How can we increase our chances of IVF success?

Dear Professor Winston,
Thanks, first of all for caring enough to do what you do. I am very impressed. My wife and I are trying to decide where to go after our recent, failed ivf attempt. All of our stats looked very good for our age (I am 45, My wife is 43), no underlying problems were identified and all went well right up until blastocyst transfer. It didn’t stick, but the positive results for our ages and our good health have given us hope for success during another cycle. Our first cycle was NHS funded at Leeds. We want to optimise our chances of course and are trawling through the statistics for various clinics. London based clinics seem to come out on top at an outrageous cost. We can only afford one shot at this due to our ages and financial reserves: Is it worth paying the price at these London clinics and will it give us a better chance of conception, all things being considered? I know the odds are low, I just want to make the best choice for another attempt. For info… Relevant Female Factors Age 43 Para 00 Regular Cycle/28 BMI 22 AMH 13.7 (category for age = good) FSH 4.6 Antral follicle count 46=10 Relevant Male Factors Normal semen analysis Thanks in advance for your help. Kind regards, P

Dear P,

You have forgotten the most crucial information of all – what is the cause of your failure to conceive?

But what I have to tell, no matter how depressing, is that if you wife is 43 her chances of conception and live birth with IVF are around 4% and roughly speaking, half of all pregnancies in this age group end in miscarriage. Yes – I do understand that the results you have sent me may be reassuring but I am afraid that the hard truth is that these will make little difference to the overall prognosis. Moreover, if you have unexplained infertility which I suspect is the problem in your case, in my view your chances of a pregnancy are as good with no treatment at all as with IVF. If it turns out that my guess about the cause of your infertility is correct, I am happy to send you some data which emphasise this point.

As for clinics in London – I am not in a position to nominate a preferred clinic because this website has to protect its strict lack of bias and a reputation for impartiality. But frankly I cannot see the slightest advantage in travelling to London. What is wrong with Leeds where they know you and have your records – a significant advantage?

Best wishes
Robert Winston