Factors Influencing IVF Success -
A Holistic Overview
Presented By:
Dr. Kavita Mantry ( Mundra )
Fertivision Conference, Ahmedabad.
December 6, 2024
Decoding IVF Success: Patient and Technique-Based
Predictors
Patient-Based Predictors Technique/Lab-Based
Predictors
Age Embryo Quality
BMI (Body Weight) Day of Embryo transfer
Ovarian Reserve Fresh/Freeze-thaw
Duration & Cause of Infertility
Embroys
Number of Embroys
History of Previous Pregnancy
Stimulation Protocol
Number of Oocytes
Semen Parameters
Life-style factors
Chasing Dreams, Missing Timelines : The Age Dilemma in
Motherhood
Age defines the dual trajectory of fertility decline and miscarriage risk - early
Age
Significance of Age in IVF
• Female age significantly impacts oocyte quality
and quantity, making it a key predictor of live
birth (LB), with IVF success varying nonlinearly
across age groups.
Live Birth Rate Trends
• Highest LBRs: Women aged 25–30 years.
• Decline begins at age 35; negligible success
>45 years.
• Notable studies:
⚬ Templeton et al. (highest LBR: 25–30
years).
⚬ Hughes et al. (best outcome: 26–30
years, sharp decline >34 years).
⚬ Jones et al. (peak at 30 years, decline
>35 years). Templeton et al.-1996
Shingshetty L, Cameron NJ, Mclernon DJ, Bhattacharya S. Predictors of success after in vitro fertilization. Fertil Steril.
2024;121(5):742-751.
The Clock That Can’t Be Turned Back: Age and IVF
Success
"Prioritize Parenthood Early" – Plan for a family during the optimal reproductive years, ideally
before 35.
"Preserve Fertility Proactively" – Consider fertility preservation options like egg freezing if
Weight on the scale, stake on success
BMI strongly correlates with IVF success
Optimal BMI Range:18.5–24.9 kg/m² - highest chances 32%
Model
of success. s
< 19.5 kg/m²: 33% decline in
fertility per unit decrease.
> 19.5 kg/m²: 3% decline in
fertility per unit increase.
BMI 25–29.9 BMI 30–34.9
KG/M² KG/M²
aOR aOR
0.91 (95% CI: 0.83– 0.70 (95% CI: 0.62–
0.96) 0.83)
Random Forest Analysis : BMI ranked as the 2nd most important predictive factor
Life style
The Easiest Fix We Love to Overlook !
factors
Smoking Alcohol Caffeine
Poor sleep Sedentary lifestyle High stress
patterns levels
Unbalanced diet inc
lack of exercise
seafood
esp sea fish
Olive oil and Gestational Sac (GS) Detection is positively
associated:
Urata Y et al, Front Endocrinol
Ovarian Reserve: AFC and AMH Levels
Ovarian Reserve : Size of the remaining follicular pool measured using Antral
Follicle Count (AFC) or Anti-Müllerian Hormone (AMH) levels.
AFC positively correlates with retrieved oocytes and negatively with age.
AMH predicts ovarian response to stimulation but not directly pregnancy
outcomes
Ovarian sensitivity Index = log No. of Oocytes Retrieved x 1000/totalHuber et al 2013
dose of FSH
WOMEN <35 WOMEN >39 YEARS
YEARS
AMH> 1.2 ng/ml & AFC > 10 AMH > 1.2 ng/ml & AFC > 10
PROBABILITY OF LIVE BIRTH (LB) PROBABILITY OF LB 25.2%
42%
AMH < 0.7 ng/ml & AFC < 6
AMH < 0.7 ng/ml & AFC < 6 PROBABILITY OF LB 5.9%
PROBABILITY OF LB 8.5%
Gómez et al. - Extremely low AMH does not eliminate success
potential.
Guvenir
Silva et al.
et al. 2015
- AFC Feature
> 27 weight
follicles ranking:
shows AFC:0.5498,
no added gestation
Age:0.3957, BMI:0.1534
benefits. AFC has a higher predictive value for IVF success than age or BMI
Infertility Timeline: The Clock's Ticking (But Don’t Let It
Run Out!)”
