Predicting IVF Success 101:
Univfy’s Fertility Chronicles is pleased to present an occasional blog series explaining the many fertility factors, such as age, ovarian reserve, body mass index, and others, that determine your personal probability of having a baby with IVF. Univfy IVF Prediction Tests analyze the sum total of all these factors unique to you to determine your personal probability of IVF success. We hope that explaining these factors will give you a better understanding of Univfy IVF Prediction Tests’ ability to help you and your fertility doctor make more informed and confident decisions about your fertility treatment. Welcome to the blog series, “Predicting IVF Success.”
---Mylene Yao, M.D., CEO and Co-founder, Univfy Inc
In our other blog, Your Personal Chances of IVF Success- Ovarian Reserve, we talked about how embryo quality declines with age, affecting your fertility. Often, fertility specialists refer to declining ovarian response to hormonal stimulation during fertility treatment as diminished ovarian reserve (DOR).
If you’re confused by the term diminished ovarian reserve, you are in good company. There is no standard definition of DOR for a good reason. A low ovarian response can mean poor chances of successful fertility treatment with one woman, while another woman with a similar response may have a pregnancy.
The tricky part is that ovarian reserve often correlates with success rates, but by itself is limited in predicting IVF success. It is important to understand that if you’re using ovarian reserve test results to predict IVF success, you need to put those results together with other pieces of the puzzle, to get an accurate idea of your personalized IVF success.
DOR can mean any or all of the following in the context of IVF: Decreased ovarian response to hormonal medical stimulation, resulting in few eggs, few eggs or embryos with good quality, or a combination of the above. Your doctor looks for evidence of diminished ovarian reserve if you’ve had prior treatments such as intrauterine insemination (IUI) or IVF, and/or ovarian function tests, such as serum Day 3 follicle-stimulating hormone (FSH), antimullerian hormone (AMH), and antral follicle count (AFC).
Of course, your doctor needs to know your ovarian reserve for a reason other than predicting your IVF success. He/she uses the ovarian reserve information to guide the starting dose of gonadotropins (hormonal medications to stimulate the ovaries) that your body will likely need, to produce an optimal number of eggs. Your ovarian reserve information also tells your doctor if you’re likely to need a higher dose of medications after the initial doses, or if you’re at risk for ovarian hyperstimulation syndrome (a condition in which the body responds too much, causing medical complications), in which case he/she will start you on a lower dose of medication and monitor your treatment more frequently than normal.
Anti-mullerian hormone (AMH) is a hormone produced by granulosa cells in the ovary when follicles are very small. AMH has been found to be useful for anticipating the number of eggs that can be retrieved at IVF and correlates with ovarian reserve. The test is often used to help determine the starting dose for IVF medications. Though other ovarian reserve tests, such as antral follicle count (AFC) and Day 3 FSH, are also generally useful for determining the starting dose of medications in IVF, AMH is an especially convenient indicator, because it can be tested during any part of the cycle.
AMH may have limitations as a broader predictor of fertility, though. It is unclear whether AMH can predict the probability of either natural or IVF pregnancy, for example. The scientific evidence is also unclear yet whether a low AMH result means that the pace of egg decline is occurring more rapidly than normal. It may simply mean a woman’s egg supply is naturally lower, compared to women with higher AMH levels.
Overall, unless your ovarian reserve test values are at the extreme ends of the spectrum, an ovarian reserve test by itself has only limited power to predict the chances of IVF working for you. If you are a woman with lower AMH for your age, you do not necessarily have a very low chance of pregnancy with IVF, since other fertility factors may be working in your favor to create a better fertility prognosis than expected on the basis of your AMH result alone,
The power of Univfy IVF Prediction Tests is that they can take multiple factors into account to predict more powerfully the value of IVF as a treatment for you. For instance, your ovarian reserve test results are also highly associated with the number of available eggs and embryos you produce, which by themselves can obviously impact your IVF success.
Currently, Univfy IVF Prediction Tests require one blood lab test: Your FSH hormone levels on Day 3 of your cycle (Day 3 FSH). If you have information about your antral follicle count, that can also be used in the prediction model, although antral follicle count is not required. Univfy also works with individual IVF clinics to include AMH in Univfy IVF Prediction Tests customized for those practices.
The power of the prediction tests we use is that we can analyze ovarian reserve test results such as Day 3 FSH, antral follicle count, and AMH together with other factors specific to you, to realize more fully the predictive power of each ovarian reserve test.