Cumulative Live Birth Delivery Rates Research Articles

Oocyte competence is comparable between progestin primed ovarian stimulation with Norethisterone acetate (NETA-PPOS) and GnRH-antagonist protocols: A matched case-control study in PGT-A cycles

ObjectiveTo outline oocyte competence after progestin primed ovarian stimulation with Norethisterone acetate (NETA-PPOS) compared to conventional GnRH-antagonist protocol. Study designRetrospective matched case-control study involving advanced-maternal-age women undergoing ICSI with PGT-A. 89 NETA-PPOS were matched with 178 control patients based on maternal age and ovarian reserve biomarkers. Both groups underwent recombinant-FSH OS with GnRH-agonist ovulation trigger and collected ≥1 MII. In the study group, NETA (10 mg/day) was administered orally starting from day2 of the menstrual cycle. Euploid blastocyst rate per cohort of metaphase-II oocytes (EBR per MII) was the primary outcome. All other embryological and clinical outcomes were reported. Gestational age, birthweight and length were also assessed. ResultsThe EBR per MII was comparable among PPOS and control (13.9 % ± 19.3 % versus 13.3 % ± 17.9 %; the sample size allowed to exclude up to a 10 % difference). Blastocysts morphology and developmental rate were similar. No difference was reported for all clinical outcomes among the 61 and 107 vitrified-warmed euploid single blastocyst transfers respectively conducted. The cumulative live birth delivery rate per concluded cycles was also comparable (24.7 % versus 21.9 %). Neonatal outcomes were analogous. ConclusionsOocyte competence after NETA-PPOS and standard OS is comparable. This evidence is reassuring and, because of its lower cost and possibly higher patients’ compliance, supports PPOS administration whenever the patients are indicated to freeze-all (e.g., fertility preservation, PGT-A, oocyte donation). More data are required about follicle recruitment, oocyte yield, gestational and perinatal outcomes. Randomized-controlled-trials are advisable to confirm our evidence.

Oocyte donation: not all oocyte cryobanks are the same

Research questionIs the efficacy of imported vitrified oocyte donation affected by the cryobank of origin? DesignLongitudinal cohort study, including 249 completed oocyte warming cycles from 200 recipients (January 2016–July 2020). No severe male factor was included. Vitrified oocytes were provided by three Spanish cryobanks. Primary outcome was cumulative live birth delivery rate (CLBR) per completed oocyte warming cycle. ResultsAfter warming 1535 oocytes, 1244 survived (81.0%) and 945 fertilized (76.0%); embryo utilization rate was 65.3%. The overall CLBR per completed cycle was 47.0% but was lower in cryobank 1 (31.2%) versus cryobank 2 (56.0%, P = 0.0010) and cryobank 3 (50.8%, P = 0.0241). Multivariate logistic regression analysis identified survival of four or more oocytes as the strongest predictor for delivery (P = 0.0282). Only 202 out of 249 oocyte warming cycles had four or more survived oocytes in a proportion that was significantly lower in cryobank 1 versus cryobank 2 (70.1% versus 89.0%, P = 0.0020); comparison with cryobank 3 (81.0%) was not significant. In the 202 oocyte warming cycles, CLBR in cryobank 1 (37.0%) was lower versus cryobank 2 (58.8%, P = 0.0115) and cryobank 3 (60.8%, P = 0.0019), suggesting a reduced viability in oocytes from cryobank 1 that survived warming. ConclusionsDifferences were found in the efficacy of imported vitrified oocytes in relation to the cryobank of origin. Each centre needs to evaluate the results internally when starting a collaboration with an oocyte cryobank to establish the necessary measures to maximize treatment efficacy.

Measuring success in IVF is a complex multidisciplinary task: time for a consensus?

The goal of an IVF cycle is the birth of at least one baby per intention to treat. However, IVF cannot confer competence on an embryo, but only can provide each couple with a safe treatment to meet a predetermined chance of success. This commentary highlights how clinical, financial and patient-centred perspectives should be included in the definition of success in IVF. The primary outcome, which is the cumulative live birth delivery rate per intention to treat, must always be complemented by analyses of risks, costs and time invested, as well as by measures of patient satisfaction. Finally, it is essential, whenever clinical conditions exist, to limit treatment discontinuation after failed attempts. Constant monitoring of the data is pivotal and must be adjusted for patient characteristics and compared with national and international registers. The authors aimed to review all these aspects and highlight the points that are still open for discussion. Is it time for a consensus?

