Outcomes: Chances of Pregnancy
The cause of your fertility problem will determine which treatment program you embark on. The type of program affects your chances of pregnancy, as do a number of other factors, such as, the woman’s age and, if IVF occurs, the quality and number of the embryos replaced. On average our pregnancy rates range from 20-40% per treatment cycle, unless a woman is above the age of 37 years, when they are lower.
This pregnancy rate might not seem very high, but it is important to remember that as a race, humans are not particularly fertile, and it appears to be the ability of our embryos to hatch out and become an ongoing pregnancy that limits our fertility. A couple with no fertility problems who have intercourse at the time of ovulation, still only have a 15-20% chance of having a recognisable pregnancy each month. It appears that up to double that number might conceive, but the embryo never implants or does so for such a short time that the woman doesn’t recognise she is pregnant. Unfortunately, until science is able to counteract this problem, the pregnancy rates we achieve with any form of fertility treatment will be less than we would like.
We include a regular review process in our treatment programs, so that if a treatment cycle is not successful, we assess if we need to modify your next treatment cycle to improve your chances of success. If a pregnancy has not occurred after 2 to 4 treatment cycles we will have a formal consultation with you to discuss future options.
Light bleeding or spotting occurs in up to 50% of pregnancies and should not cause undue concern, unless associated with increasing abdominal pain and bright red blood loss. If that is happening, call us and we will arrange a blood test and/or earlier scan, depending upon the stage of your pregnancy. If you’re not sure what is happening, just call. While these are very anxious times, try to occupy yourself positively. Bed rest is not usually indicated, however, we suggest that you do whatever you feel comfortable with, and this can include going to work. Don’t underestimate the emotional impact that a threatened pregnancy loss will have. You may both need support people at this time who understand and who are available. The team will be here for you.
Other pregnancy side effects and the transition to antenatal care are discussed in the information we give you when your pregnancy is diagnosed
Approximately 1 in 5 of all pregnancies will miscarry, and unfortunately, pregnancies that result from fertility treatments are not exempt. Often, these early fetal losses are associated with some abnormal development of the fetus.
The loss rate is related to a woman’s age, her weight and past obstetric and medical history. Unfortunately, as a woman’s age and weight increase so does her risk of miscarriage. A woman who is aged 25 years or less has a 1 in 7 chance of a miscarriage. A woman who is aged above 40 years has a 1 in 2.5 chance of a miscarriage. If a woman is 20% or more above her ideal body weight, she also has an increased risk of miscarriage. A very early miscarriage, under 7 weeks gestation, does not necessarily require a uterine curettage (D&C), but you should contact Fertility First, your obstetrician or general practitioner for advice.
Sometimes the pregnancy appears to be going well, but when you have your pregnancy scan at 6 to 7 weeks (4 to 5 weeks after treatment), we see that the embryo has stopped growing and there is no heart beat. This is called a ‘missed abortion’. Sometimes we see a gestational sac inside the uterus but no embryo. This is called a ‘blighted ovum’. If an ultrasound had not detected the loss at this time, you would eventually miscarry. At this stage of the pregnancy, a D&C is required.
Pregnancy loss is an extremely difficult time, and we would strongly urge you to see what coping strategies our counsellor can help you both with.
Congenital Abnormalities (Birth Defects)
In Australasia, we have the best records of ART pregnancies in the world. All treatment cycles and their outcomes are reported to the National Perinatal Statistics Unit and an annual report is produced. The reports are anonymous so that your confidentiality is maintained. It is available at Fertility First if you wish to look at it. This report indicates that the congenital abnormality rate for ART babies is 3.5%, which is consistent with that of the general population. This means that 3 to 4 children born out of every 100 will have some form of congenital abnormality.
It you have a family history of any congenital abnormalities, such as cystic fibrosis, blood disorders, neural tube defects, Down Syndrome or cardiac abnormalities, it is important to discuss them with us before proceeding with treatment. This is a standard recommendation for all couples planning to conceive and is part of pre-pregnancy counselling. We might recommend you see a clinical geneticist before you start treatment, if there is a possible risk of the two of you also having an affected child.
Long Term Issues
Follow-up and Records
The Fertility Society of Australia (FSA), in conjunction with the National Perinatal Statistics Unit, is keen to continue long term studies of children conceived following fertility treatments. Therefore, it might be that we will contact you in the future about a particular issue. This is optional and will not impact upon your confidentiality.
If you would not like to be contacted, please let us know at the ‘consent appointment’. Whether you agree to follow-up or not will have no effect whatsoever on the treatment you will receive. In addition, to allow long term follow-up for yourselves as well as us, we will keep your records, and those of any pregnancy, for a minimum of 23 years.
Cancer and Fertility Drugs
Ovarian cancer occurs in approximately 1 in 90 women in the general community. It is more common in women who have not had children and/or who have not used the oral contraceptive pill. Breast cancer occurs in 1 in 12 women, and once again is more common in women who have not had children. It is currently the most common form of death from cancer in Australian women. The various procedures, including the drugs, used in fertility treatments may have unknown long-term effects. However, from the Australian cancer registers there has NOT been any increase in breast or ovarian cancer. A study from Monash University, published in 1995, compared the outcome, in terms of cancers, between infertile women who had ART treatments, compared to those who did not. They did not find an increase in breast or ovarian cancer in the treated group. A report on the study is available at Fertility First. In addition, those women who do get pregnant then have less risk of breast and ovarian cancer than women with fertility problems in general.
The FSA is monitoring this issue and has instigated ongoing research to look for any associations between a variety of infertility conditions and long-term health risks. We fully support this work and, like other fertility units in Australia, contribute part of the fee for each ART cycle towards the Society’s running costs.
In the interim, we recommend you continue to have annual gynaecological reviews. Self breast examination on a monthly basis is recommended. If you have a family history of breast cancer, regular screening, such as an annual mammogram may indicated, depending on your age and family history.