Great expectations: patients overestimate success in IVF

Study results a reminder to set realistic estimates of outcome for both female and male partners

Embargo: 15.35 CEST Tuesday 7 July 2020

7 July 2020: Couples embarking on IVF to treat their infertility tend to overestimate their chance of success, according to a prospective study of 69 couples having at least their second treatment attempt. Such over-optimism, suggest the authors, may be a source of distress or even a reason to discontinue their IVF treatment.

The results of the study will be presented today by embryologist Johanna Devroe from the University Hospital of Leuven, Belgium, during ESHRE's online Annual Meeting.

Reports in the past have suggested that couples usually have some degree of optimism when embarking on treatment, but, says Ms Devroe, "to the best of our knowledge, the live birth rates expected by patients during their IVF cycle have yet to be studied and compared to their individual prognosis. In addition, it is not known whether these expected birth rates are affected by factors like gender and an individual's general level of optimism."

The study thus measured a couple's individual expectations about their treatment and their natural disposition to optimism according to a validated questionnaire. In addition, the study used a mathematical model to calculate each couple’s IVF prognosis by taking account of clinical and IVF laboratory factors. This allowed the study to calculate the degrees of mis-estimation for both the male and female partner of each couple.

The mean calculated prediction of live birth among the study participants was 32%, after treatments with both fresh and frozen embryo transfers. However, 85% of the female partners overestimated their chances (by 34% on average), with almost half of them expecting their birth rate to be more than double their treatment prognosis. Similarly, 88% of men overestimated their outcomes, with 54% expecting their birth rate to be more than double their calculated prognosis. When comparisons were made between the female and male partners, it was found that the men generally had significantly higher expectations than their female partners (64% vs 59%), although partners did not differ in their overall levels of optimism. Indeed, the correlation between their anticipated success rates and their general level of optimism was generally weak, suggesting that personal disposition does not fully explain the results of this study.

While this was a single-centre study and no study has as yet compared patient expectations with prognosis in this way, Ms Devroe notes that studies in several countries have all indicated that future IVF patients (and the general public) have high expectations of success shaped by the press and internet, besides their own clinics.

"Clinics do share average success rates on their websites," says Ms Devroe, "but these are often only relevant to a reference population of younger patients. And many patients do not think that average success rates apply to them. They expect greater success, thinking of their healthy lifestyle or their experienced doctors. So the message to clinics is, work on setting realistic expectations. We are now investigating this, to see if disclosing an individual's predicted success rate rather than a clinic's average success rate helps to set realistic expectations."

There is already some evidence from other researchers that unrealistic expectations do result in greater disappointment, which in turn may lead some patients to drop out of treatment. "We are currently following up the couples from our study group to correlate levels of unrealistic expectations with levels of disappointment and uptake of another IVF cycle," explains Ms Devroe.

Abstract 0-185, Tuesday 7 July 2020
The realism of men and women's expected IVF live birth rates

The reality of live birth rates in IVF
1. International, regional and national IVF registers show consistently that pregnancy rates from a single fresh IVF or ICSI treatment, though patchy and dependent on female age, have generally stabilised in recent years at about 30%, with live birth rates a little lower. Some countries, such as Spain (the leader in Europe) or the USA have somewhat higher results. Even higher rates are recorded with the transfer of embryos cultured for five or six days (blastocysts) or those thawed after freezing. Nevertheless, and despite continued developments to improve delivery rates, a single IVF cycle is unsuccessful more often than otherwise; this is why a more realistic measure of success today is "cumulative live birth rate", in which records outcome over several transfer cycles (fresh + frozen) after an initial egg collection cycle. Recent figures from the USA show a cumulative live birth rate of almost 50%
2. Dealing with the disappointments of IVF has prompted many studies, and counselling - both before and after - is a required component of treatment in most countries.

* When obtaining outside comment, journalists are requested to ensure that their contacts are aware of the embargo on this release.

For further information on the details of this press release, contact:
Christine Bauquis at ESHRE
Mobile: +32 (0)499 25 80 46
E-mail: [email protected]