In my line of work, we spend a lot of time going over the concept of risk versus reward/return. I decided that I would carry this over into infertility and the world of ART. I'd like to take this illustration for the benefit of those in the midst of deciding what step to take or are fretting over the success of the path they choose.
Many of us who are part of the ALI world get caught up in the cases where things did not work out successfully and we immediately think the worst is going to happen to us too. But, there are no absolutes. And many times we just end up being more exposed to those that have had a bumpier journey than those that have had everything work out. You don't really see someone who although may have technically been in the category of infertile have everything work out the first time starting an infertility blog. But, they do exist. For something to have a 50% chance of success that means that with two people one person who succeeds has a rate of 100% whereas the other person is at 0%.
In my case, I have been caught up in the thought that even after 3 IVF attempts (the number I am limited to under my insurance) I will still end up with three BFN's. Why? Because I've seen so many woman who have gone through greater than 3 attempts and with no pregnancy. And I think how things haven't worked out for me so far in the last 8 years of TTC what makes me think this will be different? In addition, I like many others pondered the question of why should I continue with a course like IUI when it has such a limited success rate vs. IVF? I now think I have a few items that may help with this decision making process.
First we will illustrate odds with a little game. The Flip-A-Coin to Make a Baby Game. What I'm going to do is show you what 50% odds look like. This represents the odds in the case of IVF. *Why 50%? Woman less than age 38 have a 45-50% chance of success. What I did was flip a coin 100 times. Which remember has odds of 50/50 as well. If it landed heads it equaled a baby, if it were tails it was no baby. I did this 100 times so that way we had a statistically valid sample. The 100 attempts represents 100 different woman like me who have three shots at IVF.
I broke the 100 participants into 4 groups. Each group ended up with four kinds of results:
First attempt: In Yellow
Second attempt: In Teal
Third attempt: In Pink
No baby after Three: In Grey
Click here to view the full experiment results.
I know there's a major commitment here in reviewing my results but seriously take a look at it. You could take a look at a few things. For one thing you might be thinking..."Man -Group Two - they had a 92% success rate they rocked...-Group Four- had an 84% success rate...they sucked." BUT, if you factor in the first and second shots - Group Four ended up with almost the same number of babies, 19 to Group Two's 20.
If I have just completely lost you then just look at the bottom line to my mad scientifically unscientific skills. Even though any given ONE shot only ever had a 50% chance of a baby...when you factor in three attempts it jumps the odds up to 86%! The highest chance was on the first attempt at 48%!
Which if any one has ever taken a look at the "odds of success" of IVF it is plus or minus a few points, right in line with my experiment. I'm not trying to minimize the difficulty of IVF, or gloss over the ones who ended up with no baby by any means. There were 14 woman out of the 100 who ended up with three BFN's. It was really tough on those 14 woman. What I'm trying to do is help those of us who think we are facing an absolute impossibility to realize that there really were 86 woman for whom it did work. By golly, they do exist! Does this make anybody besides me feel better? I really hope so.
What about if you are like me and have currently undergone two IUI's and you are wondering why continue the course? Or maybe this is all new to you anyway and your not sure what your treatment path should look like. Take a look at this chart. (Seriously, click on the link and look at it)
Decision Making Progress. I found it in a woman's health book (shocking! I know!). It was created by a Houston RE who has this chart on his website.
Okay, I know reading my post required may more commitment than you were prepared for, but hang in there with me a second.
It covers a lot, so let me explain. First, what it shows you is the fecundity rate (READ: Success rate) of: The Normal Fertile Couple, The Subfertile (READ: Infertile) Couple with no treatment, The Subfertile Couple + IUI/Clomid, The Subfertile Couple + IUI/Injectibles, The Subfertile Couple + IVF. Then it lists out their success rate at various month increments. It also covers the commitment level of each step. Monitoring an ovulation cycle is cheap and easy vs. IVF involves anesthesia and surgery. Lastly it covers the medical risk of multiples and medical risk of hyperstimulation requiring hospitalization with each type of scenario.
I'm telling you I love this chart.
Look at the normal fertile couple for a second. Yeah, I know we want to strangle them for their "luck" sometimes...but look - after 12 months they have a 93% chance of becoming pregnant. That's not exactly random luck is it? Or how about after 24 months at 99%? How much closer to an absolute can you get?
