Those planning in vitro fertilization want to know how successful their attempt can be and what complications may arise on the way to a long-awaited pregnancy. Many clinics provide assisted reproductive services and claim to have “a high rate of successful protocols on the first try,” and the couple really want to believe that. Of course, “high percentages” are spoken of for advertising purposes, and this is quite understandable, because the desire to have a child is so great that common sense is sleeping at that moment. In this article, we have collected all the statistics on IVF in Russia. Compare, think, draw your own conclusions.
About figures and facts
First of all, it should be noted that statistics is a stubborn thing, of course, but experience shows that it can “bend” to the interests of those who use it. These interests are quite understandable - benefit, profit, prestige. Thus, each clinic and every reproductive center in Russia maintains its own statistics of successful and unsuccessful IVF attempts, but not every clinic will use real numbers on its website or in conversation with potential clients. In order to interest clients (and IVF is an expensive procedure), sometimes they take all-Russian figures and slightly “embellish” them, because the patient has practically no opportunity to check the veracity of the clinic.
To select the most truthful data, we did not rely on the statistics announced by individual clinics, since they cannot be considered reliable. For this article, we used data from a large-scale study of the European Center for Reproduction and Embryology, which annually prepares reports on the state and problems of reproductive techniques in the world for WHO (World Health Organization). These data are devoid of commercial motives, and therefore more trustworthy.
About the demand
The method of in vitro fertilization (IVF) has been practiced in the world for four decades. During this time, due to the method of fertilization outside the mother's body (in vitro, "invitro"), about 5 million children were born on the planet. Infertility is a much more common problem than it might seem at first glance. About 20% of couples experience some form of female, male, or mutual infertility. Most of the reasons that lead to the inability to conceive a baby can be eliminated by other methods - medication, surgery. IVF is required in about 25% of infertility cases.
Every year, Russian doctors perform about 70 thousand IVF protocols. About 18% of them are carried out according to a quota at the expense (and with the participation) of funds from regional and federal budgets (according to the compulsory medical insurance policy). Due to the fact that the IVF program in 2012 was recognized at the state level and supported both legislatively and financially, the number of children conceived in the "test tube" and born only thanks to the efforts of doctors is growing rapidly. In 2017-2018, the percentage of IVF babies among the total mass of newborn Russians and Russian women was 0.7-1.5% (depending on the region of the country).
Who does IVF and why?
Among the patients of clinics in Russia there are people of different ages, but most often women from 32 to 35 years old apply for reproductive help - almost 80% of them. The standard of living of these patients, according to the study, is above average. Affects the considerable cost of such services (by the way, according to statistics in 2018 in Russia it averages from 140 to 250 thousand rubles). Even under compulsory medical insurance, the procedure will not be completely free, the amount of additional payment can range from several thousand rubles to several hundred thousand rubles.
Among the reasons why couples are shown in vitro fertilization, there are no definite "leaders". Male factors of infertility account for about 45% of all IVF cases, and female factors - about 40%. The rest of the reasons are mutual reasons for which natural pregnancy does not occur due to a combination of factors on the part of both spouses, or the reasons have not been identified.
87% of couples are legally married, about 11% are not registered couples, but living together. About 2% of clients of reproductive workers are single women with various forms of infertility and the absence of a permanent partner, about 0.1% of patients are single men who want to raise and raise their own child, which a surrogate mother carries for them.
Among patients who first apply for IVF, the average experience of "infertility" exceeds 6-7 years. Up to 90% of patients undergo other methods of fertility treatment before IVF. Women are more worried about the results and consequences of in vitro fertilization, since only they turn to psychotherapists in clinics for support during treatment. No men have been seen at the reception yet.
Among the methods, traditional IVF prevails, in which eggs are fertilized in a laboratory Petri dish, and then, after a few days, are transferred into the woman's uterine cavity. ICSI (a method of intracytoplasmic sperm injection, in which sperm is "manually" injected into the egg) accounts for about 40% of all IVF protocols. IMSI (a method of collecting sperm for injection into an egg) is required in 89% of ICSI cases.