Poor intracytoplasmic sperm injection outcome in infertile males with azoospermia factor c microdeletions

To explore whether the presence of azoospermia factor c (AZFc) microdeletions adversely affects intracytoplasmic sperm injection (ICSI) outcome. Retrospective cohort. University hospital. A total of 293 patients with azoospermia or severe oligozoospermia AZFc deletions underwent 345 ICSI cycles, and 363 idiopathic patients with normal Y chromosome underwent 462 ICSI cycles. Testicular sperm aspiration, microdissection testicular sperm extraction. The main clinical outcome parameters were cumulative clinical pregnancy rate, cumulative live birth delivery rate, and no embryo suitable for transfer cycle rate. Compared with the control group, the AZFc deletion group exhibited poorer ICSI outcome, with significant differences between the 2 groups for cumulative clinical pregnancy rate (45.39% vs. 67.49%; odds ratio [OR], 2.843; 95% confidence interval [CI]), cumulative live birth delivery rate (35.15% vs. 53.44%; OR, 2.234; 95% CI), no embryo suitable for transfer cycle rate (15.07% vs. 8.23%; OR, 0.565; 95% CI), fertilization rate (46.80% vs. 53.37%; adjusted β, -0.074; 95% CI), implantation rate (28.63% vs. 31.26%; adjusted β, -0.075; 95% CI) separately. The poor ICSI outcome of the AZFc deletion group was related to AZFc microdeletions by linear and logistic regression analyses. AZFc microdeletions adversely affect ICSI outcome; patients with AZFc deletion should be informed that they have reduced opportunities to be biological fathers.

Oocyte competence is independent of the ovulation trigger adopted: a large observational study in a setting that entails vitrified-warmed single euploid blastocyst transfer.

To assess whether the GnRH-agonist or urinary-hCG ovulation triggers affect oocyte competence in a setting entailing vitrified-warmed euploid blastocyst transfer. Observational study (April 2013-July 2018) including 2104 patients (1015 and 1089 in the GnRH-a and u-hCG group, respectively) collecting ≥1 cumulus-oocyte-complex (COC) and undergoing ICSI with ejaculated sperm, blastocyst culture, trophectoderm biopsy, comprehensive-chromosome-testing, and vitrified-warmed transfers at a private clinic. The primary outcome measure was the euploid-blastocyst-rate per inseminated oocytes. The secondary outcome measure was the maturation-rate per COCs. Also, the live-birth-rate (LBR) per transfer and the cumulative-live-birth-delivery-rate (CLBdR) among completed cycles were investigated. All data were adjusted for confounders. The generalized-linear-model adjusted for maternal age highlighted no difference in the mean euploid-blastocyst-rate per inseminated oocytes in either group. The LBR per transfer was similar: 44% (n=403/915) and 46% (n=280/608) in GnRH-a and hCG, respectively. On the other hand, a difference was reported regarding the CLBdR per oocyte retrieval among completed cycles, with 42% (n=374/898) and 25% (n=258/1034) in the GnRh-a and u-hCG groups, respectively. Nevertheless, this variance was due to a lower maternal age and higher number of inseminated oocytes in the GnRH-a group, and not imputable to the ovulation trigger itself (multivariate-OR=1.3, 95%CI: 0.9-1.6, adjusted p-value=0.1). GnRH-a trigger is a valid alternative to u-hCG in freeze-all cycles, not only for patients at high risk for OHSS. Such strategy might increase the safety and flexibility of controlled-ovarian-stimulation with no impact on oocyte competence and IVF efficacy.

Fifteen Year Regional Center Experience in Sperm Banking for Cancer Patients: Use and Reproductive Outcomes in Survivors.

