Cumulative Live Birth Rates after In Vitro Fertilization and Maternal andFetal Complications (2000-2008) in Kaohsiung Medical University Hospital

Abstract

Abstract Background: The Success of In-vitro fertilization (IVF) is usually linked with the number of pregnancies per IVF cycle, with less concern on the Indications of Infertility, whether a live healthy infant is born, and the maternal and fetal complications. Method: Cumulative Live Birth Rate was estimated at Kaohsiung Medical University Hospital, Kaohsiung, Taiwan. The study involved 630 patients who received treatment from the years 2000-2008. These patients were followed from the day patients started their cycles until their discontinued the treatment, or delivered their infants and were deemed complication free. The data were analyzed using EXCEL and JMP. Patients’ ages, types of Infertility, body mass index, indications for IVF, number of cycles, ovarian protocols, pregnancies, delivery methods, number and gender of fetus, and complications. Optimistic and Conservative estimates were used. Optimistic estimates assumed that all patients whether they had 2 or more cycles had equal chances at pregnancy as these patients who had more cycles. Conservative estimate assumed that only those who had 3 or more cycles had a chance at getting pregnant. RESULTS: With the 630 patients studied, the ages who came for IVF treatment were widely distributed with a large number of the patients actually being 40 years and older (33.49%). There were surprisingly a large number of them below 35 years (41.43%) and the rest between 35 and 40 years (25.08%). Study of Indications showed that the Male factor (associated with Female factors) is the main cause (31.75%), with Endometrial Affectations (17.31%) and Tubal Ligation or Occlusion (26.19%) also being huge contributors also. The other causes such as Polycystic Ovarian Syndrome (8.73%), Maternal age (4.76%), Adenomyosis (11%) were found to be less of a causes in the study population, but were equally important. Short Ovarian Protocol showed that it had a larger percentage of successful pregnancies (75%), however its outcome was of minimal difference from that of the patients placed under the Long Ovarian Stimulation Protocols (69.35%). Twenty Five percent (25%) of the study population got pregnant, about 70% of them achieved a successful pregnancy. It was found that the mothers with less than 35 years were found to have better results at successful pregnancy (34.38%) than the other age ranges, however the differences were not statistically significant (p=0.2183). Caesarean Delivery being the most frequent (60.56%) followed by Normal Vaginal delivery (43%). The other types were not frequent. The majority of babies born were Singletons (63.16%) however a large number of Twins (36.84%) were born. The Female sex or gender was more frequent however the difference in occurrence between Male (48.70%) and Female gender (51.30%) were not statistically significant. The Maternal and Fetal Complications were no different from Natural birth and delivery. Kaplan Meier Curve shows with 1 or 2 cycles there is a 25% chance of getting pregnant, whereas with 12 to 13 cycles, there is a 70% chance of getting pregnant. The success of pregnancy with 1 or 2 cycles had a little less than 20 % chance of a successful pregnancy, compared to that of 12 to 13 cycles who has a little less than 60%. CONCLUSION: IVF can be used to overcome Infertility in women of different age groups, and Men, offering them a fair chance at pregnancy with limited and similar complications and outcomes as Natural Fertilization Pregnancies.