Obviously, if the same couple decides to have more children at age 38, the chances won't be 25% anymore; it is likely that they are about 10%, which translates into a reduced pregnancy chance. This does not mean the couple has become infertile. Since they weren't absolutely fertile at age 32, it is only logical that their pregnancy chances at 38 are so low.
One of the biggest challenges is balancing enjoying the child you have with wondering if you'll ever get the larger family you want. "I watched my daughter take her first steps and thought, 'Maybe I'll never have this again,'"‰'' Bozinovich says. (Her problem was never pinpointed, but, happily, she went on to have two more children.) That is tough, the experts agree. "Worrying about what's happening next robs you of the pleasure of the moment," says Dr. Davidson. "It's not easy, but counseling and talking yourself through the rough moments can help you say, 'I'm doing the best I can, and meanwhile I'm living my life.'"‰"
Women who switch from IUI to IVF sooner or begin with IVF get pregnant quicker than those who stick or start with IUI. One study found that undergoing immediate IVF resulted in superior pregnancy rates with fewer treatment cycles compared to those who did two rounds of IUI before switching to IVF.  While the immediate IVF group got pregnant quicker, the overall success after up to 6 IVF cycles was similar.
Because not each IVF cycle that is started will lead to oocyte retrieval or embryo transfer, reports of live birth rates need to specify the denominator, namely IVF cycles started, IVF retrievals, or embryo transfers. The SART summarised 2008–9 success rates for US clinics for fresh embryo cycles that did not involve donor eggs and gave live birth rates by the age of the prospective mother, with a peak at 41.3% per cycle started and 47.3% per embryo transfer for patients under 35 years of age.
According to the data collected for 2014, these are the IVF success rates nationally, when using non-donor eggs, per egg retrieval. (These are not per cycle. In other words, these are the odds of a live birth after one egg retrieval, which may mean conception with fresh eggs/embryos in the cycle of the egg retrieval ​or after a frozen embryo transfer cycle in the following months.) 
Undergoing fertility treatment requires precise scheduling of frequent tests and procedures—a tricky proposition when you're a parent. "I've had to go to the doctor early in the morning three times a week for testing," says Bozinovich. "Who can you find to babysit at 7 a.m. on a weekday?" (The answer: a grandparent or, when all else fails, a nurse at the doctor's office.) Your instinct might be to keep your treatment a secret, but it can make your life easier to enlist a friend or relative to help with child care. Also, choose a doctor's office you're comfortable with. You'll be spending a lot of time there; a compassionate staff can make treatment easier.
For women, problems with fertilisation arise mainly from either structural problems in the Fallopian tube or uterus or problems releasing eggs. Infertility may be caused by blockage of the Fallopian tube due to malformations, infections such as chlamydia or scar tissue. For example, endometriosis can cause infertility with the growth of endometrial tissue in the Fallopian tubes or around the ovaries. Endometriosis is usually more common in women in their mid-twenties and older, especially when postponed childbirth has taken place.[55]
On or after the day of your retrieval, and before the embryo transfer, you'll start giving yourself progesterone supplements. Usually, the progesterone during IVF treatment is given as an intramuscular self-injection as progesterone in oil. (More shots!) Sometimes, though, progesterone supplementation can be taken as a pill, vaginal gel, or vaginal suppository.
I had a wonderful experience at CHA Fertility Clinic and got pregnant on my first cycle.  My son will turn two this year and I immediately contacted them when we were thinking of having a second child.  The doctors and staff are so kind, informative, and helpful, and they really put my mind at ease.  We had looked at other fertility clinics … Read More
Artificial insemination, including intracervical insemination and intrauterine insemination of semen. It requires that a woman ovulates, but is a relatively simple procedure, and can be used in the home for self-insemination without medical practitioner assistance.[171] The beneficiaries of artificial insemination are women who desire to give birth to their own child who may be single, women who are in a lesbian relationship or women who are in a heterosexual relationship but with a male partner who is infertile or who has a physical impairment which prevents full intercourse from taking place.
Couples experiencing infertility have a range of treatment options. Women can take fertility drugs to stimulate ovulation, or undergo certain surgeries and procedures, like intrauterine insemination, which carefully places healthy sperm in the uterus right before an egg is released to increase the chances of fertilization. Men can also take fertility medication or undergo surgery to increase the chances of conception.
Couples experiencing infertility have a range of treatment options. Women can take fertility drugs to stimulate ovulation, or undergo certain surgeries and procedures, like intrauterine insemination, which carefully places healthy sperm in the uterus right before an egg is released to increase the chances of fertilization. Men can also take fertility medication or undergo surgery to increase the chances of conception.

