Cumulative live-birth rate with repeat in vitro fertilization treatment cycles of chinese advanced age women

Abstract

With introduction of the universal two-child policy in China, increasing number of advanced age women seek helps from reproductive medical centers.However,most of them have to receive repeat treatments to achieve pregnancy because of low live-birth rate(LBR) in single cycle. The aim of the study is to determine the extent to which repeat cycles continue to increase the likelihood of a live-birth in advanced age women. China needs their own data to estimate the effectiveness of ART treatment and guide clinical decision-making. Prospective study. We linked data from the database of Reproductive Centre of the First Affiliated Hospital of Sun Yet-sen University. Female aged≥35 years old and had their first IVF/ICSI cycle between 2009 to 2015 were included and followed until Dec 2016. A cycle is defined as an episode of ovarian stimulation and all subsequent fresh and frozen embryo transfers. LBR per cycle and cumulative live-birth rates(CLBR) across all cycles in each age subgroup were analyzed. Opitmal and conservative CLBR were estimated assuming that women who discontinued IVF treatments would have live-birth rate similar to those continuing treatments(opitmal) or would have a live-birth rate of zero(conservative). A total of 3486 patients who received 5050 ovarian stimulation cycles were enrolled. In all women the LBR for the first cycle was 32.1% (95%CI:30.6, 33.7). The CLBR continued to increase up to the fourth, with 48.5%(47.2,49.9)of women achieving a live birth by the fourth cycle. For women aged 35-37, the LBR for the first cycle was41.0% ((95%CI:38.8, 43.2), which continued to increase up to the fourth achieving an optimal and conservative estimated CLBR of 71.1% (68.1, 74.2) and 52.1%(50.1,54.1).For women age 38-39,the first cycle LBR dropped to 29.6(95%CI:26.4,32.8), with four cycles achieving an optimal and conservative estimated CLBR of 54.6% (51.6,57.6) and 39.0%(36.1, 41.9).LBR in age 40-42 subgroup further declined to 16.0% (95%CI:13.1, 19.0) in the first cycle. Four cycles achieved CLBR of 34.7% (32.1, 37.2) and 23.8% (21.1, 26.5) respectively. For women older than 42 years old, all rates within each cycle were less than 4% and there was no upward trend in consecutive cycles. The CLBR after four cycles were 48.5% in advanced age women, with significant variations by age. Women younger than 42 years old would achieve increasing LBR after repeated treatments beyond three to four cycles. However,the prognosis for women older than 42 is disappointing despite of repeated attempts. Data of our research can be used as reference for ART counseling of Chinese advanced age women.