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How Long to Try Before IVF

How Long to Try Before IVF

Nicole Knight, AHCJ | June 15, 2021 | trying to conceive
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Countless couples and individuals struggle to get pregnant every year. When you're trying to conceive, it's natural to wonder: How long should I keep trying on my own? When should I opt for in vitro fertilization (IVF)?

Before trying IVF, it’s important to understand the facts about fertility and your treatment options. Here, we'll explain how long it generally takes to get pregnant without fertility assistance and when to enlist expert medical help. We'll share the success rates of intrauterine insemination (IUI), the health conditions that may require leapfrogging straight to IVF, and the number of IVF cycles it commonly takes to have a baby. We'll wrap by sharing a little-known fact about people with infertility and IVF.

How long does it take to conceive?

Although it's common to hear stories about couples that conceived the instant they started trying, getting pregnant for most people requires patience (1). 

Couples aged 2933 with no reproductive health issues have just a 20-25% chance of conceiving in any given cycle. After 6 months of trying to conceive, 60% of couples typically get a big fat positive (BFP) on their own, without any medical intervention (1). 

For couples who aren’t getting pregnant in these time frames, the age of both partners may be playing a role, and may influence the success of IVF as well (more on this shortly) (2).

Aging and fertility

Back in the day, the medical world believed aging only affected female fertility, but now scientists and doctors recognize the influence of age on male fertility too. Still, age remains one of the most important factors for women in terms of conceiving and bearing a healthy child, although many women can conceive naturally into their late 30s (2).

Fertility slowly declines in the 30s and falls more rapidly after age 35. Statistics suggest that a woman over age 35 will need to try twice as long to get pregnant as a woman under the age of 25 (2).

According to the American Society for Reproductive Medicine (ASRM), a healthy, fertile 30-year-old woman who's trying to conceive has a 1 in 5 chance of conception in any given cycle. So, in a group of 100 30-year-olds who are trying to get pregnant, 20 would become pregnant in one cycle, and 80 would need to try again (2). 

By age 40, the likelihood of success per cycle drops to under 5%. This means that fewer than 5 out of every 100 women who are trying in a given cycle would be expected to get pregnant that cycle (2).

But as we know, the chances of conception don't depend solely on women. Male factors are the reason for infertility in 40–50% of couples who can’t conceive. A man's likelihood of having a successful pregnancy with his partner falls 4.1% with each passing birthday, regardless of the age of the woman (3, 4).

As you can tell, age is one of several factors to weigh as you consider if and when to try IVF to conceive. Experts also offer guidance based on how long you’ve been trying and whether you or your partner have certain health conditions that may affect fertility.

How long should I try before seeing a fertility specialist?

The American College of Obstetricians and Gynecologists (ACOG) advises women under age 35 to try to get pregnant for a year before seeing a fertility specialist. For women over 35, the group suggests trying for 6 months before seeking assistance. ACOG recommends seeing a specialist right away if either partner suspects they have, or have been diagnosed with, the following conditions (5):

  • Sperm issues
  • Endometriosis
  • Uterine, tubal, or peritoneal disease
  • Oligomenorrhea (infrequent periods)
  • Amenorrhea (the absence of periods)

If you seek expert help, your provider may suggest tests to rule out health issues that interfere with conception, such as polycystic ovary syndrome (PCOS), uterine fibroids, and hormonal or metabolic imbalances. Women can expect an examination of the uterus and fallopian tubes. Men typically undergo a complete semen analysis to assess sperm production and function (5).

Pro tip: If you know that you and your partner don't have any of the above issues, make sure you're timing sex to your fertile window. Having sex 2 days before you ovulate may significantly boost your chances of getting pregnant (6).

What can I try before IVF?

If you see a specialist, expect them to make treatment recommendations based on your specific circumstances. For example, with irregular ovulation, they may suggest either clomiphene or letrozole to stimulate ovulation. Each medication usually spurs the development of 2–4 eggs per cycle. You can then time sex to ovulation at home or undergo IUI at the clinic (7). 

(For a deep dive into fertility drugs, read Kindara’s interview with a fertility expert here.)

IUI involves inserting sperm directly in the uterus near the time of ovulation. The idea is to shorten the journey to the egg to overcome fertility problems that may thwart conception, such as low sperm count or poor sperm movement. The success rate for a couple treated with medication and IUI may reach 15-20% per cycle (7).

However, research suggests the chances of getting pregnant plummet after the third IUI cycle. Expect your doctor to recommend IVF at that point (8). 

When should I start IVF?

If less-invasive fertility treatments haven’t panned out or aren’t recommended for your circumstances, it’s probably time to consider whether IVF is the right step for you and your partner. A typical IVF cycle involves stimulating a woman's ovaries to produce multiple eggs and retrieving those eggs, which are then fertilized in the lab to create embryos, and implanted. The process can be very effective, but it’s also often lengthy, costly, physically demanding, and emotionally taxing (9).

If you have insurance coverage of fertility treatment, your insurance may require you to try IUI before IVF. In certain cases, however, you may want to opt immediately for IVF. The Society for Assisted Reproductive Technology (SART) recommends going straight to IVF if you and your partner have been trying for a year and one of the following conditions is present (10):

  • Extremely low sperm count or poor motility
  • Blocked fallopian tubes 
  • Lack of ovulation
  • Advanced endometriosis
  • A partner with a history of a vasectomy
  • Few eggs and poor egg vitality
How long does it take to get pregnant with IVF?

The U.S. Centers for Disease Control and Prevention (CDC) offers a trove of national data on IVF success rates. In 2017, the most recent year available, the percentage of embryo transfers using a patient’s own egg that resulted in live births was (11):

  • 48.5%: Age 35 and under
  • 43%: Age 35–37
  • 35.8%: Age 38–40
  • 20.1%: Over age 40 

The odds of success increase with multiple cycles of IVF, according to research in the Journal of the American Medical Association. In a study group of 157,000 women of a median age of 35, almost 30% achieved pregnancy in their first IVF cycle, and by the sixth attempt, the cumulative success rate had jumped to 68% (9).

Similarly, a 2017 paper showed that women who started IVF before age 30 had a 92.8% success rate by the seventh IVF cycle. Close to 11% of women aged 40–44 had a baby in their first IVF attempt, and their chances rose to 39.9% by the eighth IVF cycle (12).

Still, when read another way, this means 60% of women aged 40-44 in the study did not have a baby after 8 IVF cycles. IVF is wonderful in that it helps people have a baby when they otherwise might not be able to, but it is expensive, stressful and invasive. Estimate your personal odds, based on age, health history, infertility issues, and so on, with this handy free tool from SART. 

How long do people wait before IVF?

Although we can infer from data that people are waiting until their 40s to pursue IVF, there's scant research delving into the reasons people delay fertility treatment. Cost, of course, is among the myriad factors to consider with IVF, especially since many U.S. insurance plans are only now beginning to cover fertility care in a meaningful way (1). 

But insurance coverage isn't always a deciding factor, as demonstrated by a study in the United Kingdom, a nation where government health insurance largely covers IUI and IVF (13). 

When researchers surveyed 15,162 British men and women, they found that 42.7% of women and nearly half of men who'd experienced infertility had not sought fertility assistance. The findings may hint at the lingering stigma that surrounds infertility and fertility assistance to this day (13). 

If you're considering IVF — or even if you're not — don't be shy about seeking the help of professionals, if that's the path that's right for you and your partner. And if you're trying to conceive without a medical leg-up, know that there's a vast, supportive community that has your back, no matter which road you choose.

References +
How Not to Waste Another Month When Trying to Conceive
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