When transferring more than one embryo, the risk of pregnancy and newborn complications also increases.1 Among IVF babies, twins are 12 times more likely than singletons to be delivered prematurely, 16 times more likely to be underweight and 5 times more likely to suffer from respiratory complications. Among IVF mothers, mothers of twins are 2.5 times more likely to have pre-eclampsia, over 8 times more likely to have premature preterm rupture of membranes and 4 times more likely to require a Caesarean section.

In general, the cost of IVF is higher than for IUI, but IVF confers the highest pregnancy rates per cycle. It is impossible to put a precise figure on the two treatments for comparison as much will depend on your personal treatment program. You can see some ballpark figures on the website of the Society for Assisted Reproductive Technology. It also contains an overview of the differences between IUI and IVF.

Federal regulations in the United States include screening requirements and restrictions on donations, but generally do not affect sexually intimate partners.[185] However, doctors may be required to provide treatments due to nondiscrimination laws, as for example in California.[114] The US state of Tennessee proposed a bill in 2009 that would have defined donor IVF as adoption.[186] During the same session another bill proposed barring adoption from any unmarried and cohabitating couple, and activist groups stated that passing the first bill would effectively stop unmarried people from using IVF.[187][188] Neither of these bills passed.[189]


Success rates vary with the number of embryos transferred. However, transferring more and more embryos at one time does not increase the chance of live birth significantly, but may only increase the risk of a multiple pregnancy, and its associated risks. The impact of the number of embryos that are transferred also varies with the age of the woman.  
Infertility can have a profound impact on one’s mental health. When men and women find out that they can’t conceive, they may experience the same painful emotions as anyone coping with grief or profound loss. Common reactions include shock, frustration, grief, anger, decreased self-esteem, anxiety, and depression, but feelings about infertility can vary greatly depending on the source of the problems. Men, in particular, find it far easier to deal with a partner’s infertility than with their own.
Once the medications take their effect, your doctor will use a transvaginal ultrasound to guide a needle through the back wall of your vagina, up to your ovaries. She will then use the needle to aspirate the follicle, or gently suck the fluid and oocyte from the follicle into the needle. There is one oocyte per follicle. These oocytes will be transferred to the embryology lab for fertilization.
Only 30 percent of patients who receive 100 mg of Clomiphene a day will produce more than three follicles. Patients that produce less than than three follicles have about half the chance of getting pregnant than those that produce greater than three follicles. Patients that receive fertility medications but do not do an insemination have only half the success rates compared to those who do.

