The "Magic Number Study" & How Patients Can Use It

The latest study of assisted reproductive technology to make big news is one conducted by a team of European university- and hospital-based researchers and published in the journal, Human Reproduction. In "Association between the number of eggs and live birth in IVF treatment: an analysis of 400 135 treatment cycles", researchers conclude that women who had 15 eggs retrieved during one IVF cycle were more likely to have a live birth than those with fewer or more eggs.

In a medical arena ripe with desperate-feeling patients and a primary treatment (IVF) that is effective but dependent on many variables (including some that are still a mystery to scientists and clinicians alike), most research that zeros in on a single point of success makes big news. One of its main appeals to fertility consumers: the simplification of a very complex process.

If only IVF success were as simple as making sure your patient produces the right number of eggs. Any fertility specialist knows how much more is involved in helping facilitate a conception and live birth. Patients, too, are often savvy in their knowledge of statistics and how those numbers apply to not just "real life" but to their particular infertility situation. There will always be some, however, who read the attention-grabbing headlines and fall into a trap of hope based on misunderstanding.

Importantly, the researchers are making sure media reports include an important piece of data from their study: The magic number doesn't do much for women over 40 who are using IVF.

From a Globe and Mail article on the study:

"While 15 eggs may be the perfect number, it doesn’t offset the effects of aging. In the British study, the predicted live birth rate with 15 eggs retrieved was 40 per cent for women aged 18 to 34, compared with 16 per cent for those aged 40 and over."

Dr. Sonja Kristiansen, Medical Director of Houston Fertility Center, offers a compassionate yet clarifying response to her patients who bring "exciting news" into consultations.

"Hope -- for your treatment and, more importantly, about the new life you're working hard to create -- is indeed a factor in your stress level. So I understand patients grabbing for hopeful data, but I caution them to not put all of their hope in one aspect of the IVF process."

Dr. Kristiansen adds that it's also helpful for clinicians to have a number at which to aim, but that on a per-patient basis, it's not that meaningful.

She wrote in her related Question & Answer blog, "So while it's handy to have a nice, neat number to aim at, chances are good you won't find me or my colleagues calling off your stimulated cycle because there are only 5 or 10 eggs in there -- not for that reason alone. If there are other factors at play in a cycle -- for some other reason your health is at risk -- cancelling a cycle may be the best thing to do. But never just because your ovaries didn't hit the magic number!"

Dr. Kristiansen adds that patients can add this bit of research news to their own knowledge for an idea of how tenuous conception can be, even when all the right things are being done. "Use that information to motivate yourself when necessary, to do what you can about the fertility factors you can control, like your lifestyle choices -- nutrition, weight, stress, medications, etc." But don't, she says, think all hope is gone if your ovaries don't make 15 eggs.



Study abstract:
Association between the number of eggs and live birth in IVF treatment: an analysis of 400 135 treatment cycles

Hum. Reprod. (2011)
doi: 10.1093/humrep/der106
First published online: May 10, 2011

Study Says Fresh or Frozen The Same for Donor Eggs

Promising new research says that when it comes to pregnancy success from donor eggs, frozen is as good as fresh. This represents a positive step forward in the use of egg freezing techniques that are rapidly gaining popularity.

From a Fox News article on this latest study conducted in the nation of Cyprus:

"The researchers assigned 77 infertile women who had volunteered for the study to receive either fresh or frozen eggs from a total of 36 donors. In each case, the researchers injected sperm from the father directly into the eggs. Any resulting embryos were implanted in the mother's uterus.

Overall, the researchers found no differences in the success of the sperm injections, the quality of the embryos, or the number of women who became pregnant with fresh or frozen eggs."

The promise of oocyte cryopreservation, or egg freezing, is in the amount of reproductive control it offers to women. Just as the advent of readily available birth control pills made it so much easier to plan pregnancy, egg freezing allows a woman to retrieve healthy egg cells and freeze them at a time when the cells are believed to more fertile. Then when the time is right for pregnancy and a baby, the cells can be thawed and used to create embryos via IVF.