Simple SummarySperm cryopreservation before gonadotoxic iatrogenic treatments is the only method currently available to preserve fertility in men with cancer. The aims of this study were to report our 15 years of experience, the clinical outcomes of assisted reproductive treatments as well as neonatal characteristics of babies born. We retrospectively reviewed 682 oncological patients who were referred to our center from 2004 to 2019 for fertility preservation. Data regarding cancer diagnosis, age, and the use of frozen semen were analyzed. The cumulative live-birth delivery rate per couple was 35%. No stillbirths, as well as no malformations in the babies born, were recorded. These successful findings demonstrated that pregnancy could be safely achieved using frozen-thawed sperm of cancer survivors who cryopreserved before gonadotoxic therapies.Cancer treatments frequently impair the reproductive ability of patients by damaging spermatogenesis. International guidelines recommend semen cryopreservation to preserve the fertility of oncological adult males and pubertal boys. However, due to the low usage rate of banked samples, not a lot of data on assisted reproductive treatments (ART) success rates in this population and follow-up data for children born are available in the literature. The aims of this study were to report our 15 years of experience, the clinical outcomes of ART as well as neonatal characteristics of babies born. We retrospectively reviewed 682 oncological patients who were referred to our center from 2004 to 2019 for fertility preservation. Over the years, only 26 patients (4%) returned to use their sperm by ART. They were survivors of leukemia and lymphomas (52%), testicular cancer (20%), and other malignant diseases (28%). These couples performed 45 cycles: 34 intracytoplasmic sperm injection (ICSI) plus 11 frozen embryo transfers. A total of 13 children were born, with 35% of the cumulative live-birth delivery rate per couple. No stillbirths or malformations were recorded. These successful findings demonstrated that pregnancy could be safely achieved using frozen-thawed sperm of cancer survivors who cryopreserved before gonadotoxic therapies.

Endometriosis shows no impact on the euploid blastocyst rate per cohort of inseminated metaphase-II oocytes: A case-control study

ObjectiveTo evaluate the true impact of endometriosis on oocytes’ competence defined as blastulation, euploidy and implantation rates. DesignRetrospective multicenter case-control study involving infertile couples undergoing ICSI with qPCR and trophectoderm biopsy-based PGT-A. Patients affected from endometriosis (n = 210) were diagnosed through transvaginal sonography or surgical history with histological confirmation. Each case was matched to two controls (n = 420) according to IVF clinic, maternal age at retrieval (38.6 ± 2.7 yr), number of previous failed IVF treatments (0.5 ± 0.8) and number of metaphase-II oocytes retrieved (6.1 ± 3.7 per patient). The primary outcome was the mean euploid blastocyst rate per cohort of inseminated metaphase-II oocytes. Other embryological, clinical, obstetric and neonatal outcomes were also evaluated. ResultsThe mean euploid blastocyst rate per cohort of inseminated metaphase-II oocytes was identical in the two groups (18 %±22 %) independently of maternal age. No difference was shown for all embryological outcomes investigated. The live birth rates per vitrified-warmed single euploid blastocyst transfer were also similar (67/158, 42 % in patients affected from endometriosis versus 132/327, 40 % in matched-controls). No difference was reported in the gestational and neonatal outcomes. The cumulative live birth delivery rates among completed cycles were also identical (61/201, 30 % versus 117/391, 30 % in endometriosis and matched-control groups, respectively) independently of maternal age. ConclusionsEndometriosis might not impair oocyte developmental and reproductive competence, although its potential impact on the number of metaphase-II oocytes retrieved cannot be ignored. This information is critical for clinicians during counseling to outline an effective strategy to treat infertile patients affected from this condition. Future prospective studies are needed to evaluate the impact of endometriosis stage on euploidy rates.

Definition of a clinical strategy to enhance the efficacy, efficiency and safety of egg donation cycles with imported vitrified oocytes.

Definition of a clinical strategy to enhance the efficacy, efficiency and safety of egg donation cycles with imported vitrified oocytes.

A stepwise approach to move from a cleavage-stage to a blastocyst-stage transfer policy for all patients in the IVF clinic

A stepwise approach to move from a cleavage-stage to a blastocyst-stage transfer policy for all patients in the IVF clinic

How successful is TESE-ICSI in couples with non-obstructive azoospermia?