The likelihood of a diagnosis of unexplained infertility is increased substantially in women 35 and over - and greatly increased in women over 38. The reason for this is that there are more likely to be egg quantity and quality problems as women age. Since we do not have a "standard category" called egg factor infertility, these couples sometimes get lumped in to the "unexplained" infertility category.
Having no period means ovulation isn’t taking place at all, so a pregnancy can’t happen because no eggs is making itself eligible to be fertilized. Similarly, having irregular periods makes achieving pregnancy difficult, because it’s hard to time intercourse properly -- if sperm and egg aren’t at the same place at the same time, there is no chance of pregnancy.
Israel has the highest rate of IVF in the world, with 1657 procedures performed per million people per year. Couples without children can receive funding for IVF for up to two children. The same funding is available for women without children who will raise up to 2 children in a single parent home. IVF is available for women aged 18 to 45.[153] The Israeli Health Ministry says it spends roughly $3450 per procedure.
Women who switch from IUI to IVF sooner or begin with IVF get pregnant quicker than those who stick or start with IUI. One study found that undergoing immediate IVF resulted in superior pregnancy rates with fewer treatment cycles compared to those who did two rounds of IUI before switching to IVF.  While the immediate IVF group got pregnant quicker, the overall success after up to 6 IVF cycles was similar.
Treatment with Clomid tablets plus IUI improves fertility rates. For unexplained infertility, studies have shown that for women under 35, monthly success rates for Clomid plus insemination are about 10% per cycle. This pregnancy rate holds up for about 3 tries and the success rate is considerably lower after that. More about success rates with IUIs is on the insemination page and on the Clomid for unexplained infertility page. The insemination component boosts fertility more than the Clomid does - but success rates are higher when both are used together.
In 2006, Canadian clinics reported an average pregnancy rate of 35%.[11] A French study estimated that 66% of patients starting IVF treatment finally succeed in having a child (40% during the IVF treatment at the centre and 26% after IVF discontinuation). Achievement of having a child after IVF discontinuation was mainly due to adoption (46%) or spontaneous pregnancy (42%).[14]
Women are not always the source of a couple's infertility—in approximately one-third of cases, men may have difficulty with conception. In another third of cases, men are a contributing factor, along with female infertility and other problems. Men should be evaluated by a physician if there is a family history of infertility, if they have undergone cancer treatment, if they have small testicles, a swollen scrotum, or a low sperm count, or if they have any other testicular, prostate, or sexual problems.
Fertility is often something people do not consider until they are actively trying to start a family, or in many cases after they have started having trouble conceiving. What many don’t realize is that couples ages 29-33 with normal functioning reproductive systems only have a 20-25% chance of conceiving in any given month. Add in any number of infertility factors from either gender and those chances can decrease significantly.

How will you handle a multiple pregnancy? If more than one embryo is transferred to your uterus, IVF can result in a multiple pregnancy — which poses health risks for you and your babies. In some cases, fetal reduction can be used to help a woman deliver fewer babies with lower health risks. Pursuing fetal reduction, however, is a major decision with ethical, emotional and psychological consequences.
If IVF were to involve the fertilisation of only a single egg, or at least only the number that will be implanted, then this would not be an issue. However, this has the chance of increasing costs dramatically as only a few eggs can be attempted at a time. As a result, the couple must decide what to do with these extra embryos. Depending on their view of the embryo's humanity or the chance the couple will want to try to have another child, the couple has multiple options for dealing with these extra embryos. Couples can choose to keep them frozen, donate them to other infertile couples, thaw them, or donate them to medical research.[90] Keeping them frozen costs money, donating them does not ensure they will survive, thawing them renders them immediately unviable, and medical research results in their termination. In the realm of medical research, the couple is not necessarily told what the embryos will be used for, and as a result, some can be used in stem cell research, a field perceived to have ethical issues.
West states that the "hardest thing about secondary fertility issues is that you want a sibling for your child." Fiona, who has a son of five and has been trying to conceive a second child for two years, says she can no longer look out of the window at her son playing in the garden. "It breaks my heart. He just looks so alone out there. All I want is a sibling for him but I don't think it's going to happen."
However, the more you understand about what's coming next, the more in control you'll feel. While every clinic's protocol will be slightly different and treatments are adjusted for a couple's individual needs, here is a step-by-step breakdown of what generally takes place during in vitro fertilization, as well as information on the risks, costs, and what’s next if your IVF treatment cycle fails.
Secondary infertility is a secret club and one, I've discovered, with permanent membership. I was in a supermarket the other day and ahead of me in the cereal aisle was a woman with a boy of about nine and twin babies in the trolley. As I passed, she turned and looked at us. I saw her clocking my children and their age-gap and she saw I was doing the same with hers. We looked at each other for a moment; she smiled and I smiled back and then we walked on.

