Abstract
Objectives:To find a pretreatment predictor for achieving a live birth. Assisted reproduction technology with IVF/ICSI is the ultimate chance for some couples to conceive a child. The expectations are high and it is important to give them a realistic perspective about the chances of achieving a live birth.Methods:A retrospective cohort study of all IVF/ICSI cycles performed in our center between 2012 and 2016. We considered only those cycles with a live birth delivery after 24 weeks, or cycles with no surplus embryos left. The following data was evaluated: AMH; AFC; age; BMI; previous diagnosis; type of treatment; number of previous deliveries; ethnicity, smoking status. Univariate and multivariate analysis were used to examine the association of live birth with baseline patient characteristics. We determined the odds-ratio for all the statistically significant variables (p<0.05), in a multivariate model. The results are presented according to the predictors founded.Results:739 cycles were evaluated: 9.1% were canceled; 10.2% did not have oocytes; 15.6% did not have D2 embryos; 31.4% achieved a live birth. The univariate analysis revealed statistically significant differences regarding AMH, AFC and women’s age between couples with and without a live birth (p<0.001), and the cause of infertility. We found no association with live births in other variables. These variables were categorized and used in a multivariate analysis.Conclusion:Age, AMH, AFC and cause, when sub-classified, are independently associated with the results of an IVF/ICSI treatment. These results enable couples to face real expectations in their particular scenario.
Highlights
Infertility is defined as the failure to conceive within 12 months of regular unprotected intercourse, affects approximately one in six couples and many of those with prolonged unresolved infertility will be treated with Assisted Reproduction Treatments (ART) regardless of the cause (Leijdekkers et al, 2018)
Of the 739 started cycles, 9.1% were canceled; 1.1% did not have oocytes (n=7); 4% had no embryos (n=31) and 1.4% had no embryos for transfer because of poor quality (n=10)
The pretreatment models estimate the probability of a live birth using the characteristics of the couple when they intend to undergo an IVF/ ICSI cycle, such as the woman’s age, duration of infertility, type of infertility, previous pregnancy status of the couple, ovarian reserve and/or its biomarkers, and treatment type
Summary
Infertility is defined as the failure to conceive within 12 months of regular unprotected intercourse, affects approximately one in six couples and many of those with prolonged unresolved infertility will be treated with Assisted Reproduction Treatments (ART) regardless of the cause (Leijdekkers et al, 2018). Subfertile couples should, be well informed about the chances of success with IVF/ ICSI cycles before starting their first or before continuing with a new treatment (van Loendersloot et al, 2014). The threshold at which the couple will start or continue treatment may differ according to insurance company’s support, the taxpayers’ funds, and the patients own option (van Loendersloot et al, 2014). This probability of success is important in the management of public Fertility Clinics and in the management of their waiting lists on public health national systems. Clinical decision-making, and access to health care provision, prediction models for live birth after IVF have been constructed (Nelson & Lawlor, 2011)
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