What are the chances of a couple with infertility due to non-obstructive azoospermia (NOA) having their genetically own child by testicular sperm extraction combined with ICSI (TESE-ICSI)? Candidate TESE-ICSI patients with NOA should be counselled that, when followed-up longitudinally, only a minority (13.4%) of men embarking for TESE eventually become a biological father. Data available in the literature are only fragmentary because they report either on sperm retrieval rates after TESE or on the outcome of ICSI once testicular spermatozoa has been obtained, mostly in a selected subpopulation. Unfortunately, reliable data to counsel men with NOA on their chance to become a biological father are still lacking. This is a retrospective cohort study performed in the Centre for Reproductive Medicine, University Hospital of Brussel, approved by the institutional review board of the hospital. We identified all patients with NOA, based on histology, who had their first testicular biopsy between 1994 and 2009. Patients were followed longitudinally during consecutive ICSI cycles with testicular sperm. The primary outcome measure was live birth delivery. The cumulative live birth delivery rate was calculated, based only on ICSI cycles with testicular sperm (fresh and/or frozen) available for injection. When patients delivered after transfer of supernumerary frozen embryos, this delivery was tallied up to the (unsuccessful) original fresh ICSI cycle. The sperm retrieval rate and pregnancy rate were secondary outcome measures. Among the 714 men with NOA, 40.5% had successful sperm retrieval at their first TESE. In total, 261 couples had 444 ICSI cycles and 48 frozen embryo transfer cycles, leading to 129 pregnancies and 96 live birth deliveries. Crude and expected cumulative delivery rates after six ICSI cycles were 37 and 78%. A retrospective cohort study design was the only way to study the cumulative delivery rate after TESE-ICSI in couples with NOA. Intrinsic limitations are related to the observational study design. TESE-ICSI is a breakthrough in the treatment of infertility due to NOA, with almost 4 out of 10 (37%) couples having ICSI obtaining a delivery. However, unselected candidate NOA patients should be counselled, before undergoing TESE, that only one out of seven men (13.4%) eventually father their genetically own child. None declared.

Economic evaluation of elective single-embryo transfer with subsequent single frozen embryo transfer in an in vitro fertilization/intracytoplasmic sperm injection program

To analyze the cost-effectiveness of IVF-ICSI cycles with elective single-embryo transfer (eSET), plus elective single frozen embryo transfer (eSFET) if pregnancy is not achieved, compared with double-embryo transfer (DET). Cost-effectiveness analysis. Public hospital. A population of 121 women (<38years old), undergoing their first or second IVF cycles. We conducted a cost-effectiveness analysis using the results of a prospective clinical trial. The women in group 1 received eSET plus eSFET, and those in group 2 received DET. A probabilistic sensitivity analysis was performed. Live birth delivery rate. The cumulative live birth delivery rate was 38.60% in the eSET+eSFET group versus 42.19% in the DET group. The mean costs per patient were €5,614.11 in the eSET+eSFET group and €5,562.29 in the DET group. These differences were not statistically significant. The rate of multiple gestation was significantly lower in the eSET group than in the DET group (0 vs. 25.9%). This study does not show that eSET is superior to DET in terms of effectiveness or of costs. The lack of superiority of the results for the eSET+eSFET and the DET groups corroborates that the choice of strategy to be adopted should be determined by the context of the health care system and the individual prognosis.

Cumulative live birth rate after two single frozen embryo transfers (eSFET) versus a double frozen embryo transfer (DFET) with cleavage stage embryos: a retrospective cohort study.

According to the latest ART report for Europe, about 13% of pregnancies after frozen embryo transfer are multiple. Our objective was to analyse the impact on the multiple pregnancy rate of two eSFET (elective single frozen embryo transfers) versus a DFET (double frozen embryo transfer) in women aged under 38 years, who had not achieved pregnancy in their fresh transfer and who had at least two vitrified embryos of A/B quality. This study was conducted from January 2010 to June 2013 at a public hospital. The couples were divided into three groups. Group DFET: the first cryotransfer of two embryos (105 women); cSFET group: the only cryotransfer of a single vitrified embryo (60 women); eSFET group, individually vitrified embryos: 20 patients included in a clinical trial of single-embryo fresh and frozen transfer and 21 patients who chose to receive eSFET. The clinical pregnancy rate was 38.1% in the DET group and the cumulative clinical pregnancy rate was 43.3% in the eSFET group. There were no significant differences between the DFET and eSFET groups (30.0 vs 34.1%) in cumulative live birth delivery rate. The rate of multiple pregnancies varied significantly between the DFET and eSFET groups (32.5 vs 0%, p < 0.05). For good-prognosis women aged under 38 years, taking embryo quality as a criterion for inclusion, an eSFET policy can be applied, achieving acceptable cumulative clinical pregnancy and live birth rates and reducing multiple pregnancy rates.

