Live Delivery Rate Research Articles

In vitro Fertilization Outcome following Embryo Transfer with or without Preinstillation of Human Chorionic Gonadotropin into the Uterine Cavity: A Randomized Controlled Trial

Background: Intrauterine injection of human chorionic gonadotropin (hCG) at embryo transfer (ET) has been shown to improve the outcome of assisted reproductive techniques. The aim of this study was to confirm previous findings. Methods: In this randomized controlled trial, 483 infertile women who were candidates for in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) for the first time were randomly assigned to receive an intrauterine injection of 500 IU hCG or placebo (tissue culture media) before ET. The main outcome measures were implantation and clinical pregnancy rates. Results: Both the hCG-treated group (n = 240) and control group (n = 243) were similar at baseline in terms of demographic and obstetrical characteristics. There were significant differences between the two groups regarding the implantation rate (23.6 vs. 12.2%, p < 0.001), pregnancy rate (54.6 vs. 35.8%, p < 0.001), clinical pregnancy rate (50 vs. 32.1%, p < 0.001), ongoing pregnancy rate (15.3 vs. 9.2%, p < 0.001) and live delivery rate (14.3 vs. 8.4%, p < 0.001). The rate of fertilization and abortion rates were not statistically different. Conclusion: Intrauterine injection of hCG before ET improves implantation and pregnancy rates and may be considered an adjuvant in IVF/ICSI.

Effectiveness of in vitro fertilization in women with previous tubal sterilization

ObjectiveThe objective was to determine the effectiveness of in vitro fertilization (IVF) on live-delivery rates in women who had previously undergone tubal sterilization. Study designWe examined first IVF live deliveries for women aged 20–44 years at their first embryo transfer (ET) with history of hospital admission for tubal sterilization in Western Australia (WA). The ET cycles (n=178) were ascertained over the period of 1996 to 2010 using WA hospital records. A control group of subfertile women matched by age was randomly selected (n=178). We used Kaplan–Meier curves and life-table analysis to evaluate the cumulative live-delivery rates. ResultsAn overall cumulative live-delivery rate in women who had undergone previous tubal sterilization (31%) was comparable to that of subfertile controls (34%) within the first 24 months. Younger women (aged 20–34 years) with previous sterilization (34%) were slightly more likely to deliver an IVF live baby than older women (aged 35–39 and 40–44 years) (33% and 22%, respectively), although this difference was not statistically significant (p=.449). ConclusionWomen who desire fertility after a tubal sterilization procedure and undergo IVF have rates of pregnancy similar to age-matched subfertile IVF control patients. ImplicationsIn vitro fertilization success in women who had undergone previous tubal sterilization is similar to that of the subfertile controls and thus does not depend on past fertility. Age is the most important predictive factor in achieving pregnancy.

Clinical outcomes following cryopreservation of blastocysts by vitrification or slow freezing: a population-based cohort study.