Egg freezing has so far been mostly acceptable by the American Society for Reproductive Medicine for use by cancer patients prior to chemo or radiation therapy, both of which can render a woman sterile. But the ASRM has pulled up short in regards to egg cryo's use by women in less than dire circumstances. The reason for the professional organization's reticence hasn't been for fear of harm being done by the technique; it's been because research still needs to prove that it works well.

"Even though it's a small study, their results are encouraging," says Dr. Sonja Kristiansen. The Medical Director of Houston Fertility Center says she has patients who will appreciate the day when egg banks are as commonly available as sperm banks are now.

"There are many good reasons for women to have this family-planning option accessible. I think I safely speak for all reproductive specialists by saying that everyone wants to make child-bearing a joyful, planned event. Whether you're using your own egg cells or those of a donor, it's a relief to know that your options for later conception are expanded by the use of frozen cells."

And Dr. Kristiansen adds that as soon as more studies confirm that frozen donor eggs are just as usable as fresh donor eggs, she imagines more agencies will begin "banking" eggs -- and that conceivably will result in less costly treatments, a benefit for third-party reproductive patients who now are required to bear the additional expense of compensating donors for their time and inconvenience during each cycle.

IVF Is More Likely To Succeed Beyond First Attempt (And Patients Need to Know)

A study by Australian researchers, recently published in Fertility & Sterility, says that the more treatment cycles a woman undergoes, the greater her chances of IVF success.

From the BioNews article about the study:

"Lead author Louise Stewart, researcher at the School of Population Health, stated: 'The results of this study suggest that IVF has the potential to be more effective if women, especially those over 35, are able to undertake more than the usual two to three cycles'."

(She's referring to the number of cycles recommended in the U.K. by their National Institute for Health and Clinical Excellence guidelines.)

Another interesting result of the study, which retrospectively analyzed Western Australia's IVF success rates from 1993 to 2002, is the number of women who went on to get pregnant without IVF and have a child after stopping IVF treatment -- 21% of 20-somethings and 11% in their early 40's.

Asked by Reuters to comment, University of California's Dr. Mitchell Rosen is quoted as saying that the study results are "pretty obvious" and points out that even so, success odds decrease with each cycle over time. He adds that eventually, "the psychological side effects and the cost" will stand in the way of continuing IVF for some patients.

Sonja Kristiansen, Medical Director of Houston Fertility Center, adds, "Studies like this are helpful in demonstrating the illusive nature of IVF rates for both success and risks. It's important to educate patients about the tremendous gray areas of medicine, even with full access to the highest state-of-the-art technology and facilities. Much of practicing medicine is dependent on the art of communication with patients."

Dr. Kristiansen believes that new fertility patients can be educated about the risks and chances for success of IVF so that their expectations about fertility treatment outcomes are based on the realities of reproductive medicine. "With reasonable expectations for fertility treatment, patients will feel more secure about choosing among available options to help them get pregnant successfully."

The Grief of Infertility

It's common to connect grief to traumatic life events.

But many fertility patients don't think of grieving as part of their treatment.

Dr. Sonja Kristiansen remarks, "Even pro-active patients who are enthusiastic about treatment are experiencing loss. And with loss comes grieving."

She says virtually every infertility patient experiences losing the dream of how they thought it would be to get pregnant and have a baby.

"I've had patients come to me and say, 'Dr. Kristiansen, I'm finding it hard to stay positive about our fertility treatment.' And they worry about the impact of stress on their results."

She says acknowledging the losses of infertility is an important first step to getting through the grief.

"It doesn't mean you're being pessimistic. Optimism requires starting exactly where you are in order to move toward resolution. No need to wallow in it, but if you find yourself doing so, be forgiving. Seek help. It's here."

The staff of Houston Fertility Center, under the direction of Sonja Kristiansen, refers patients to specially-trained and experienced support resources for help with coping.

Online articles related to grieving and infertility:

"Infertility: I Wish Someone Would Have Told Me"
by Ryan Jacobson

How to Grieve Infertility Losses
By FaithAllen on eHow

You can find out more about Sonja Kristiansen on the Houston Fertility Center website.