Randomised clinical trial comparing elective single-embryo transfer followed by single-embryo cryotransfer versus double embryo transfer

ObjectiveTo analyze the impact of the eSET followed by single-embryo cryotransfer versus double embryo transfer in older women (<38 years) without taking into account embryo quality. Study designThis is a prospective randomised clinical trial performed on 194 couples attempting a first IVF cycle in a Public Hospital in Spain. The women in Group 1 received eSET plus a single-embryo cryotransfer, and those in Group 2 received a double embryo transfer (DET). ResultsIn the intention-to-treat analysis, the cumulative live birth delivery rate in the eSET group was similar to the results obtained for the DET group (45.2% vs. 41.8%; p = 0.60). The rate of multiple gestation was significantly lower in the eSET group than in the DET group (0% vs. 26.4%; p < 0.05). The findings obtained in the per-protocol analysis were similar to those obtained in the intention-to-treat analysis. The per-protocol analysis revealed no significant differences in the rate of implantation (29.8% in eSET vs. 29.7% in DET; p = 0.98), in cumulative pregnancy rates per transfer (49.1% in eSET vs. 46.9% in DET; p = 0.80) or in the cumulative live birth delivery rate (38.6% in eSET vs. 42.2% in DET; p = 0.69). In the cycles with eSET, there were no twin pregnancies (0% in eSET vs. 27.6 in DET; p < 0.05). ConclusionsFor women aged under 38 years with good prognosis, without taking embryo quality as a criterion for inclusion, an eSET policy can be applied, achieving acceptable cumulative clinical pregnancy rates and birth rates.

National assisted reproductive technology (ART) cycle linkage

OBJECTIVE: To determine the feasibility of linking all ART cycles in the Society for Assisted Reproductive Technology Clinic Outome Reporting System (SART CORS) for 2004-08 and calculating per cycle and cumulative live birth rates.DESIGN: Historical cohort study.MATERIALS AND METHODS: Cycles reported to the SART CORS between January 1, 2004 and December 31, 2008 were included. Cycles were linked by woman's date of birth, last name, first name, and social security number (when present); linkages across clinics also included partner's name and sequence of ART outcomes, as needed. The following cycles were excluded from the final match: cancelled, research, no outcomes, gestational carriers, and embryo banking and no outcome reported. Cycles were limited to those up to and including the first live birth.Tabled 1Cycles of ARTLive Birth Deliveries in Each Cycle (N)Number of Women at Risk in Each Cycle (N)Live Birth Delivery Rate at Each Cycle (%)Cumulative Live Birth Deliveries (N)Cumulative Live Birth Delivery Rate Per Woman (%)1110,019306,56535.9110,01935.9236,518122,66929.8146,53747.8314,81050,86329.1161,34752.645,80021,29327.2167,14754.552,3559,14525.8169,50255.361,1004,14226.6170,60255.6≥77253,81919.0171,32755.9 Open table in a new tab CONCLUSION: This analysis demonstrates the feasibility of a national linkage of ART cycles, and the calculation of live birth rates per woman. OBJECTIVE: To determine the feasibility of linking all ART cycles in the Society for Assisted Reproductive Technology Clinic Outome Reporting System (SART CORS) for 2004-08 and calculating per cycle and cumulative live birth rates. DESIGN: Historical cohort study. MATERIALS AND METHODS: Cycles reported to the SART CORS between January 1, 2004 and December 31, 2008 were included. Cycles were linked by woman's date of birth, last name, first name, and social security number (when present); linkages across clinics also included partner's name and sequence of ART outcomes, as needed. The following cycles were excluded from the final match: cancelled, research, no outcomes, gestational carriers, and embryo banking and no outcome reported. Cycles were limited to those up to and including the first live birth. CONCLUSION: This analysis demonstrates the feasibility of a national linkage of ART cycles, and the calculation of live birth rates per woman.