What are the clinical efficacy and perinatal outcomes following transfer of vitrified blastocysts compared with transfer of fresh or of slow frozen blastocysts? Compared with slow frozen blastocysts, vitrified blastocysts resulted in significantly higher clinical pregnancy and live delivery rates with similar perinatal outcomes at population level. Although vitrification has been reported to be associated with significantly increased post-thaw survival rates compared with slow freezing, there has been a lack of general consensus over which method of cryopreservation (vitrification versus slow freezing) is most appropriate for blastocysts. A population-based cohort of autologous fresh and initiated thaw cycles (a cycle where embryos were thawed with intention to transfer) performed between January 2009 and December 2011 in Australia and New Zealand was evaluated retrospectively. A total of 46 890 fresh blastocyst transfer cycles, 12 852 initiated slow frozen blastocyst thaw cycles and 20 887 initiated vitrified blastocyst warming cycles were included in the data analysis. Pairwise comparisons were made between the vitrified blastocyst group and slow frozen or fresh blastocyst group. A Chi-square test was used for categorical variables and t-test was used for continuous variables. Cox regression was used to examine the pregnancy outcomes (clinical pregnancy rate, miscarriage rate and live delivery rate) and perinatal outcomes (preterm delivery, low birthweight births, small for gestational age (SGA) births, large for gestational age (LGA) births and perinatal mortality) following transfer of fresh, slow frozen and vitrified blastocysts. The 46 890 fresh blastocyst transfers, 11 644 slow frozen blastocyst transfers and 19 978 vitrified blastocyst transfers resulted in 16 845, 2766 and 6537 clinical pregnancies, which led to 13 049, 2065 and 4955 live deliveries, respectively. Compared with slow frozen blastocyst transfer cycles, vitrified blastocyst transfer cycles resulted in a significantly higher clinical pregnancy rate (adjusted relative risk (ARR): 1.47, 95% confidence intervals (CI): 1.39-1.55) and live delivery rate (ARR: 1.41, 95% CI: 1.34-1.49). Compared with singletons born after transfer of fresh blastocysts, singletons born after transfer of vitrified blastocysts were at 14% less risk of being born preterm (ARR: 0.86, 95% CI: 0.77-0.96), 33% less risk of being low birthweight (ARR: 0.67, 95% CI: 0.58-0.78) and 40% less risk of being SGA (ARR: 0.60, 95% CI: 0.53-0.68). A limitation of this population-based study is the lack of information available on clinic-specific cryopreservation protocols and processes for slow freezing-thaw and vitrification-warm of blastocysts and the potential impact on outcomes. This study presents population-based evidence on clinical efficacy and perinatal outcomes associated with transfer of fresh, slow frozen and vitrified blastocysts. Vitrified blastocyst transfer resulted in significantly higher clinical pregnancy and live delivery rates with similar perinatal outcomes compared with slow frozen blastocyst transfer. Comparably better perinatal outcomes were reported for singletons born after transfer of vitrified blastocysts than singletons born after transfer of fresh blastocysts. Elective vitrification could be considered as an alternative embryo transfer strategy to achieve better perinatal outcomes following Assisted Reproduction Technology (ART) treatment. No specific funding was obtained. The authors have no conflicts of interest to declare.

No adverse effects were identified on the perinatal outcomes after laser-assisted hatching treatment

The aim of this study was to evaluate the safety of laser-assisted hatching (LAH) by comparing obstetric and neonatal outcomes between assisted hatching and control groups in cryopreserved embryo transfer cycles. A retrospective cohort analysis was carried out. A total of 699 women with 392 infants delivered were included. Laser- assisted hatching was carried out on D-3 thawed and warmed embryos before transfer in 480 cryopreserved embryos transfer cycles. Obstetric outcomes, neonatal outcomes, and congenital birth defects were recorded. A total of 815 cryopreserved embryo transfer cycles (480 in LAH group and 335 in control group) in 699 patients were analysed. Statistically significantly higher implantation (31.85% versus 16.95%), clinical pregnancy (53.96% versus 33.43%) and live delivery (44.58% versus 23.88%) rates were observed in the LAH group (all P < 0.001). For either singleton or multiple gestations, no statistically significant differences were found in mean gestational age, mean birth weight and mean Apgar score. Four major malformations occurred in the assisted hatching group and three malformations (one major and two minor) in the control group. This study did not identify any harmful effect of LAH on neonates, which suggested that LAH may be a safe treatment in cryopreserved embryo transfer cycles.

Preimplantation genetic diagnosis by fluorescence in situ hybridization of reciprocal and Robertsonian translocations

ObjectiveThe presence of reciprocal and Robertsonian chromosomal rearrangement is often related to recurrent miscarriage. Using preimplantation genetic diagnosis, the abortion rate can be decreased. Cases treated at our center were reviewed. Materials and methodsA retrospective analysis for either Robertsonian or reciprocal translocations was performed on all completed cycles of preimplantation genetic diagnosis at our center since the first reported case in 2004 until the end of 2010. Day 3 embryo biopsies were carried out, and the biopsied cell was checked by fluorescent in situ hybridization using relevant informative probes. Embryos with a normal or balanced translocation karyotype were transferred on Day 4. ResultsThirty-eight preimplantation genetic diagnosis cycles involving 17 couples were completed. A total of 450 (82.6%) of the total oocytes were MII oocytes, and 158 (60.0%) of the two-pronuclei embryos were biopsied. In 41.4% of the fluorescent in situ hybridization analyses, the results were either normal or balanced. Embryos were transferred back after 21 cycles. Three babies were born from Robertsonian translocation carriers and another two from reciprocal translocation carriers. The miscarriage rate was 0%. Among the reciprocal translocation group, the live delivery rate was 8.3% per ovum pick-up cycle and 18.2% per embryo transfer cycle. Among the Robertsonian translocation group, the live delivery rate was 14.3% per ovum pick-up cycle and 20.0% per embryo transfer cycle. ConclusionThere is a trend whereby the outcome for Robertsonian translocation group carriers is better than that for reciprocal translocation group carriers. Aneuploidy screening may possibly be added in order to improve the outcome, especially for individuals with an advanced maternal age. The emergence of an array-based technology should help improve this type of analysis.