44.2%
Model
s
Highest chance of
LB within 1-3
years of
infertility.
Significant
decline after 7
years of
infertility.
The earlier you seek treatment, the better your chances. Time is not always on
your side!
Unexplained Wins the
Race?"
Unexplained infertility shows better LBRs compared to tubal disease or male
factor infertility.
• Women with unexplained infertility had a 19.7% LBR per ET, higher than tubal
disease cases (16.5%).
• UK data of 121,744 women : Higher LB odds with unexplained infertility
compared to tubal or male factors.
Cause Specific
Insight
Positive Association Negative Association
Anovulatory cycles (aOR: 1.45) Diminished ovarian reserve (aOR:
0.75)
Male factor (aOR: 1.15)
Tubal disease (OR: 0.91)
Unexplained infertility (aOR:
1.17) Male factor infertility (OR: 0.90)
Causes matter but unexplained infertility may hold an advantage
How Previous Pregnancies Boost IVF
Odds!
“Once a Winner, Always in the
Women with previous pregnanciesGame”
have higher LBRs compared
to those with no pregnancy history. 39.5%
Model
Higher LBR in women with prior pregnancies, especially those s
with IVF-induced pregnancies leading to LBs.
LIVE BIRTH
PREVIOUS
NON-IVF IVF PREGNANC PREVIOUS
LBS LBS Y LOSS LB
aOR OR OR OR
1.19 (95% CI: 1.14– 1.58 (95% CI: 1.46– 1.35 (95% CI: 1.28– 1.97 (95% CI: 1.82–
1.24) 1.71) 1.43) 2.14)
A previous live birth almost doubles the likelihood of success in future IVF
attempts (OR = 1.97 compared to no pregnancy history)
A history of prior pregnancies, regardless of outcome, significantly improves IVF
success.
Number of Oocytes Collected & IVF
Success
Positive correlation between LB and oocyte number 30.2%
UK
up to 15 oocytes. Plateaus between 15-20 oocytes, Model
Study: s
followed by a decline.
Cumulative Increased steadily with more oocytes, reaching 70%
LBR: for >25.
7-20 Oocytes: Balanced for fresh LBR.
>25 Oocytes: High cumulative LBR, but risk
of ovarian hyperstimulation
Balance is the key : Too little falls short, too much overwhelms. Aim for just right.
How Semen-inal Factors Shape IVF/ICSI
Success!" 23.2%
Sperm Motility Sperm Morphology Model
s
Significant impact on IVF
fertilization rates and LBRs. Crucial for fertilization and
Progressive motility: P = 0.012 clinical pregnancy in ICSI
cycles.
Motility after capacitation: P = P < 0.001 for LBR
0.002 prediction.
Strong predictor of IVF success
(fertilization, pregnancy, LBRs)
Motile sperm count >10 million predictive of success in IVF and ICSI
treatments
Sperm motility is important in IVF while morphology in ICSI.
Embryo Parameters and IVF
Morphological quality
Success
44.2%
Model
Day of transfer s
Number of embryos transferred
Fresh vs. frozen embryos
Grading
Higher quality embryos consistently linked to higher implantation and clinical
pregnancy rates
Hunault Model (2002): Development stage of the second-best embryo and
morphology of the best embryo transferred were strong predictors of ongoing
pregnancy.
Pre-implantation Genetic Testing: In its absence, embryos are selected based on
morphological quality
"Blastocyst vs. Cleavage-Stage Embryos: The Day of Transfer
Showdown!"
Initial studies showed higher success rates with blastocyst-stage 23.2%
Model
embryos. s
Shift in practice towards blastocyst-stage transfer due to better
Randomized trials show comparable success
outcomes.
between cleavage-stage and blastocyst-stage
embryos.
More embryos are needed in cleavage-stage
transfers to achieve similar LBRs.
While blastocysts often take the spotlight,
cleavage-stage embryos aren’t far behind—
just need a bit more backup to compete!
“Different Days Embryos, Same path, Same Destiny.”
