Success in IVF is intertwined with the age of the woman, ovarian reserve, sperm quality, embryo quality, the uterine environment, lifestyle, and the personalized planning of the treatment. The first step in supporting success is a detailed evaluation of the couple in terms of both female and male factors, and establishing the treatment protocol based on this evaluation.
Among the key steps that help support success in IVF treatment are:
● Accurate and sequential diagnosis
● Personalized treatment protocol
● Proper prioritization of embryos
● Evaluation of the uterine environment
● Avoiding smoking and alcohol
● Maintaining a healthy weight range
● Working with an experienced reproductive health team
Although the success rate appears to be a single number, there are different definitions behind it. The pregnancy rate indicates that pregnancy has begun based on tests. The live birth rate shows the frequency of the treatment resulting in a live birth. The definition of a live birth is based on the baby showing signs of life after birth; it does not by itself reflect the health status of the baby or whether complications will be experienced during pregnancy. Success per transfer is the result of a single embryo transfer. Cumulative success, on the other hand, shows the total result of all embryos obtained from a single egg retrieval procedure, including fresh and frozen transfers. For a couple, the most meaningful information is often the cumulative live birth rate. Published average rates are calculated from large groups. A couple's own chance depends on their own clinical picture, not on this average. As emphasized in the current guidelines of the World Health Organization, the factor that predicts the risk of infertility most consistently is increasing female age.
Factors that can affect the success of IVF treatment are grouped under several headings.
Age is one of the most decisive factors in IVF. Current expert guidelines also state that maternal age is the strongest predictor of the outcome in couples undergoing treatment, and that the chance of natural pregnancy decreases significantly as women approach their 40s. It is not only the number of eggs that decreases with age; egg quality is also affected, and this is associated with a higher frequency of chromosomal number abnormalities, namely aneuploidy, in embryos. Aneuploidy means that there are more or fewer chromosomes in the embryo than expected. Nevertheless, the number and quality of eggs in two women of the same age can be different from each other. Age alone does not determine everything.
Ovarian reserve describes the amount of eggs remaining in the ovaries. AMH (anti-Müllerian hormone) and antral follicle count evaluate this reserve. There is a common confusion here: these tests predict the ovarian response, that is, how many eggs can respond to medications. They do not predict the pregnancy outcome on their own. Current guidelines state that the diagnosis of low reserve can primarily be based on age. Still, there are situations where the power of age to predict reserve remains limited. For example, in premature ovarian insufficiency, meaning an ovarian function that declines earlier than expected, a young woman may also have a low reserve. Therefore, age alone is not an indicator of reserve. AMH and follicle count maintain their place in individual evaluation. High reserve is also a separate topic. In high-responder patients, the risk of ovarian hyperstimulation syndrome (OHSS) may increase. This situation is taken into account from the very beginning during planning.
Embryo quality describes the appearance of the embryo under the microscope, namely its morphology. The development stage and general structure of the embryo are evaluated with specific criteria by experienced embryologists in the laboratory. This examination helps determine which embryo will be used first among them. A good appearance is a positive sign. Still, it does not guarantee pregnancy on its own, because the chromosome structure and implantation potential of the embryo cannot be definitively read from its appearance.
The male factor can contribute to the picture on its own or together with the female factor in approximately half of the couples experiencing infertility. In the initial evaluation, the reproductive history is taken and one or more sperm analyses are performed. The reproductive potential or infertility status of a man cannot be reliably read by looking at a single sperm parameter. A value being below or above the lower limit does not predict fertility on its own; parameters are evaluated as a whole. The sperm DNA damage test is not routinely applied to everyone in the initial infertility evaluation. If there are recurrent pregnancy losses, unexplained treatment failures, or specific male factor findings, it may come to the agenda through expert evaluation. How the test result will change the treatment decision is handled specifically for the patient.
Recurrent pregnancy losses or recurrent failed transfers require a separate evaluation. In unsuccessful IVF cycles or in two or more pregnancy losses, the evaluation of the male partner, and if deemed appropriate, karyotype and sperm DNA damage tests may come to the agenda. On the other hand, the sperm DNA damage test is not routinely recommended in the initial basic evaluation. This test gains meaning in specific clinical situations, not in everyone.
The first step in supporting success is to ask the right question in the right order. Before the question "Which treatment?", the question "At what stage is the pregnancy struggling?" must be clarified. In infertility evaluation, men and women are equal stakeholders. Current expert guidelines state that the initial evaluation should cover both partners simultaneously. If the male evaluation is bypassed, unnecessary and costly procedures may come to the agenda for the female partner. Tests are not requested in the same way for every patient. They are planned according to findings such as history, physical examination, and ultrasound. Progesterone measurement in the second half of the menstrual cycle to confirm ovulation; options like antral follicle count, AMH, or FSH on the 2nd-3rd day of the cycle for reserve are included in the guidelines. Comfortable and modern imaging methods are used today to examine the inside of the uterus and the tubes. The patency of the tubes is often evaluated with a medicated uterine X-ray (HSG) or a similar method performed under ultrasound guidance (HyCoSy). If there is a question mark in the uterine cavity, an ultrasound examination performed by administering saline solution or a three-dimensional ultrasound may come into play. When a polyp, a benign muscle tissue (submucosal fibroid), or an adhesion is suspected, hysteroscopy, which directly visualizes the inside of the uterus, can be added. These examinations are not a scary list of obligations, but tools used to offer you the most accurate plan. Sperm analysis is the basic examination of male reproductive health and is included as a strong recommendation in the initial evaluation. In the analysis, semen volume, sperm count and concentration, motility, and morphology are evaluated. For accurate results, the man is usually expected to come to the analysis with 3-5 days of sexual abstinence. In the first visit, the history is taken, a gynecological examination and mostly a vaginal ultrasound are performed for the woman. When coming to the appointment, menstrual dates, duration of trying to get pregnant, past surgeries, history of infections and miscarriages, and old test results, if any, should be brought. The duration of the process, potential risks, and cost headings are also clearly discussed in this meeting.
Lifestyle is one of the few controllable headings of the process. Current guidelines support offering low-cost lifestyle recommendations before and during treatment. This recommendation is based on a low certainty of evidence and does not include guarantees. Recommendations may cover nutrition, alcohol, smoking, physical activity, and weight management. Smoking stands out in this heading. Brief advice to quit for all tobacco users is a relatively strong recommendation, and smoking is associated with a higher risk of infertility. This risk may be more pronounced in women. Regarding weight, ESHRE's current ovarian stimulation recommendations state that body mass index is a factor that can predict pregnancy and live birth, while obesity is negatively associated with the live birth rate after IVF. Still, the effect of weight is not presented as a decisive threshold on its own. Regular physical activity supports general health and weight management; positive effects on semen parameters have been reported in some men. Still, it cannot be guaranteed that exercise alone will increase the pregnancy or live birth rate in IVF. Vitamins and supplements should not be used without a physician's recommendation, because the effect of every supplement is not proven.
A good embryo may find it difficult to settle into an unprepared ground. The uterine environment is the other half of the process. The endometrium, the inner lining of the uterus, is the ground where the embryo will settle. Although its thickness is a frequently used criterion, there is no single limit that can be called "above this thickness is definitive success." A very thin endometrium may be associated with a lower chance of pregnancy; still, thickness alone does not determine the outcome. Intrauterine polyps, submucosal fibroids, adhesions, and congenital anomalies can affect implantation; surgical correction may come to the agenda based on findings. The uterine environment also has a functional dimension. The short period when the endometrium is most suitable for accepting the embryo is called the implantation window. The routine use of receptivity tests is still controversial, and the necessity is evaluated on a person-by-person basis. Whether the transfer will be performed on day 3 or at the blastocyst stage, i.e., day 5, varies depending on the number and development of the embryos obtained. The number of embryos to be transferred is evaluated in terms of the risk of multiple pregnancy as much as the chance of success. Twin or more pregnancies can carry additional risks for the mother and the baby. Therefore, single embryo transfer comes to the fore in many cases. After the transfer, most patients can return to their daily lives. There is no strong evidence that overly restrictive bed rest increases the chance of pregnancy.
The way to support success at an advanced age is often to use time correctly. The time of application becomes clear according to age. Evaluation is recommended if pregnancy has not occurred despite regular and unprotected intercourse for 12 months under the age of 35, and for 6 months at age 35 and above. Over the age of 40, it is more accurate to apply directly without waiting. If there is a history of chemotherapy, pelvic surgery, or a known reproductive problem, these periods are not awaited. Treatment is established according to the woman's reserve and general picture, not according to a standard template, and is managed by monitoring the ovarian response. The genetic test that evaluates the chromosome number of embryos is not routine for every patient; whether it is required or not is decided based on age and clinical picture. The chance of success at an advanced age is discussed with real data and in a clear language. Pregnancy can never be absolutely guaranteed in any age group. On the other hand, accurate diagnosis and personalized planning are the ways to use the available chance in the best way.
Many additional applications can come to the agenda in IVF, but not all of them are suitable for every patient. The criterion is whether the application is evidence-based and really necessary for that patient. A concrete example is the fertilization method. Microinjection (ICSI) is the direct delivery of a single sperm into the egg and is valuable especially in the presence of a significant male factor in overcoming the fertilization barrier. Choosing ICSI automatically for every patient without a significant male factor is not seen as an advantage that increases success. ESHRE's current evaluations remind that even complying with a guideline does not guarantee a specific result. There is no method that absolutely guarantees success in IVF. The way that supports the chance of success with realistic hope is an accurate diagnosis, an evidence-based approach, and a personalized decision.
Talking about risks clearly while discussing success is a part of patient safety. IVF is safely applied in most patients; still, there are conditions that need to be known. OHSS is a condition that can be seen when the ovaries respond more than expected to medications. OHSS, which can occur in women with sensitive or high-responder ovaries, can now be kept under control to a very large extent thanks to today's modern medical approaches and personalized dosage adjustments we apply in our clinic. In women carrying a risk, it is a strong recommendation to prefer special medication protocols used to mature the eggs together with the Freeze-all approach, in which all embryos are frozen. Freeze-all is the freezing of embryos in that cycle and transferring them in a more suitable cycle. Egg retrieval (OPU) is a comfortable and short-term clinical procedure performed entirely under anesthesia, during which you will not feel any pain. Rarely, bleeding, infection, or ovarian torsion may be seen. These situations are rare, and the necessary precautions are taken in the clinic from the beginning. Multiple pregnancy is among the possible risks, and single embryo transfer can reduce this risk. Even if the embryo is transferred to the uterus, it can rarely settle in the tube, and this is called an ectopic pregnancy. Follow-up is also valuable after the pregnancy test is positive. Being safe at every moment of the process is our priority. In order for you to notice the unusual reactions of your body to the treatment, even if it is very rare, we recommend that you apply to the clinic or emergency room without losing time if one of the following symptoms is seen:
● Severe and increasing abdominal pain or rapid abdominal swelling ● Significant weight gain in a short time ● Shortness of breath or a significant decrease in the amount of urine ● Unstoppable or heavy vaginal bleeding ● High fever ● Severe one-sided groin pain, shoulder pain, or feeling of fainting while the pregnancy test is positive
These symptoms are not seen in every patient; the aim is to draw the safety boundary clearly. The process is not only biological; especially the waiting period after transfer can create anxiety. Psychological support can be considered as a valuable component of the treatment plan.
The first step in supporting success in IVF treatment in Izmir is not to choose a treatment directly, but to understand why pregnancy is delayed in the correct order. The first interview is a step taken together at the beginning of the process rather than a "test review" session; your history is listened to, an examination and ultrasound are performed, and a sperm analysis is planned. If deemed necessary, hormone tests, reserve evaluation, and advanced imaging are added. Personalized planning comes to life in a few concrete decisions. Choosing the medication protocol, whether the fertilization will be done with conventional IVF or microinjection, determining the day of embryo transfer, and deciding on the number of embryos to be transferred are at the forefront of these. The same path is not recommended to every patient. The plan is established according to your clinical picture. Assoc. Prof. Dr. Funda Göde evaluates each of these decisions together with you under the guidance of current scientific guidelines and centering your situation. From the first day you come to our center in Izmir, the process is planned not as a single list of procedures, but as a companionship that is by your side until the end. You can contact us to talk about your own clinical picture and to establish your process together.
It is not determined by a single factor, but rather by several factors together. A woman’s age is one of the key variables in assessing reproductive potential and treatment outcomes. However, age alone does not indicate ovarian reserve. AMH levels and antral follicle count are evaluated together, particularly to predict how the ovaries might respond to ovarian stimulation medications. Ovarian reserve, sperm parameters, embryo development, and the uterine environment are also taken into account.
Embryo quality is not a score that can be directly improved. Even a lower-grade embryo can implant. This is because morphology describes the embryo’s appearance but does not determine the outcome on its own.
It is not correct to say that it will definitely fail. Sperm findings are evaluated in conjunction with egg and embryo development. In some cases, intracytoplasmic sperm injection (ICSI) can help overcome a fertilization barrier.
If pregnancy has not occurred after 12 months for women under 35 or 6 months for women 35 and older, an evaluation is recommended. For women over 40, it is best to seek evaluation without delay. If there is a history of irregular periods, pelvic infection, ectopic pregnancy, or fallopian tube surgery, evaluation should not be delayed.
No. There is no method that guarantees success. The path to increasing the chances of success involves accurate diagnosis, an evidence-based approach, and personalized decisions.
Note: This content is for general informational purposes only and does not replace diagnosis or treatment. A physician evaluation is required for personal diagnosis and treatment planning.