Cycle 1 as predictor of assisted reproductive technology treatment outcome over multiple cycles: an analysis of linked cycles from the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System online database

To determine whether the first cycle of assisted reproductive technology (ART) predicts treatment course and outcome. Retrospective study of linked cycles. Society for Assisted Reproductive Technology Clinic Outcome Reporting System database. A total of 6,352 ART patients residing or treated in Massachusetts with first treatment cycle in 2004-2005 using fresh, autologous oocytes and no prior ART. Women were categorized by first cycle as follows: Group I, no retrieval; Group II, retrieval, no transfer; Group III, transfer, no embryo cryopreservation; Group IV, transfer plus cryopreservation; and Group V, all embryos cryopreserved. None. Cumulative live-birth delivery per woman, use of donor eggs, intracytoplasmic sperm injection (ICSI), or frozen embryo transfers (FET). Groups differed in age, baseline FSH level, prior gravidity, diagnosis, and failure to return for Cycle 2. Live-birth delivery per woman for groups I through V for women with no delivery in Cycle I were 32.1%, 35.9%, 40.1%, 53.4%, and 51.3%, respectively. Groups I and II were more likely to subsequently use donor eggs (14.5% and 10.9%). Group II had the highest use of ICSI (73.3%); Group III had the lowest use of FET (8.9%). Course of treatment in the first ART cycle is related to different cumulative live-birth delivery rates and eventual use of donor egg, ICSI, and FET.

Cumulative live-birth delivery after IVF/ICSI since the progressive introduction of single-embryo transfer

The only way to decrease the incidence of multiple pregnancies in the IVF/intracytoplasmic sperm injection (ICSI) population is to introduce single-embryo transfer (SET). This study investigated the impact of the progressive introduction of SET for the whole IVF/ICSI population from the patients' point of view by calculating the cumulative live-birth delivery rate. During a 5-year period (2001-2005), the outcome of 2164 cycles with oocyte aspiration in 1047 patients was analysed. A subanalysis was made to calculate the additional effect of frozen-thawed cycles. Survival analysis was performed with the Kaplan-Meier method and the endpoint was live-birth delivery. In this 5-year period, the cumulative live-birth delivery rate per patient was 51% after three IVF/ICSI cycles and 58% after six cycles. With a more permissive method of survival analysis, these results were 64% and 85%, respectively. The additional effect of the frozen-thawed cycles since reimbursement was only 5%. SET was progressively introduced in this period leading to a twin live-birth delivery rate of only 6.7%. It is concluded that a favourable outcome was observed for the cumulative live-birth delivery rate since the introduction of SET but with a disappointing additional effect of the frozen-thawed cycles.

The influence of age on reproductive outcome in preimplantation genetic diagnosis (PGD)

OBJECTIVE: The aim of this study was to compare the pregnancy outcome in PGD cycles between different group of ages and to estimate the maximum female age at which clinical application of these techniques can be considered useful. DESIGN: Prospective observational study. MATERIALS AND METHODS: Between 1993-2005, the relationship between patient age and pregnancy outcome was assessed at a large academic referral centre for PGD. Subgroup analysis was performed between age groups per 5 years. Bivariate analysis (T-test) was used to determine the effect of age on clinical, ongoing and live birth delivery rate per oocyte collection cycle (OCC). Kaplan-Meier analysis of cumulative live birth delivery rate was used and Cox regression analysis was performed for the effect of age on cumulative outcome. RESULTS: During 9 years, a total of 2753 cycles of PGD for monogenic disorders, numerical and structural chromosomal abnormalities (1453) and preimplantation genetic screening for aneuploidy (PGS) (1300) on 1498 patients were performed, resulting in the birth of 583 children. Based on Kaplan-Meier analysis the observed cumulative delivery rate was 29% vs 64% expected cumulative delivery rate. Our Cox regression analysis model demonstrates that the effect of age on cumulative live birth delivery rate is highly significant (p<0,01) between the age group ≥ 40years (11.3% real cumulative delivery rate) and the other age groups (<25years: 48.5% real cumulative delivery rate, 25-29 years: 38.8%, 30-34 years: 33.8% and 35-39 years: 28%). Cumulative reproductive outcome is not influenced significantly by mode of inheritance, fertility status and type of ovarian stimulation protocol used. Over the age of 40, the reproductive outcome related to age difference is not significantly different, but shows a trend towards lower success as from the age of 42. CONCLUSIONS: Age has a significantly negative effect on reproductive outcome in PGD especially over the age of 40. Mode of inheritance, fertility status and type of ovarian stimulation protocol does not influence success rates in PGD.