Use of fresh/freeze-thaw embryos
Use of frozen embryos was
positively correlated with
clinical pregnancy, while
the transfer of fresh
embryos was negatively
correlated.
Partial dependence plots show the use of fresh/freeze-thaw
influences clinical pregnancy outcomes
Wang, Cheng-Wei et al. “Predicting clinical pregnancy using clinical features and machine learning algorithms in in vitro
fertilization.” PloS one vol. 17,6 e0267554. 8 Jun. 2022
Number of embryos transferred
• Positive correlation: More
embryos transferred in an IVF
cycle increase the chances of
clinical pregnancy.
• Greater effect: Transferring
one or two embryos
significantly improves
pregnancy chances.
• Limited benefit: Transferring
Partial dependence plots show the number of embryos
three or four embryos offers
transferred influences clinical pregnancy outcomes little additional advantage
compared to one or two
embryos.
Wang, Cheng-Wei et al. “Predicting clinical pregnancy using clinical features and machine learning algorithms in in vitro fertilization.” PloS one vol.
17,6 e0267554. 8 Jun. 2022
Ovarian stimulation protocol
• Ultralong and Long Protocols: Standard methods for ovarian
stimulation.
• Ultralong Protocol: Uses a GnRH antagonist, which is effective
for patients with endometriosis.
• GnRH agonist reduces the impact of endometriosis, allowing
embryo transfer in the same cycle.
• Short Protocol:
• Stimulation is quicker and does not require pretreatment.
May have a negative effect compared to long/ultralong protocols
because it skips GnRH agonist pretreatment.
Wang, Cheng-Wei et al. “Predicting clinical pregnancy using clinical features and machine learning algorithms in in vitro
fertilization.” PloS one vol. 17,6 e0267554. 8 Jun. 2022
Reaching New Heights in Fertility!
Finding: Each 1 cm increase in height boosts live birth
odds by 1.1% CI 1.002-
(OR 1.11,95%
1.021)
“Sometimes, a little height goes a
long way!”
“Remember stand tall - not just in centimeters but also in hope and
Vageter et al, Fert Steril (2017)
Treatment add-ons
high quality evidence shows this add-on is effective at improving the
treatment outcome.
not clear whether this add-on is effective because there is conflicting
moderate/high quality evidence.
insufficient moderate/high quality
evidence.
moderate/high quality evidence shows that this add-on has no effect on the
treatment outcome.
potential safety concerns and/or this add-on may reduce treatment
effectiveness.
Treatment add-
ons
• Assisted Hatching
• Immunological tests and
• Endometrial receptivity
testing
treatments for fertility • Immunological tests and
(Intralipids) treatments for fertility
• Intracytoplasmic morphologic (IVIg,Steriods)
sperm injection (IMSI) • Pre-implantation genetic
• Intrauterine culture testing for aneuploidy (PGT-
A)
• Elective freeze all cycles • Physiological
• Endometrial scratching intracytoplasmic sperm
• Hyaluronate enriched pre- injection (PICSI)
transfer culture medium (e.g. • Time-lapse imaging and
EmbryoGlue) incubation
Scientific and Clinical Advances Advisory Committee (SCAAC)
Treatment add-
Champagne Price,Soda
ons Benefits?
IVF Success: “A Recipe for Eggs-quisite
AGE MATTERS
Results!" Oocyte Count Oocyte Count
ACT EARLY TO MITIGATE AGE-RELATED Balance
FERTILITY DECLINE
Balancehigher
higherretrieval
retrievalwith
with
OHSS
OHSSrisk
risk
Timing is Key Semen
Semen& &Embryo
EmbryoQuality
Quality
Address infertility promptly; earlier Critical
Criticalfor
forhigher
highersuccess
success
intervention
rates
rates
Healthy Lifestyle: Optimal BMI Transfer
Transfer Day
Day
improves outcomes and reduces Limited
Limited impact—focus
impact—focus on on overall
overall
risks quality
quality
Not all predictors carry equal weight. Age, infertility duration, and prior
pregnancy are key game-changers, while some tests add marginal value
to success estimates
Tailored, timely, and holistic care ensures better IVF outcomes!
