Cumulative live-birth rates (CLBR) considering the total number of embryos replaced in 26504 consecutive ovum donation cycles (OD)

Abstract

OBJECTIVE: CLBR instead of the raw live-birth rate per cycle is a good IVF success estimation, but the number of embryos transferred (ET) is not considered with this approach and survival curves drawn from CLBR are poorly defined. Our aim was to describe the cumulative outcome of OD per total number of ET needed to achieve live-birth.DESIGN: Retrospective cohort analysis.MATERIALS AND METHODS: CLBR and 95% confidence intervals (CI) was estimated by Kaplan–Meier method according to the sum of embryos transferred (SoET) in each set of treatments (SOT), defining SOT as all consecutive OD cycles performed in a couple until they abandoned, or reached a live-birth, including fresh and frozen embryo replacements, excluding preimplantational genetic screening. When the number of ET was equal to the number of implanted (EI) in cycles with newborn only one embryo was summed (the first implanted) and the median number of ET, if EI was different to ET in cycles with newborn, given the impossibility to discern which embryo succeeded.RESULTS: We included 9659 patients in 26054 OD cycles, 9657 SOT and 59422 ET. Patient's mean age was 39.9(CI39.8-40.0) years old. CLBR reaches 64.8%(CI95%63.6-65.9) when SoET=5, meaning an increase of 6.5% per embryo. This is reduced to 2.0% per embryo, given that the CLBR is 85.2%(CI95%84.0-86.3), when the SOeT=10 embryos. CLBR when SoET=15 embryos is 92.4%(CI95%91.3-93.5), increasing only 1.4% per embryo added compared with CLBR when SOeT=10 embryos in. When 25 embryos have been replaced, CLBR is 96.8%(CI95%95.6-97.8), with only an increase rhythm on their live-birth chances of 0.44% per embryo added. OD presents the same curves of CLBR when categorized by age, confirming the relevance of oocyte quality but not in endometrial receptiveness.CONCLUSION: CLBR depending on SoET provide with realistic, and precise information regarding the likelihood of OD success, and can be used to inform patients and counsel in the decision-taking process. OBJECTIVE: CLBR instead of the raw live-birth rate per cycle is a good IVF success estimation, but the number of embryos transferred (ET) is not considered with this approach and survival curves drawn from CLBR are poorly defined. Our aim was to describe the cumulative outcome of OD per total number of ET needed to achieve live-birth. DESIGN: Retrospective cohort analysis. MATERIALS AND METHODS: CLBR and 95% confidence intervals (CI) was estimated by Kaplan–Meier method according to the sum of embryos transferred (SoET) in each set of treatments (SOT), defining SOT as all consecutive OD cycles performed in a couple until they abandoned, or reached a live-birth, including fresh and frozen embryo replacements, excluding preimplantational genetic screening. When the number of ET was equal to the number of implanted (EI) in cycles with newborn only one embryo was summed (the first implanted) and the median number of ET, if EI was different to ET in cycles with newborn, given the impossibility to discern which embryo succeeded. RESULTS: We included 9659 patients in 26054 OD cycles, 9657 SOT and 59422 ET. Patient's mean age was 39.9(CI39.8-40.0) years old. CLBR reaches 64.8%(CI95%63.6-65.9) when SoET=5, meaning an increase of 6.5% per embryo. This is reduced to 2.0% per embryo, given that the CLBR is 85.2%(CI95%84.0-86.3), when the SOeT=10 embryos. CLBR when SoET=15 embryos is 92.4%(CI95%91.3-93.5), increasing only 1.4% per embryo added compared with CLBR when SOeT=10 embryos in. When 25 embryos have been replaced, CLBR is 96.8%(CI95%95.6-97.8), with only an increase rhythm on their live-birth chances of 0.44% per embryo added. OD presents the same curves of CLBR when categorized by age, confirming the relevance of oocyte quality but not in endometrial receptiveness. CONCLUSION: CLBR depending on SoET provide with realistic, and precise information regarding the likelihood of OD success, and can be used to inform patients and counsel in the decision-taking process.