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The majority of our patients have done IVF before coming to us. When we ask them why they went for IVF, they say they did it because they couldn’t conceive naturally — usually trying anywhere from 6 months to 2 years.
The interesting thing is that very few of them had managed to figure out why they were struggling to get pregnant naturally — it was usually not their fault, as their GPs and gynaecologists told them that their best option was IVF. In our opinion, fertility clinics are by and large IVF clinics: Fertility doctors are generally not that interested in natural pregnancy unless there are obvious physical issues, such as fibroids, endometriosis and cysts; when these are found, the doctors offer surgery, followed by IVF. Giving the option of getting pregnant naturally is often not discussed.
In our experience, the majority of women who have fertility issues have no physical issues: Most of our patients who’d tried IVF were told everything seems to be fine; some are told they have unexplained infertility, which, as its name says, is not an explanation. Nearly all were told that they should do IVF.
It seems curious that patients are told that they are fine, but are still offered an IVF procedure anyway.
In our experience, the single most common reason why women have fertility issues is poor egg quality. In turn, the determining factor for poor egg quality is hormonal imbalance.
I often conduct a little thought experiment with patients to figure out why hormones are the determining factor:
Imagine you have 3 women: the first has regular periods, the second has irregular periods, and the third has no periods. Which one has better egg quality?
Patients invariably say the first has the best egg quality.
They are then asked what directly impact periods. They say hormones, and they’re right.
We therefore always ask patients which hormone tests they have had done. About half of our patients who’ve gone through and failed IVF simply answer that their doctors did the blood tests and said everything is fine, yet the doctors recommended IVF. (That is, everything is fine but you should have a procedure anyway.) Many had no idea what hormones were tested. When we see their results, we often find that some key hormones are missing (for example, FSH is tested without checking oestradiol at the same time, and testosterone is often ignored), some are done on the wrong day of the cycle (progesterone is not done 7 days before a period), and some are not interpreted correctly (especially AMH, as explained in our blog).
Given the importance of hormones and their direct impact on egg quality, it seems a little odd that doctors don’t seem to give them the rightful place they deserve in fertility issue diagnosis. With hormones ignored, patients are left with doing IVF, which essentially sidesteps the issues — but not quite.
IVF may not be the solution because the issue of poor egg quality remains.
IVF is a procedure where eggs are collected by stimulating the ovaries through hormone injections to grow eggs quickly in a short space of time so they can be collected. It is not a procedure to make the egg quality better. The egg quality before ovary stimulation remains the same during the stimulating process, assuming it doesn’t negatively affect egg quality. If a patient has poor egg quality to begin with, the problem will not be fixed through IVF.
The reason why IVF may be successful, though, is because it is a more targeted approach. In an IVF environment, a sperm will meet an egg; this may not be the case with natural pregnancy.
When patients discuss IVF success rate with us, we are constantly surprised that many routinely overestimate the success rates of IVF, usually 2 or 3 times more than they actually are.
The graph below shows IVF success rate by age.
After 40, IVF success rate is below 10%. After 44, it is below 2%.
A curious phenomenon that many patients don’t know is that, for women 46 or over, the IVF success rate using one’s own eggs is zero. Clinics in the UK are therefore told by the regulatory authority not to accept patients over 46 using their own eggs in order to stop unscrupulous clinics’ exploiting patients. Some of our patients, though, have told us some clinics still do so.
To get around this, a significant minority now go overseas. Turkey, Greece, Cyprus and Spain seem to be the preferred choices — they do not seem to have the same stringent criterion on age limit as the UK has. Some patients are under the impression that success rate overseas is higher, even though there is no evidence to support this view.
While there is an age ceiling for IVF success, there is no such ceiling for natural pregnancy — other than menopause, when a woman has very few poor-quality eggs. Although it would be difficult, it’s not impossible for women over 46 to get pregnant naturally, and some women we’ve helped have achieved precisely that. In fact, at TCM Healthcare, we have helped women up to the age of 48 have successful pregnancies.
It is important to recognise that age is not a disease. Age is associated with many conditions — dementia, cardiac issues, diabetes, stroke, hormonal imbalance to name but a few — but age itself is not a disease. The reason why it is harder for older women to achieve natural pregnancy or IVF success is because, as we get older, our hormones begin to change for the worse. In the case of women who have an intrinsic hormonal imbalance condition (such as PCOS), the condition amplifies when women get older. In other words, the problem is mainly about hormonal imbalance, which impacts egg quality more adversely.
If hormones are the culprit, rather than age, any treatment that can positively impact hormones should help with egg quality — that is exactly what we at TCM Healthcare do. This is also why we are able to help older women to achieve natural pregnancy success.
A substantial number of our patients had miscarriages before they went and did IVF unsuccessfully.
It is unclear how IVF may be beneficial to patients who have had miscarriages since they have managed to get pregnant naturally in the first place. If a woman has a miscarriage, she is clearly able to have the embryo developed, but the embryo has not stuck. When IVF doesn’t work, it usually fails at the implantation stage, rather like a miscarriage — the embryo is developed but when put in the uterus, it does not stick either.
The advantage of IVF is to guarantee a sperm meets an egg. Women who've had a miscarriage have gotten through that stage, so there is no reason to go for IVF as IVF is likely to fail at implantation too.
In our opinion, the key to dealing with miscarriages again may lie with improving egg quality. Please check our blog on
miscarriages, which is coming soon.
While we have seen that IVF does not work well with older women, it also doesn’t work well with women with low AMH.
We often have patients coming to us, worrying about their low AMH. We have to reassure them that low AMH is only a problem with IVF; it is not an issue with natural pregnancy, which is what we help patients with. This is supported by scientific evidence. I have written about this in another blog, which you can read by clicking here.
After a few failed cycles of IVF, patients are often gently eased towards using donor eggs. This is particularly the case with older women. The success rate for using donor eggs is clearly higher, but it is never over 50%.
Many women do not want to take up this option, but some are persuaded as they feel they have no other choice.
When patients approach us, we often find that the real reasons for problems with natural pregnancy and IVF failures have not been looked at, nor treated, properly. Many patients who went (unsuccessfully) for IVF, including using donor eggs, ended up getting pregnant naturally when their hormones improved. Read more from some of them in our testimonials and reviews pages. To test your egg quality, please click here.
