The Reality Gap: What Women Need to Know About IVF Success Rates

Jennifer Chen was 30 when she first froze her eggs. Like many women of her generation, she viewed egg freezing as an insurance policy — a way to preserve her fertility while pursuing her career, waiting for the right partner, or simply not yet ready for motherhood.

"My doctor told me I had retrieved five eggs, and I remember feeling relieved," said Ms. Chen, now 41. "Nobody explained what that actually meant in terms of my chances for a baby later."

What Ms. Chen didn't understand then — and what fertility clinics often fail to clearly communicate — is the stark mathematics of reproductive technology: the significant attrition rate at each stage of the in vitro fertilization (IVF) process, and how dramatically those numbers worsen with age.

Today, after seven rounds of IVF and tens of thousands of dollars spent, Ms. Chen has produced just one euploid embryo (chromosomally normal and suitable for transfer) — and even that one was a "day-7" embryo, which carries a lower chance of resulting in a live birth than those that develop more quickly.

"I wish someone had shown me the real numbers," she said. "I would have made different choices."

The Numbers No One Talks About

While fertility clinics often advertise their success rates, these statistics can be misleading. Many clinics highlight the number of eggs retrieved or even fertilization rates, but rarely do they explain the full "funnel" — how many eggs actually result in a baby.

Dr. Elena Martinson, a reproductive endocrinologist at Columbia University Fertility Center, sees this information gap routinely in her practice.

"We're doing women a disservice by not being transparent about the numbers," Dr. Martinson said. "The average woman undergoes three rounds of IVF before either succeeding or stopping treatment, according to data from the Society for Assisted Reproductive Technology (SART) registry. That's not what most patients expect when they start."

The attrition begins immediately after egg retrieval and continues at each stage:

1. Not all retrieved eggs are mature enough to be fertilized

2. Not all mature eggs successfully fertilize when exposed to sperm

3. Not all fertilized eggs develop into blastocysts (day 5-6 embryos)

4. Not all blastocysts are chromosomally normal (euploid)

5. Not all euploid embryos successfully implant when transferred

6. Not all implanted embryos result in live births

Each of these drop-offs becomes more pronounced with age.

The Age Factor: A Statistical Breakdown

For women considering egg freezing or IVF, understanding age-specific statistics is crucial. Here's what the science tells us about expected outcomes at different ages:

Success rate for each age group

Ages 30-34

• Eggs retrieved: 15-25 eggs on average

• Mature eggs: 80-85% (~12-21 mature eggs)

• Fertilization rate: 70-80% (~8-17 fertilized eggs)

• Blastocyst rate: 40-55% (~3-9 blastocysts)

• Euploid rate: 60-70% (~2-6 euploid blastocysts)

• Live birth rate per euploid transfer: 65-70%

• Estimated retrievals needed: Often 1-2 cycles for a live birth

Ages 35-37

• Eggs retrieved: 12-18 eggs on average

• Mature eggs: 75-80% (~9-14 mature eggs)

• Fertilization rate: 65-75% (~6-11 fertilized eggs)

• Blastocyst rate: 40-45% (~2-5 blastocysts)

• Euploid rate: 50-60% (~1-3 euploid blastocysts)

• Live birth rate per euploid transfer: 60-65%

• Estimated retrievals needed: Generally 2-3 cycles for a live birth

Ages 38-40

• Eggs retrieved: 8-12 eggs on average

• Mature eggs: 70-75% (~6-9 mature eggs)

• Fertilization rate: 60-70% (~4-6 fertilized eggs)

• Blastocyst rate: 30-40% (~1-2 blastocysts)

• Euploid rate: 30-40% (~0.3-0.8 euploid blastocysts per cycle)

• Live birth rate per euploid transfer: 55-60%

• Estimated retrievals needed: Approximately 3-5 cycles for a live birth

Ages 41-42

• Eggs retrieved: 6-10 eggs on average

• Mature eggs: 65-75% (~4-7.5 mature eggs)

• Fertilization rate: 55-65% (~2-5 fertilized eggs)