When Sarah Bozinovich and her husband, Joe, decided to start a family, they were amazed by how quickly they were on the road to parenthood. "I went off birth control in April and was pregnant in May," says Bozinovich, of Mokena, Illinois. About a year and a half after their daughter's arrival, the couple was ready to expand their family. But they'd try for more than two years and endure many medical tests and fertility treatments to have the second child they so badly wanted. Like many other parents, they struggled with secondary infertility, the inability to conceive or carry a baby to term after having one or more children. Says Bozinovich, who was 27 when her problems began, "It's so surprising because no one could tell me why I couldn't get pregnant, when I got pregnant so easily before."
In the United States, expect to spend an average of $12,400 for one cycle of IVF if you're using your own eggs and your partner's sperm. The amount you'll pay depends on how much medicine you need, where you live, and whether your state mandates insurance coverage for fertility treatments. If your insurance doesn't cover them, you'll probably have to pay the entire cost up front.
The main durations of embryo culture are until cleavage stage (day two to four after co-incubation) or the blastocyst stage (day five or six after co-incubation).[71] Embryo culture until the blastocyst stage confers a significant increase in live birth rate per embryo transfer, but also confers a decreased number of embryos available for transfer and embryo cryopreservation, so the cumulative clinical pregnancy rates are increased with cleavage stage transfer.[30] Transfer day two instead of day three after fertilisation has no differences in live birth rate.[30] There are significantly higher odds of preterm birth (odds ratio 1.3) and congenital anomalies (odds ratio 1.3) among births having from embryos cultured until the blastocyst stage compared with cleavage stage.[71]
Stay positive. Search for success stories — there are so many out there. Look within your personal network or support groups to find other women who have similar experiences with infertility. Connect with them and share your stories. Learn what they have done, what doctors they have worked with, and what contributed to their successful pregnancies.
Regardless of pregnancy result, IVF treatment is usually stressful for patients.[42] Neuroticism and the use of escapist coping strategies are associated with a higher degree of distress, while the presence of social support has a relieving effect.[42] A negative pregnancy test after IVF is associated with an increased risk for depression in women, but not with any increased risk of developing anxiety disorders.[43] Pregnancy test results do not seem to be a risk factor for depression or anxiety among men.[43]
Preimplantation genetic screening (PGS) or preimplantation genetic diagnosis (PGD) has been suggested to be able to be used in IVF to select an embryo that appears to have the greatest chances for successful pregnancy. However, a systematic review and meta-analysis of existing randomised controlled trials came to the result that there is no evidence of a beneficial effect of PGS with cleavage-stage biopsy as measured by live birth rate.[81] On the contrary, for women of advanced maternal age, PGS with cleavage-stage biopsy significantly lowers the live birth rate.[81] Technical drawbacks, such as the invasiveness of the biopsy, and non-representative samples because of mosaicism are the major underlying factors for inefficacy of PGS.[81]
Success rates for IVF also vary according to individual circumstances, with the most significant factor again being the age of the woman. At RMA, the likelihood of live birth after transfer of a single, genetically normal blastocyst is 60-65% on average. It is a legal requirement in the US for success rates of fertility clinics to be reported to the CDC. This includes live birth rates and other outcomes. The Society for Assisted Reproductive Technology also reports on these statistics. All of our RMA clinics report their results individually and you can check them in the published data. You should remember that results for different clinics are not always comparable with each other because of differences in the patient base.

Antiphospholipid syndrome (phospholipid antibody syndrome or Hughes syndrome) is an immune system disorder with symptoms that include: excessive blood clotting, miscarriages unexplained fetal death, or premature birth. In antiphospholipid syndrome, these symptoms are accompanied by the presence of antiphospholipid antibodies (cardiolipin or lupus anticoagulant antibodies) in the blood. Treatment focuses on preventing clotting by thinning the blood with the use of anticoagulants and aspirin.
Availability of IVF in England is determined by Clinical commissioning groups. The National Institute for Health and Care Excellence recommends up to 3 cycles of treatment for women under 40 years old with minimal success conceiving after 2 years of unprotected sex. Cycles will not be continued for women who are older than 40 years old.[156] CCGs in Essex, Bedfordshire and Somerset have reduced funding to one cycle, or none, and it is expected that reductions will become more widespread. Funding may be available in "exceptional circumstances" – for example if a male partner has a transmittable infection or one partner is affected by cancer treatment. According to the campaign group Fertility Fairness at the end of 2014 every CCG in England was funding at least one cycle of IVF".[157] Prices paid by the NHS in England varied between under £3,000 to more than £6,000 in 2014/5.[158] In February 2013, the cost of implementing the NICE guidelines for IVF along with other treatments for infertility was projected to be £236,000 per year per 100,000 members of the population.[159]
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