The 120% Illusion: When Doing More Tests Doesn’t Mean Better Results

Can you really boost your IVF success rate by doing everything before an embryo transfer? In this episode of Taco Bout Fertility Tuesday, Dr. Mark Amols breaks down one of the most common misconceptions in fertility treatment — the belief that more testing automatically means better results. From ERA and Receptiva testing to add-ons like PRP or HCG washes, Dr. Amols explains why these extra steps can’t push your chances beyond what the embryo already has — because you can’t beat the math.

Using simple numbers, national success rate data, and a memorable coin-flip analogy, he helps you understand how cumulative odds really work, when testing does make sense, and why giving “120%” isn’t possible in IVF. Whether you’re preparing for your first transfer or recovering from a failed one, this episode will help you focus on what truly improves your chances — patience, persistence, and perspective.

Thanks for tuning in to another episode of 'Taco Bout Fertility Tuesday' with Dr. Mark Amols. If you found this episode insightful, please share it with friends and family who might benefit from our discussion. Remember, your feedback is invaluable to us – leave us a review on Apple Podcasts, Spotify, or your preferred listening platform.

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Join us next Tuesday for more discussions on fertility, where we blend medical expertise with a touch of humor to make complex topics accessible and engaging. Until then, keep the conversation going and remember: understanding your fertility is a journey we're on together.

