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Cumulative birth rates with linked assisted reproductive technology cycles - PubMed

  • ️Sun Jan 01 2012

Cumulative birth rates with linked assisted reproductive technology cycles

Barbara Luke et al. N Engl J Med. 2012.

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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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Figures

Figure 1
Figure 1. Cumulative Live-Birth Rates, According to Initial Treatment Year, 2004–2008

Panel A shows the optimal estimate of the cumulative live-birth rate, which assumed that the live-birth rate among women who did not return for further treatment would be the same as the rate among those who continued treatment. Panel B shows the conservative estimate of the cumulative live-birth rate, which assumed that women who did not return for further treatment would never have a live birth. Panel C shows the discontinuation rate, expressed as the percentage of women without a live birth who did not return for a subsequent cycle of treatment. The data from 2008 (truncated) show the results for women whose initial treatment was in 2008, with cycles truncated to those occurring during 2008.

Figure 2
Figure 2. Cumulative Live-Birth Rates in Cycles with Only Autologous Oocytes, According to Maternal Age and Infertility Diagnosis, with Original Cycle Numbering

Panel A shows the optimal estimates of cumulative live-birth rates, Panel B the conservative estimates, and Panel C the percentage of cycles in which a donor oocyte was used, according to maternal age group at the first cycle. Panel D shows the optimal estimates of cumulative live-birth rates, according to diagnosis. Endo denotes endometriosis, Male male-factor infertility, Ovarian diminished ovarian reserve, PCOS the polycystic ovarian syndrome (including ovulation disorders), Tubal tubal-factor infertility, and Uterine uterine-factor infertility.

Figure 3
Figure 3. Optimal Estimates of Cumulative Live-Birth Rates, According to Treatment Method, with Original Cycle Numbering

Panel A shows the rates according to source (donor [D] vs. autologous [A]) and state of the oocyte (fresh vs. thawed). Panel B shows the rates associated with cycles with fresh oocytes, according to source and status with respect to simultaneous cryopreservation of embryos (cryopreservation [Cryo] vs. no cryopreservation [No cryo]). Panel C shows the rates according to source and the number of embryos transferred (1, 2, or 3). Panel D shows the rates according to source and day of transfer of the embryo (day 2 or 3 vs. day 5 or 6).

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