Now, let's look at the infertile couple doing nothing but just timed intercourse. Even though their odds of success in any given month is way less than the fertile couple, after 24 months it's 38%. That's not so shabby really. Of course the downside is that it is a lot of time, and in woman's reproductive years that is an eternity.
So, how about the IUI + Clomid couple? After four months they have a 39% chance of success with pretty minor medical cost and risk.
Moving on to IUI + Injectible couple. After four months they have a 67% chance of success. We have increased the risks a bit, but still a pretty healthy shot I would say.
Then there's the IVF couple. 90% by attempt number three.
What I also want you to notice is how much the jumps are with each month increment. As you increase your attempts at doing the say IVF...the incremental increase you are making doesn't increase as much. 1-2% jumped to 60% with the first attempt...that is HUGE. But the jump from attempt 2 to 3... not so much. What you should be asking yourself is, "Is it worth the increased risk for such a small jump in odds?"
Obviously, changing the game around with say donor gametes changes everything too. But, that's an illustration for another day.
I'm sorry for such a cumbersome post for such a trivial concept as odds. I hope this helps you to really understand the risk/reward of the ART treatment you are either considering or are currently undergoing. Good luck to you all!!!
Many of us who are part of the ALI world get caught up in the cases where things did not work out successfully and we immediately think the worst is going to happen to us too. But, there are no absolutes. And many times we just end up being more exposed to those that have had a bumpier journey than those that have had everything work out. You don't really see someone who although may have technically been in the category of infertile have everything work out the first time starting an infertility blog. But, they do exist. For something to have a 50% chance of success that means that with two people one person who succeeds has a rate of 100% whereas the other person is at 0%.
In my case, I have been caught up in the thought that even after 3 IVF attempts (the number I am limited to under my insurance) I will still end up with three BFN's. Why? Because I've seen so many woman who have gone through greater than 3 attempts and with no pregnancy. And I think how things haven't worked out for me so far in the last 8 years of TTC what makes me think this will be different? In addition, I like many others pondered the question of why should I continue with a course like IUI when it has such a limited success rate vs. IVF? I now think I have a few items that may help with this decision making process.
First we will illustrate odds with a little game. The Flip-A-Coin to Make a Baby Game. What I'm going to do is show you what 50% odds look like. This represents the odds in the case of IVF. *Why 50%? Woman less than age 38 have a 45-50% chance of success. What I did was flip a coin 100 times. Which remember has odds of 50/50 as well. If it landed heads it equaled a baby, if it were tails it was no baby. I did this 100 times so that way we had a statistically valid sample. The 100 attempts represents 100 different woman like me who have three shots at IVF.
I broke the 100 participants into 4 groups. Each group ended up with four kinds of results:
First attempt: In Yellow
Second attempt: In Teal
Third attempt: In Pink
No baby after Three: In Grey
Click here to view the full experiment results.
I know there's a major commitment here in reviewing my results but seriously take a look at it. You could take a look at a few things. For one thing you might be thinking..."Man -Group Two - they had a 92% success rate they rocked...-Group Four- had an 84% success rate...they sucked." BUT, if you factor in the first and second shots - Group Four ended up with almost the same number of babies, 19 to Group Two's 20.
If I have just completely lost you then just look at the bottom line to my mad scientifically unscientific skills. Even though any given ONE shot only ever had a 50% chance of a baby...when you factor in three attempts it jumps the odds up to 86%! The highest chance was on the first attempt at 48%!
Which if any one has ever taken a look at the "odds of success" of IVF it is plus or minus a few points, right in line with my experiment. I'm not trying to minimize the difficulty of IVF, or gloss over the ones who ended up with no baby by any means. There were 14 woman out of the 100 who ended up with three BFN's. It was really tough on those 14 woman. What I'm trying to do is help those of us who think we are facing an absolute impossibility to realize that there really were 86 woman for whom it did work. By golly, they do exist! Does this make anybody besides me feel better? I really hope so.
What about if you are like me and have currently undergone two IUI's and you are wondering why continue the course? Or maybe this is all new to you anyway and your not sure what your treatment path should look like. Take a look at this chart. (Seriously, click on the link and look at it)
Decision Making Progress. I found it in a woman's health book (shocking! I know!). It was created by a Houston RE who has this chart on his website.