Transcript

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Today we're talking about why doing everything before your embryo transfer doesn't mean you'll get better odds. Because you can't give 120% when the max is already 100%. I'm, Dr. Mark Amels and this is Taco about Fertility Tuesday. Today we're going to dig into a common trap that so many couples fall into. The idea that if they do more testing, more supplements, more treatments before an embryo transfer, somehow they'll boost their odds beyond what's already possible. And trust me, I get it. IVF is emotional. I've been through it myself. You've invested time, money and hope. So it's easy to think if I just do one more thing, maybe this time it will work. But here's the truth. There's a limit. You can't make a, 60% embryo suddenly have an 80% chance just by adding more testing. Now we've all heard people say I give 120%. Usually in like sport movies, right before someone makes some game winning shot, we tell someone before a test, make sure you give 110%, 120%. But in real life, and especially in medicine, that's impossible. You can only give 100%. And sometimes your odds are only 100%. And this also goes for IVF. Each embryo has its own built in chance of success. If the best possible chance of live birth or transfer is, is 60%, then no combination of extra tests, biopsies or even uterine boosters is going to turn that into 120%. That's not pessimism, that's math. What I'm saying is, is that the max is 100%. And realistically no one's getting to 100% live birth rate. Now the common thought would be, well, if I do this test, my chances are better. But in reality, when you do a test, let's say like the ERA test, you're not making your chances better. Only if the ERA was off. If it was off, then your chances wouldn't be 60%, which might be the baseline chances. Instead, your chances may be more like 40%. And by doing the test, you're just getting back to that 60%. Lets break it down with some real numbers. Nationally, the live birth rate per transfer hovers around 50 to 60% depending on your age, clinic and whether the embryo has been genetically tested, let's say about 60% chance of success. When you go through that means there's still a 40% chance it won't implant or result in a Live birth. Even if everything looks perfect. So what if you do two transfers? Well, you don't add them up. Like 60 plus 60 equals 120. Instead, you multiply the chance of failure each time. That's the math behind cumulative probability. So using those same Numbers, on the first transfer, you'll have a 60% chance. On the second transfer, you'll have an 84% chance of at least having a live birth. And by the third transfer, it'd be 93.6% chance. Now, if we use 50% as the baseline rate, then your first transfer would be 50%, your second would be 75%, and your third transfer would put you at an 87.5% of a live birth. So, yes, your overall accumulated chances improves, but each individual embryo still carries the same odds. You can't beat the math. You can only give biology more chances to work. So why am I even bringing this up? Because a lot of times someone will do a transfer and they'll fail. And then they'll do some testing, such as an ERA or other testing, or add embryo glue or some type of HCG or PRP wash, and it doesn't work. And they don't understand. They say, I don't get it. I did everything. Why did it not work? And that's because their chances still didn't go above that 60%. That's the max. So everything they're doing is just getting them back to that 60%. But it never becomes 100%. And this is where people get stuck. They think if they do more tests before even their first transfer, they'll somehow stack the deck. They start ordering ERA testing or checking for endometriitis, or even doing receptiva testing, adding HCG washes or PRP washes, all before their uterus has even had its first chance to prove itself. After one or two chemical pregnancies, panic sets in. They think something must be wrong with me. But here's what I tell my if your success rate is 60%, then 40% of the time it's supposed to not work, even when everything is perfect. Even two chemical pregnancies in a row might just be the statistics playing out. Now, don't get me wrong. Tests like the ERA Receptiva and infection panels have their place. If you've had multiple failed transfers of, tested embryos, then those tests are not just useful, but make sense, too. But doing them preemptively is like taking your car to a mechanic for a brake job before your first drive. There's a time and place but not before we know what you need. Now, there is an exception to this. If you only have one embryo, let's say that's it, you probably will never get another embryo. Well, then in that situation, it may make sense to do those tests, because you're not trying to get to 100%, you're just trying to get to that 60%, which everyone else has. And since you don't have time to adjust based off of how things go, you need to do those tests first. And the way I usually tell people is think of it about how hard it is for you to get embryos if you're able to go through IVF and get a bunch of embryos. Even if you only have three embryos, I wouldn't do the testing preemptively because it's not that hard for you to get embryos. Whereas if you're someone who had to go through three cycles to just get one embryo, then it makes more sense to preemptively do some of these tests, because it's not about getting back to that 100%, but it's getting back to the 60%, because you will have the same chances as everyone else out of the gate. Think of IVF like flipping a special coin. But this coin lands on heads 60% of the time. If you flip it once and it lands on tails, that doesn't mean the coin's broken. It just means that 40% of the time, even a good coin lands tails. Now, if you keep flipping it over time, the odds start to work in your favor, but the coin doesn't change. You're not enhancing it with more tests, supplements, or uterine washes. Now, let's say there's a piece of gum stuck to the coin and that caused the weight to shift. And now the coin is not flipping 60% of the time, but now 50% of the time on hands and 50% on tails. By doing the test now, you can find out the gum was stuck to the coin, causing the weight to be adjusted. And by removing it, you get back to that 60% heads again. But when you flip it and you get tails again, you think, well, I just fixed it. Why did it not get heads? Well, because 40% of the time, it's still going to land on tails. But persistence pays off. By flipping that coin multiple times, you can reach a cumulative chance that can get close to 100% eventually, but never 100%. Now, in the end, although I can sit there and say, hey, you don't need to do these tests preemptively if it's something you need, then you need to do it. We all have certain things we have to do, but statistically you don't need to do those tests. And if you do do those tests preemptively, keep in mind you're not going to get over the statistical chances it has by itself. On the same token, if you had a failed transfer and then you do the test, the common thought is, okay, now it's going to work. But you have to remember you're only improving the chances back to that 60% chance or whatever that chance is for that embryo. Even with all the testing, it can be a bit frustrating because you feel like I did everything and it still didn't work. But it's always important to remember it doesn't work 40% of the time. The point is you can't get above, 100%, just like you can't get above the chances per that embryo. The best way to think of it is like this. When you go through IVF and now you're ready for the transfer, you can assume your statistical chances are going to be that of everyone's, let's say 60%. We're going to use it as the number. Now, if you fail and it doesn't work, your chances next time are still 60%. But let's say at that time it fails again. This can be pure chance. But at this point, you're at a point where you can say only one out of seven people wouldn't have a live birth at this point. So maybe I should check to make sure there's nothing else wrong. And that's where these other tests come in, such as the ERA checking for infections, doing the add on test that can sometimes find the problem. Now, the scary part is what if it all comes back showing it was normal? Well now you think, oh my God, my chances aren't going to be better anymore. And you're correct because you can't get better than 60%. But what it means is, is that your chances are still 60% and that's because that's what your original chances were. By not finding something doesn't mean your chances are lower, it just means those things that could have caused to be lower are not there. If you're one of those people who do have a positive result, let's say on a receptiva or an era, then it means originally your chances were probably lower than 60% because that issue was lowering the chances. And so by fixing that issue you're able to get better back to 60%. And although that sounds pretty common sense, most people don't see it that way. They look as, okay, I found the problem, I fixed it. Now we're at 100%. And that's the important part here. Nobody is starting out with 100%. Everyone is starting with a limit of some number. And statistically at our clinic it's around 30, 60%, mark. And nationally it's just around 50%. My goal is to help reduce that fear. When you find out that there's nothing wrong, don't think of it as now your percentage is lower, but that you're back to where you were before, that nothing was found wrong. So your chances are still that percentage. It's only when you find something wrong that you know that in the past your percentage was lower and now by making adjustments, you're back to that 60%. But you're never better than the 60%. IVF is tough, especially emotionally, and having a failed transfer is tough enough, but doing a bunch of testing and then failing is even harder because you feel like you did everything and you did. But it's important to remember you can never get better than the absolute chances of success. And this is very important to know what your clinic's success rate is. Because if your clinic's success rate is only 30%, then every test in the world only gets you back to 30%. I had a patient the other day who came from a clinic who did testing. She also did the era, did every single add on you can do, and she's had two failed transfers. And when I explained to that patient, well, please understand, the place you're at has a 30% chance of live birth, that statistically speaking, seven out, of 10 people wouldn't have came away with a baby. So even though you did all that testing, you're still at that 30%. It was a bit of an epiphany for them. They assumed that 30% was not the max. But by doing the testing, it may go up by explaining to them, no, it doesn't go up, that is the max. Now, obviously not all patients are homogenous, and so that number is an average. So that means some people are less than 30% and some are a little bit above 30%. But in the end, it's the best number you can use to give yourself the expectations of what the chances are. Well, thanks for joining me and hopefully this was helpful. If you can share with someone who might be in that pre transfer panic mode, I appreciate it. I definitely gave 120% on this podcast today. But most of all, if you are someone who's worried about adding things on and will it help it hopefully this helped grounded you and helped you understand the statistics. It's never wrong to do the additional testing, but just keep in mind it's really not improving your chances, it's only helping you get back to the normal amount if those chances were lower due to some unknown reason. As always, if you love this podcast, please tell your friends about us. Give us a five star review on your favorite medium, and most of all, keep coming back. I look forward to talking to you next week on Taco Belt Fertility Tuesday.