Reproductive potential of women undergoing ART: analysis of linked cycles from the Massachusetts SART CORS

OBJECTIVE: To determine the numbers of cycles and delivery rates in a cohort of women undergoing ART by linking cycles of ART reported to the national database.DESIGN: Historical cohort study of 28,947 cycles of ART performed during 2004-2006 and reported to the SART CORS Online database.MATERIALS AND METHODS: ART cycles of women who were either treated or residing in Massachusetts were linked according to date of birth, last name, and first name. Misspellings and phonetic matches were identified using Soundex software. Linkages were reconfirmed through a secondary analysis using additional variables. In accordance with the specifics of the Dartmouth College IRB approval, identifiable data did not leave the offices where the SART CORS database is maintained. Evaluation of cycle characteristics for each woman was done using a de-identified dataset with coded linkages.RESULTS: There were 6,727 (23%) single cycles, 21,422 (74%) within-clinic cycle matches, and 798 (3%) between-clinic cycle matches among the 14,293 women treated with ART during the three-year period. The average number of cycles was 2.0 ± 1.3, with a range of 1-11 cycles. One out of ten women had at least one donor egg/embryo cycle and one out of four had at least one frozen cycle. The table below gives live birth delivery rates for one or more infants (plurality is not shown). Delivery rates per cycle declined with each subsequent cycle. Overall delivery rates per woman declined with advancing maternal age at first cycle: 68.7% for ages <35yr; 58.1% for 35-37yr; 44.6% for 38-40yr; and 34.5% for >40yr.TableCycles of ARTLive Birth Deliveries in Each Cycle (#)Number of Women at Risk in Each Cycle (#)Live Birth Delivery Rate at Each Cycle (%)Cumulative Live Birth Deliveries (#)Cumulative Live Birth Delivery Rate Per Woman∗This is a conservative estimate based on the assumption that all future cycles would be unsuccessful. (%)14,32914,29330.34,32930.321,9917,56626.36,32044.239153,85823.77,23550.644571,86124.67,69253.8519682723.77,88855.267634422.17,96455.772712821.17,99155.98114922.58,00256.09-1131520.08,00556.0∗ This is a conservative estimate based on the assumption that all future cycles would be unsuccessful. Open table in a new tab OBJECTIVE: To determine the numbers of cycles and delivery rates in a cohort of women undergoing ART by linking cycles of ART reported to the national database. DESIGN: Historical cohort study of 28,947 cycles of ART performed during 2004-2006 and reported to the SART CORS Online database. MATERIALS AND METHODS: ART cycles of women who were either treated or residing in Massachusetts were linked according to date of birth, last name, and first name. Misspellings and phonetic matches were identified using Soundex software. Linkages were reconfirmed through a secondary analysis using additional variables. In accordance with the specifics of the Dartmouth College IRB approval, identifiable data did not leave the offices where the SART CORS database is maintained. Evaluation of cycle characteristics for each woman was done using a de-identified dataset with coded linkages. RESULTS: There were 6,727 (23%) single cycles, 21,422 (74%) within-clinic cycle matches, and 798 (3%) between-clinic cycle matches among the 14,293 women treated with ART during the three-year period. The average number of cycles was 2.0 ± 1.3, with a range of 1-11 cycles. One out of ten women had at least one donor egg/embryo cycle and one out of four had at least one frozen cycle. The table below gives live birth delivery rates for one or more infants (plurality is not shown). Delivery rates per cycle declined with each subsequent cycle. Overall delivery rates per woman declined with advancing maternal age at first cycle: 68.7% for ages <35yr; 58.1% for 35-37yr; 44.6% for 38-40yr; and 34.5% for >40yr.