The IVF Data Wars
Recently the American Society for Reproductive Medicine (ASRM) asserted that “60 percent of women who go through [fertility] treatments eventually end up with a baby.”
Those just entering the often-confusing and misleading world of assisted reproductive technology (ART) statistics, may mistakenly assume that out of 100 women randomly walking into a clinic, 60 will emerge with a baby in their arms.
Prospective patients deciding whether to invest precious time and resources toward reproductive medical services, or pursue adoption or foster care, need to understand what the ASRM’s statistic actually means and how it differs from, and is similar, to information provided by the Centers for Disease Control (CDC). That agency’s 2010 statistics found that, overall, 70 percent of cycles result in childlessness.
The two data sets are, to quote an old adage, apples and oranges. The difference between them has to do with how and what is being counted.
Analyzing data about pregnancies per cycle, a careful review of CDC statistics based on age found a 58 percent failure rate in women 35 and younger; 78 percent failure rate women 37-39; an 88 percent failure rate in women 40-42; and a 95 percent failure rate in women 43-44. The data cited by the ASRM is pulled from one study published in 2012 in the New England Journal of Medicine, “Cumulative Birth Rates with Linked Assisted Reproductive Technology (ART) Cycles.” It also confirms a 70 percent failure rate per cycle.
The study’s ‘best possible’ numbers scenario of 60 percent rests on pregnancy outcomes for 247,000 women who underwent no more than seven linked cycles over a four-year period. Approximately 25 percent of the women dropped out after the first cycle failed, and 33 percent after subsequent failed cycles. Roughly 50 percent of the women were younger than age 35—the age group consistently known to experience the highest ART success rates. Indeed, of the women in the study who were younger than 31 years of age, 63 percent experienced live birth. Among women 40 and older, there was an 81 to 93 percent failure rate––a failure rate consistent with the CDC data reported by age. Had half the study group been older than 40, the live birth outcomes would have been significantly lower.
Many women choosing fertility services never reach the IVF “cycle” phase. Some succeed with less invasive procedures while many others cannot afford to pay for multiple cycles. In addition, a ”live birth” does not necessarily mean couples bring home a healthy baby; multiple embryo transfers can often lead to premature births and expensive, prolonged stays in neonatal intensive care units.
When we think about how best to educate prospective patients/consumers, the NEJM study is important for a host of reasons. First, it confirms that those buying these services should plan for multiple cycles and all that they entail––including drug side effects, miscarriages, strained relationships, depleted bank accounts––and the debilitating grief that goes along with all of it. As someone who has run the gamut of IVF procedures without conceiving, I can attest that the psychological costs are immeasurable, while the long-term health risks remain largely unknown. Additionally, with so few insurance policies in the U.S. providing coverage for more than one or two cycles, the study’s findings reinforce the need for customers to budget anywhere from $40,000 for two cycles, all the way up to $200,000 for ten or more.
The study also verifies that older women using their own eggs experience the least success with IVF, signaling a greater demand for controversial egg donation. Infertility specialists obtain third-party eggs by injecting so-called “donors” with potent drugs that can cause serious side effects, ranging from dangerous swelling of the ovaries to infertility, stroke, and in rare cases, death.
ART services are packaged in hope, and can be very difficult to walk away from. There are serious emotional and physical risks involved––for women, their partners, donors and surrogates, and any potential offspring. This is all the more reason why those contemplating treatments should think very carefully about the notion of self protection, and determine ahead of time how many and what kind of interventions they plan to pursue before they begin.
Miriam Zoll is the author of the new memoir-expose, Cracked Open: Liberty, Fertility and the Pursuit of High-Tech Babies (Interlink-June 2013). She is a member of the boards of the global women's health and human rights organization, Our Bodies Ourselves, and Voice Male Magazine.
Previously on Biopolitical Times: