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Success Rates: Truth or Fiction?

One of the most daunting challenges that I face in my everyday practice is giving reliable and realistic expectations for success of various treatments, especially in older women, or women with diminished ovarian reserve. Most of the large published reports involving treatments such as surgical correction of infertility or ovarian stimulation with intrauterine insemination studied women younger than 40 years old with normal ovarian function. It is a very dangerous practice to try and extrapolate those results to a different patient population. My opinion is that the only way a couple can make the decision for treatment is based on the honest facts as we know them. Recently, a review appeared on a popular website criticizing the approach that one of my partners had taken in counseling a woman. She said she was told at TFC that the treatment she needed was donor egg IVF, and she was expounding the virtue of a clinic in California that would allow her to try another cycle with her own eggs. What that says to me is that that clinic was very happy to take her money, regardless of her chances for success. On closer inspection, this couple had already done several IVF cycles with low egg numbers, poor embryo quality, and no pregnancy. She was also in the “poor prognosis” category based on age, so what my partner told her was actually the best (or only) way to achieve a successful pregnancy.

So why do the docs at TFC take a beating for being honest? There really is very little recourse when a negative review is posted, and it makes me really sad and frustrated to think that other readers may be misled by comments such as these. BTW, the cycle in California was also unsuccessful for this particular couple as well. Same thing goes for all those celebrity births in women in their 40’s we read about in People and Us Weekly. There never is a mention that those twins born to the 45 year old were conceived with donor egg IVF. I can tell you only one thing for sure: at TFC you will always be told the truth as we know it about your chances for success; only then can you make the right decision for treatment, based on truth not fiction!

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