Okay, I know reading my post required may more commitment than you were prepared for, but hang in there with me a second.
It covers a lot, so let me explain. First, what it shows you is the fecundity rate (READ: Success rate) of: The Normal Fertile Couple, The Subfertile (READ: Infertile) Couple with no treatment, The Subfertile Couple + IUI/Clomid, The Subfertile Couple + IUI/Injectibles, The Subfertile Couple + IVF. Then it lists out their success rate at various month increments. It also covers the commitment level of each step. Monitoring an ovulation cycle is cheap and easy vs. IVF involves anesthesia and surgery. Lastly it covers the medical risk of multiples and medical risk of hyperstimulation requiring hospitalization with each type of scenario.
I'm telling you I love this chart.
Look at the normal fertile couple for a second. Yeah, I know we want to strangle them for their "luck" sometimes...but look - after 12 months they have a 93% chance of becoming pregnant. That's not exactly random luck is it? Or how about after 24 months at 99%? How much closer to an absolute can you get?
Now, let's look at the infertile couple doing nothing but just timed intercourse. Even though their odds of success in any given month is way less than the fertile couple, after 24 months it's 38%. That's not so shabby really. Of course the downside is that it is a lot of time, and in woman's reproductive years that is an eternity.
So, how about the IUI + Clomid couple? After four months they have a 39% chance of success with pretty minor medical cost and risk.
Moving on to IUI + Injectible couple. After four months they have a 67% chance of success. We have increased the risks a bit, but still a pretty healthy shot I would say.
Then there's the IVF couple. 90% by attempt number three.
What I also want you to notice is how much the jumps are with each month increment. As you increase your attempts at doing the say IVF...the incremental increase you are making doesn't increase as much. 1-2% jumped to 60% with the first attempt...that is HUGE. But the jump from attempt 2 to 3... not so much. What you should be asking yourself is, "Is it worth the increased risk for such a small jump in odds?"
Obviously, changing the game around with say donor gametes changes everything too. But, that's an illustration for another day.
I'm sorry for such a cumbersome post for such a trivial concept as odds. I hope this helps you to really understand the risk/reward of the ART treatment you are either considering or are currently undergoing. Good luck to you all!!!
I have to believe my odds are stellar. Otherwise, I am sunk!
ReplyDeleteVery cool. There is nothing like seeing the odds laid out in black and white (or should I say yellow, teal, and pink).
ReplyDeleteThis is awesome! I gone through 5 failed IUI's and have been struggling with the decision to move forward with IVF because I fear it will just result in another BFN. It may have been a long post was but it was so helpful and worth the time to read it. Thank you for taking the time to write this.
ReplyDeleteI think this was a great post. I prefer facts and stats to anecdotal quips that plaster the internets. Thanks for going to the trouble to reason all that out. The odds are heartening, but, yes the odds don't go up very much once you get so far out there and that is kinda disheartening. Hey, but at least you've got some ins coverage. That makes it a little easier to stick it out.
ReplyDeleteThis was very cool! Especially since I'm still on IUI + clomid and no one seems to have any statistics on that anywhere. It's actually a bit lower than I thought, which is depressing. Still, thanks for all this careful explanation and experimentation!
ReplyDeleteI was thinking about this post from whole different angle. I hope you dont mind if I still comment :) I was thinking about how I am not far into my pregnancy and I fear miscarriage sooo much. The truth is only God knows how things will turn out but I must trust that he has my best interests at heart. Thanks for showing me something that you probably didnt even intend to. I will continue to pray for you Liv. I cant wait until I get to see your BFP post.
ReplyDeleteGirl, you're all about the numbers!!!! You and my RE would make a great team together! I'm trying to weigh the 'numbers' about what my next steps will be. Honestly, the better the 'stats' are, the scarier I think the things will get for me. I'm a hope-a-phobe I guess.
ReplyDeleteHow awesome that IVF covers three chances for you! That's certainly somethiing to celebrate. My insurance covers nothing, and I don't qualify for the shared risk programs...so that means we may get one shot and one shot only with IVF...and those odds aren't not as good as I'd like them to be.
Very cool post!
ReplyDeleteThanks for this post. I have been wondering how many tries I should do inj before we move on to IVF. I was about ready to just jump to IVF but maybe I will give it one more shot. This post was the perfect timing and actually made my day better.
ReplyDelete