Pre-implantation diagnosis (at the request of patients or the urgent recommendation of a geneticist) is carried out in about 30% of IVF cases. Basically, it is relevant for "age" mothers and fathers, as well as for those who have had cases of genetic abnormalities in the family. This diagnosis allows for the selection of embryos according to the genetic principle. Only healthy embryos will be transplanted.
Successful protocols
A successful protocol is one that ends in pregnancy. Success depends on many reasons. If we consider different types of protocols, then the greatest chances of success the first time are given by IVF with hormonal stimulation - from 35 to 45% of the protocols end in pregnancy.
Natural cycle protocols without hormonal support from the first attempt are successful only in 10-11% of cases. Cryoprotocols, which use previously frozen eggs or spermatozoa, as well as cryopreserved embryos, are successful the first time in 25-27% of cases.
IVF with the use of donor material has a fairly high efficiency compared to other types - up to 47% of successful protocols. The combination of IVF + ICSI allows approximately 36% of couples to become pregnant in one attempt.
If the spouses could not get pregnant before IVF for 3 years, the chances of conception in the baseline value are about 30%. If the experience of infertility is 3-6 years, the probability decreases to 27%, and after 6 years of infertility - 24%. After a decade of unsuccessful attempts to conceive a baby, the chances of a successful protocol on the first try do not exceed 18%.
Repeated protocols are usually more successful than the first. On the second protocol, the chances of getting pregnant increase by 5%, on the third - by 8-10%, however, after 3-4 protocols the chances usually do not increase, and in some cases they begin to decrease below the baseline average value of 30%.
The largest number of successful protocols is registered if the woman is under the age of 32. After 40 years, the probability of embryo implantation after transfer decreases to 11%, and after 43 years - to 8%.
After the first unsuccessful protocol, during the rest and recovery period between the first and the second, pregnancy can occur naturally due to the experienced hormonal stimulation. This happens in 25% of cases.
The best results with which IVF has turned out are observed with obstruction of the fallopian tubes. More than 55% of women become pregnant with this diagnosis. With infertility caused by hormonal imbalance, IVF helps 45% of women become mothers. With rather serious forms of endometriosis, the percentage of successful protocols is 43%, with polycystic ovaries - 49%, with unknown reasons, pregnancy occurs in 25% of cases, male forms of childlessness are safely resolved through IVF in 49% of cases. If both spouses are infertile, IVF is successful in 20% of cases.
Complications
Deterioration of health in the process of hormone therapy is noted by about 75% of women. About half of all patients complain of weight gain and nausea. However, negative consequences and complications do not occur as often as women themselves think.
For example, ovarian hyperstimulation syndrome has been reported in 2.5% of all stimulated protocols over the past two years. Multiple pregnancies after replanting 2 embryos develops in about 40-45% of cases. When entering into the protocol, the couple must be warned about this and the patient has the right to refuse to transfer several embryos, having given consent to only one, but the likelihood of pregnancy will be reduced by about half.
The likelihood of developing endocrine diseases in a woman after giving birth to an IVF baby is 20%, as the aggressive hormonal therapy that the woman received at the stage of preparation for fertilization and embryo transfer affects.
But the probability of cancer after IVF, according to official data from the European Center for Reproduction and Embryology, does not exceed 0.00001%. Cancer can develop only when a woman already had tumor processes before IVF, they just were not diagnosed. In this case, hormones will provoke the growth of malignant cells and the disease will make itself felt some time after childbirth. Although on this issue, doctors and scientists have not yet come to a consensus.
Pregnancy and childbirth
Unfortunately, of the absolute number of women who become pregnant through IVF, only about 80% of women carry their babies before giving birth. Two out of ten pregnant women again go into the category of planning motherhood, since the pregnancy is terminated. In 90% of cases, this occurs in the early stages (up to 12 weeks), the most common reasons are miscarriage, frozen pregnancy. The likelihood of an ectopic pregnancy after IVF is low - no more than 2%. Those who are carrying twins have higher risks for triplets, especially in the second and third trimester.