• Blastocyst rate: 25-35% (~0.5-1.8 blastocysts)

• Euploid rate: 15-25% (~0.1-0.45 euploid blastocysts per cycle)

• Live birth rate per euploid transfer: 45-55%

• Estimated retrievals needed: Approximately 5-15 cycles for a live birth

Ages 43 and older

• Eggs retrieved: 3-8 eggs on average

• Mature eggs: 60-70% (~2-5.6 mature eggs)

• Fertilization rate: 50-60% (~1-3.4 fertilized eggs)

• Blastocyst rate: 15-25% (~0.15-0.85 blastocysts)

• Euploid rate: 5-15% (~0.01-0.13 euploid blastocysts per cycle)

• Live birth rate per euploid transfer: 35-45%

• Estimated retrievals needed: May require 15+ cycles for a reasonable chance

Ms. Chen's experience illustrates these statistics all too well. When she thawed her eggs which were retrieved at age 30, only two made it to day-3 embryos. They were transferred immediately rather than cultured to the blastocyst stage because there were so few.

"When that didn't work, I tried again at 35," she said. "I had 16 eggs retrieved, but only 9 were mature. And none — not a single one — made it to blastocyst stage. Now I have to do it all over again at age 40."

Why Egg Freezing Is Not a Reliable Insurance Policy

Dr. Margaret Reynolds, an embryologist at NYU Langone Fertility Center, cautions against viewing egg freezing as a guaranteed backup plan.

"The problem is that you can't assess egg quality until you try to fertilize them and grow them to blastocyst stage," Dr. Reynolds explained. "And even then, you need genetic testing to determine if they're chromosomally normal."

This is precisely why fertility specialists are increasingly recommending women freeze embryos rather than eggs when possible. Embryos provide more information about potential success rates and survive the freezing process better than eggs.

For Ms. Chen, the revelation came too late. "If I had known that five eggs at age 30 translated to almost no chance of a baby, I would have frozen more eggs then, or maybe even created embryos," she said.

The Financial and Emotional Costs

The financial burden of multiple IVF cycles is substantial. Each cycle can cost $12,000 to $25,000, with additional costs for medication, genetic testing, and frozen storage. Most insurance plans cover limited or no fertility treatments.

Equally significant is the emotional toll. Rebecca Willetts, a fertility counselor in Boston, notes that many women experience profound grief and loss with each failed cycle.

"There's this sense of moving the goalposts," Ms. Willetts said. "First, you're excited about the number of eggs retrieved. Then you're anxious about how many fertilize. Then you're devastated when they don't make it to blastocyst or aren't chromosomally normal. It's a rollercoaster that can go on for years."

Ms. Chen knows this rollercoaster intimately. "I've been through seven rounds now since age 39," she said. "I keep going because I know statistically, I might need 10 or more cycles to have a reasonable chance at my age."

Questions Women Should Ask

Dr. Martinson recommends that women ask fertility clinics for age-specific data at each stage of the process:

• What percentage of retrieved eggs are typically mature for someone my age?

• What's your clinic's fertilization rate for my age group?

• What percentage develop to blastocyst stage?

• What's the euploid rate for my age group at your clinic?

• What's the live birth rate per transfer of euploid embryos?

• How many cycles do women my age typically need before achieving a live birth?

"If a clinic can't or won't provide these numbers, that's a red flag," she warned.

A Path Forward

Some fertility clinics are beginning to embrace greater transparency. Dr. James Weber, medical director at Boston IVF, has implemented what he calls "expectation-setting consultations" where patients receive detailed statistical breakdowns based on their age and diagnostic testing.

"We use calculators that show patients exactly what to expect at each stage based on our clinic's data," Dr. Weber said. "We've found that women appreciate the honesty, even when the numbers aren't what they hoped for."

For Ms. Chen, who is now using a surrogate for her one euploid embryo while continuing additional retrieval cycles, knowledge has been both painful and empowering.

"I don't want other women to go through what I did," she said. "Understanding the real numbers doesn't take away hope — it helps you make informed decisions about your future."