait for their blood test (β-hCG, or "beta") to exam for pregnancy instead of taking an at-home pregnancy test. I personally have never been able to look and have done home tests every time starting v days after the transfer.

It'southward helpful to ready your expectations by knowing more about the implantation rate. The "implantation rate" is the proportion of transferred embryos that implant in the uterine lining and are confirmed with a fetal heartbeat (pregnancy ultrasound).

Read When is The Earliest Yous Can Accept a Pregnancy Test During IVF?

Will my embryo implant?

At that place are many factors, including chance, that determine if an embryo will implant. Shady Grove Fertility reports that women under 35 years of age have over a 60 pct chance of pregnancy per transfer. CCRM, another clinic, shows pregnancy rates of 63-70% from frozen embryo transfers of embryos that have been genetically tested and accounted chromosomally normal. It has likewise been shown that not all doctors are equally competent at performing embryo transfers, and success rates can depend on the doctor performing the procedures.

Women under 35 years of historic period accept over a 60 percent take chances of pregnancy per IVF transfer.

In addition to genetic testing, there is a stiff correlation between blastocyst morphology and implantation. The morphology of an embryo is the shape or advent of cells in the embryo. There are a few embryo grading systems, but almost can be bucketed into "good," "off-white," and "poor."

One observational study of i,766 single embryo transfers showed that:

  • Embryos graded as "Skilful" had an implantation (pregnancy) rate of 55% and a birth charge per unit of 46.8%
  • Embryos graded as "Fair" had an implantation (pregnancy) charge per unit of 47.two% and a birth charge per unit of 39%
  • Embryos graded as "Poor" had an implantation (pregnancy) rate of 43.6% and a birth rate of 34.i%

IVF Transfer Success Rate by Embryo Quality

IVF Transfer Success Rates past Embryo Quality

Most clinics volition provide pictures of the embryo, likewise as its grading. Don't be afraid to enquire questions , similar "what are the chances an embryo of this quality will implant?" These are your potential children, and you should have as much information as you desire!

Embryo Image

Ane of my embryos that did non implant.

Step 6: IVF pregnancies that plough into alive births

The beta hCG

Nearly 10 to fourteen days after transfer, you will go back to your clinic for a blood pregnancy test (aka "beta", "beta hCG", or "β-hCG"). A beta hCG level of over 100 is mostly considered a good, positive result. But many successful pregnancies do start out with a lower beta hCG level . You'll be asked to echo the test every three days, with the goal of the number doubling.

Unfortunately, a positive pregnancy examination outcome doesn't always lead to a live nascence. One written report from 2003 establish that women who underwent IVF miscarried almost 22% of the fourth dimension. A newer study conducted in 2017 of 468 transfer cycles in i university clinic in the US found that 59% of Day-5 single-embryo transfers resulted in a pregnancy, only only 51.7% resulted in a live birth. That means that of those who got a confirmed pregnancy result, 12% miscarried.

Ane thing I wish I had known while undergoing IVF is that the beta hCG level is predictive of a live nascency.

1 thing I wish I had known while undergoing IVF is that the beta hCG level is predictive of a live nativity. One 2018 study of 177 IVF cycles showed that pregnancies with a Mean solar day thirteen beta hCG concentration under 85 mIU/mL had an 89% risk of having a first trimester loss, whereas those with a beta hCG of greater than 386 mU/mL had but a ix% chance.

The beta hCG number and miscarriage

A beta hCG level of over 100 is mostly considered a good, positive upshot. But w chapeau's more than of import than the accented beta number is if the number increases substantially over fourth dimension (it should double every 48 hours). A beta that fails to double, or one that decreases over time, nearly always indicates a failed pregnancy.

Other factors that bear on the chances of miscarriage after IVF include a high BMI, an embryo biopsy on Twenty-four hour period 6, and a high number of previous miscarriages.

Miscarriage is devastating. Read more most grief and coping . →

Empathise your chances of IVF success

The CDC has an IVF Success Estimator , which can give you lot an estimate of your chance of having a alive nascency by comparing your data to people with similar characteristics.

Your fertility physician should also be able to tell yous your chances given your medical history, test results, and their experience with similar patients. Ask them lots of questions, including the success rate at their clinic.

I've learned that IVF is office-scientific discipline, part-art, and lots of luck. That beingness said, there are factors that play into a person'due south chances of success, including:

  • Egg quality
  • Sperm quality
  • Embryo genetic quality and morphology (shape)
  • Health of the mother
  • Medication protocol
  • Reason for needing IVF
  • Having a previous successful pregnancy
  • Quality of the IVF clinic, including the fertility doctor and lab

Read How to Find the Best Fertility Clinic

IVF upshot data from real patients

I wanted to share patient data from my own experience, as well as gathered from a few friends so you could visualize the patient experience. Every funnel is different, and depends on then many factors including the reason for needing IVF, the quality of the clinic, and sheer luck. But it's interesting to see the journey some of us take taken.

Historic period : 33
 Reason for IVF : unexplained infertility
 Mature eggs retrieved : 14
 Fertilized : 13
 Solar day v : 8
 Genetically normal : four
 Transfers : 4 (1 failed transfer, 2 miscarriages)
 Live Births : one

Age : 36
 Reason for IVF : unexplained infertility
 Mature eggs retrieved : 14
 Fertilized : 14
 Day v : 9
 Genetically normal : three
 Transfers : 3 (1 failed transfer, ii miscarriages)
 Alive Births : 0

Age : 27
 Reason for IVF : PCOS
 Mature eggs retrieved : 45
 Fertilized : 32
 Day v : 12
 Genetically normal : due north/a
 Transfers : 2 (i failed transfer)
 Live Births : 1 - twins!

Age : 30
 Reason for IVF : unexplained infertility
 Mature eggs retrieved : 17
 Fertilized : 15
 Day five : four
 Genetically normal : 2
 Transfers : 2 (1 chemic pregnancy)
 Live Births : 1

Age : 32
 Reason for IVF : low AMH
 Mature eggs retrieved : 11
 Fertilized : 8
 24-hour interval 5 : viii
 Genetically normal : 4
 Transfers : 2
 Live Births : 2

Age : 25
 Reason for IVF : unexplained
 Mature eggs retrieved : 13
 Fertilized : 8
 Twenty-four hour period 5 : iii
 Genetically normal : 1
 Transfers : 1 (failed)
 Alive Births : 0

We'd love to add your data to this list! If y'all'd exist up for sharing, please fill out this quick form .

Decision

Going through IVF is challenging in so many ways. One way to better the feel is to empower yourself with knowledge and set realistic expectations. I call my mindset "cautiously optimistic." Talk to others who take gone through IVF (successfully and not). Enquire your clinic tons of questions (seriously, don't be shy). Read upward. Bring together the online communities. And stay hopeful; you've got this!

IVF can exist an amazing way to grow a family. I know—I would not be a mother today without IVF. Simply it besides comes with emotional ups and downs. If y'all desire to acquire more about fertility treatments, sign upwards for my personal IVF newsletter. 💌