In the middle and last third of pregnancy after IVF, preterm birth is considered the main threat - it ends up to 30% of pregnancies after IVF. The reasons may be different, often as complications of pregnancy there are pathologies and placenta previa, its premature aging, gestosis, polyhydramnios or oligohydramnios, and multiple pregnancy.
Only 15% of women manage to carry out pregnancy after IVF without problems and complications. The rest have certain pathologies, complications that require constant medical supervision, and sometimes intervention. Up to 85% of all term pregnancies end with a caesarean section. Not because women cannot give birth on their own. It's just that this practice has developed in Russian gynecology and obstetrics - doctors prefer not to risk the health of the mother and fetus in childbirth and pregnant "ECO-schnits" are prescribed a planned operation.
ECO children
For a long time, rumors have been cultivated in society that children conceived in a test tube are different from other children. Today, myths are gradually being debunked, since enough information has accumulated to summarize the first results of the 40-year application of the in vitro fertilization method. Thus, the statements that IVF children are infertile are not true. The first children who were born through IVF quite successfully managed to acquire their own children in a completely natural way.
Also, statements that after IVF increase the risk of having a sick child are not true. The Russian Association for Human Reproduction, within the framework of one study, studied almost 30 thousand IVF protocols, which ended in pregnancy and childbirth. It is quite clear that the percentage of children who were born with certain pathologies does not exceed those of children who were conceived naturally.
After birth, IVF children develop even ahead of the calendar terms of development. Pediatricians note that such children are less likely to get sick, in general, their health is somewhat better than that of their peers who were conceived in bed, and not in a test tube. This can be explained by a more careful selection of germ cells, monitoring of the development of a fertilized egg, and a plumb line of low-quality biomaterial.
Nevertheless, the percentage of children with congenital pathologies (about 0.02% of the total number of newborns) after IVF also has its own explanation. Artificial insemination, especially ICSI, deprives the process of conception of such an important evolutionary factor as natural selection. A spermatozoon - a carrier of a mutant gene in a natural environment, is likely to die, being outstripped by healthier “colleagues”. With ICSI, it will enter the ovum through the efforts of reproductive specialists. Therefore, the percentage of congenital diseases after ICSI is slightly higher - 0.5%.
The likelihood of having boys and girls after IVF is approximately equal. After ICSI, girls are more often born, but the difference is small - 52% of girls versus 48% of boys.
World statistics
For some reason, Russians are used to thinking that IVF is done more successfully in foreign clinics. World statistics compiled by WHO do not show such a trend, but reveals several interesting nuances:
- IN USA over the past year, many IVF babies have been born, their share in the total number of newborns is almost 1.9%. However, the effectiveness of IVF there does not exceed the Russian one - on average, it was 36% in the first attempt and 45% in the second.
- In Israelwhere there is a special attitude towards IVF (the state fully pays for attempts by infertile couples until they have two children), the effectiveness of the IVF protocol reaches 55% and this is the highest result in the world. However, the cost of the protocol, in contrast to the Russian one, is almost 2.5 times higher.
- In South Korea the number of successful protocols the first time is at the level of 39%, but only for their own. The statistics on foreign patients who come to Korea for infertility treatment and undergo IVF on the basis of local clinics is higher - almost 50%. What is the reason for this, it is difficult to say unequivocally, perhaps, with the mentality of Koreans, which can be formulated briefly: “All the best for the guest! ".
By the way, in 5% of cases, infertility, which was announced to a couple in Russia as a verdict, is not confirmed by Korean doctors. In this case, the couple is given a different treatment, which quite often helps them become pregnant naturally.
The following video shows in detail how IVF is done, broken down by medical manipulations, the timing of the procedure and an explanation of the intricacies of the assisted reproductive technologies used.
