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      Cumulative live birth rate and assisted reproduction: impact of female age and transfer day

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          Abstract

          Background: Many studies on assisted reproductive technology examine live birth rate per cycle. However, after a cycle fails, couples often want to know what their chances are of having a live birth if they continue treatment. From a patients’ perspective, the cumulative probability of live birth is more informative.

          Materials and Methods: This study includes patients who underwent fresh, frozen and non-donor ICSI cycles at our IVF unit between 2006-2012. Patients were divided into two groups; Group 1 represented those who underwent only Day 5 transfers, Group 2 represented only Day 3 transfers. Patients who underwent both were excluded. ­Cycles were analyzed until the first live birth or the end of the 3rd cycle. Using Kaplan-Meier analysis, we estimated the cumulative live birth rates for each group and according to female age.

          Results: The mean age for Group 1 was significantly lower than for Group 2. After 3 cycles, Group 1’s CLBR was 79% versus 66% in Group 2. When analyzing the live births by age and group, there was a significant difference in the CLBR after 3 cycles with the women less than 35 years having the highest CLBR and the women 40 years or older having the lowest CLBR.

          Conclusion: In women less than 35 years, excellent CLBR can be achieved irrespective of the transfer day. For women 40 years and above, better results of CLBR are observed with Day 5 transfers. Our findings may impact the counseling of couples considering IVF treatment.

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          Cumulative live-birth rates after in vitro fertilization.

          Michele Hacker, Alan S Penzias, A A Malizia (2009)
          Outcomes of in vitro fertilization (IVF) treatment are traditionally reported as pregnancies per IVF cycle. However, a couple's primary concern is the chance of a live birth over an entire treatment course. We estimated cumulative live-birth rates among patients undergoing their first fresh-embryo, nondonor IVF cycle between 2000 and 2005 at one large center. Couples were followed until either discontinuation of treatment or delivery of a live-born infant. Analyses were stratified according to maternal age and performed with the use of both optimistic and conservative methods. Optimistic methods assumed that patients who did not return for subsequent IVF cycles would have the same chance of a pregnancy resulting in a live birth as patients who continued treatment; conservative methods assumed no live births among patients who did not return. Among 6164 patients undergoing 14,248 cycles, the cumulative live-birth rate after 6 cycles was 72% (95% confidence interval [CI], 70 to 74) with the optimistic analysis and 51% (95% CI, 49 to 52) with the conservative analysis. Among patients who were younger than 35 years of age, the corresponding rates after six cycles were 86% (95% CI, 83 to 88) and 65% (95% CI, 64 to 67). Among patients who were 40 years of age or older, the corresponding rates were 42% (95% CI, 37 to 47) and 23% (95% CI, 21 to 25). The cumulative live-birth rate decreased with increasing age, and the age-stratified curves ( or = 40 years) were significantly different from one another (P<0.001). Our results indicate that IVF may largely overcome infertility in younger women, but it does not reverse the age-dependent decline in fertility. 2009 Massachusetts Medical Society
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            Single blastocyst transfer: a prospective randomized trial.

            Joanne Gardner, Eric Surrey, William B. Schoolcraft … (2004)
            To determine the efficacy of single blastocyst transfer. Prospective randomized trial. Private assisted reproductive technology unit. Forty-eight women undergoing IVF-embryo transfer with day 3 FSH 12 mm in diameter on day of hCG administration. Embryo culture to the blastocyst stage in sequential media G1/G2 followed by transfer of either one or two blastocysts. Implantation rate, ongoing pregnancy rate, and twinning. The transfer of a single blastocyst resulted in an implantation and ongoing pregnancy rate of 60.9% with no twins. The transfer of two blastocysts resulted in an implantation rate of 56%, an ongoing pregnancy rate of 76% with a 47.4% incidence of twins. Single blastocyst transfer is an effective method of eliminating multiple births while maintaining high pregnancy rates in this selected group of patients.
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              Cumulative birth rates with linked assisted reproductive technology cycles.

              Ethan Wantman, Sally Lederman, Merryl R. Lobo … (2012)
              Live-birth rates after treatment with assisted reproductive technology have traditionally been reported on a per-cycle basis. For women receiving continued treatment, cumulative success rates are a more important measure. We linked data from cycles of assisted reproductive technology in the Society for Assisted Reproductive Technology Clinic Outcome Reporting System database for the period from 2004 through 2009 to individual women in order to estimate cumulative live-birth rates. Conservative estimates assumed that women who did not return for treatment would not have a live birth; optimal estimates assumed that these women would have live-birth rates similar to those for women continuing treatment. The data were from 246,740 women, with 471,208 cycles and 140,859 live births. Live-birth rates declined with increasing maternal age and increasing cycle number with autologous, but not donor, oocytes. By the third cycle, the conservative and optimal estimates of live-birth rates with autologous oocytes had declined from 63.3% and 74.6%, respectively, for women younger than 31 years of age to 18.6% and 27.8% for those 41 or 42 years of age and to 6.6% and 11.3% for those 43 years of age or older. When donor oocytes were used, the rates were higher than 60% and 80%, respectively, for all ages. Rates were higher with blastocyst embryos (day of transfer, 5 or 6) than with cleavage embryos (day of transfer, 2 or 3). At the third cycle, the conservative and optimal estimates of cumulative live-birth rates were, respectively, 42.7% and 65.3% for transfer of cleavage embryos and 52.4% and 80.7% for transfer of blastocyst embryos when fresh autologous oocytes were used. Our results indicate that live-birth rates approaching natural fecundity can be achieved by means of assisted reproductive technology when there are favorable patient and embryo characteristics. Live-birth rates among older women are lower than those among younger women when autologous oocytes are used but are similar to the rates among young women when donor oocytes are used. (Funded by the National Institutes of Health and the Society for Assisted Reproductive Technology.).
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                Author and article information

                Journal
                Journal ID (nlm-ta): Facts Views Vis Obgyn
                Journal ID (iso-abbrev): Facts Views Vis Obgyn
                Title: Facts, Views & Vision in ObGyn
                Publisher: Universa Press
                ISSN (Print): 2032-0418
                Publication date (Print): 2014
                Volume: 6
                Issue: 3
                Pages: 145-149
                Affiliations
                [1 ]Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Hurley Medical Center, Flint, Michigan, United States, 48503.
                [2 ]Research Department, Hurley Medical Center, Flint, Michigan, United States, 48503.
                [3 ]IVF Michigan, PC, Rochester Hills, Michigan, United States, 48307.
                Author notes
                [* ] Correspondence at: obolond1@ 123456hurleymc.com
                Article
                PMC ID: 4216980
                PubMed ID: 25374657
                SO-VID: a6c0af2d-1981-4c77-945f-bf8817660b9c
                Copyright © Copyright: © 2014 Facts, Views & Vision
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Subject: Original Paper

                Keywords: ivf,icsi,art,cumulative live birth rate,female age,transfer day
                Data availability:
                Keywords: ivf, icsi, art, cumulative live birth rate, female age, transfer day

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