An analysis of the impact of embryo transfer difficulty on live birth rates, using a standardised grading system

Background: Embryo transfer (ET) is a vital part of the IVF process. While some studies have supported the hypothesis that ET difficulty alters success rate, others suggest the contrary. This large population study aimed to test this hypothesis, using a standardised ET grading system. Methods: ET data for fresh and frozen IVF/ICSI cycles between 2005 and 2010, retrieved from the IVFAustralia database, were grouped by degree of difficulty (easy, medium and difficult). Live birth rates, as the primary outcome, were compared between the groups. Biochemical pregnancy, Clinical Pregnancy Rate (CPR) and other pregnancy outcomes were assessed. The influence of blood ± mucus contamination on the transfer catheter tip and the use of intra-transfer ultrasound (US) were also analysed. Results: Of 6484 transfers, 5976 (92.2%) were considered easy, 374 (5.7%) medium and 134 (2.1%) difficult. Basic patient characteristics were similar between the cohorts. There were statistically significant differences in the live delivery rates (25.3% vs 19.5%, p < 0.05), CPR (30.7% vs 24.6%, p < 0.05), and + ve βhCG rate (35.9% vs 28%, p < 0.05) between the easy and medium/difficult groups. There was no significant difference in the rates of ectopic pregnancy, stillbirth and miscarriage between the groups. The presence of blood on the catheter did not affect pregnancy outcome adversely (p = ns). Conclusion: This study, which we believe to be the largest report using a standardised system for grading the difficulty of ET, demonstrates that difficult ETs are associated with lower live birth rates but not higher rates of ectopic or miscarriage. While the presence of blood may be an indicative of a relatively more traumatic and difficult transfer, it does not necessarily lead to a lower birth rate.

Donor age is a major determinant of success of oocyte donation/recipient programme

In recent years, particularly in developed countries, women have tended to delay childbirth until over 40 years of age. Our study aims to identify whether the donor's age or recipient's age influences the pregnancy and live birth rate following oocyte recipient cycles. A population study included 3889 fresh oocyte recipient cycles. Pregnancy and live delivery rates were compared in recipient age groups (<35, 35-39, 40-44 and ≥45 years) and donor age groups (<30, 30-34, 35-39 and ≥40 years). The highest live birth rate was of cycles in donors aged 30-34 years (25.0%), it decreased (P< 0.05) to 24.1% in donors aged <30 years, 20.7% in donors aged 35-39 years and 11.5% in donors aged ≥40 years. The multivariate analysis showed no significant differences in the success by recipient's age. Compared with cycles in donors aged 30-34 years, cycles in donors aged 35-39 years had 14 and 18% less chance to achieve a pregnancy [adjusted rate ratio (ARR) 0.86, 95% confidence interval (CI) 0.75-0.98] and a live delivery (ARR 0.82, 95% CI 0.71-0.96), while cycles in donors aged 40 years or older had 42 and 54% less chance to achieve a pregnancy (ARR 0.58, 95% CI 0.41-0.84) and a live delivery (ARR 0.46, 95% CI 0.29-0.73). Older recipients with younger donors did not have a poorer pregnancy outcome compared with younger recipients with younger donors. Choosing a donor aged <35 years would increase the chance of pregnancy and live delivery for older recipients.

Defective Oocytes are not a Common Cause of Unexplained Inferitlity as Determined by Evaluation of Sharing Oocytes Between Infertile Donors and Recipients

BACKGROUND: When no cause of infertility can be found in a couple or an infertility defect is diagnosed but correction does not lead to successful pregnancy after a reasonable number of treatment cycles the couple is considered to have unexplained infertility. Theoretically the cause of the unexplained infertility factor could be defective oocytes, defective sperm, an endometrial factor, or an occult tubal factor. OBJECTIVE(S): To determine the role of defective oocytes as an etiological factor in unexplained infertility by comparing pregnancy outcome in infertile oocyte donors and their respective recipients according to the etiology for the donor's infertility problem. MATERIALS AND METHOD(S): A retrospective comparison was made of fertilization and pregnancy rates in infertile women undergoing in vitro fertilization-embryo transfer (IVF-ET), sharing oocytes with a recipient in need of donated oocytes. The pregnancy outcome in the oocyte donors with unexplained infertility would be compared to the outcome of their respective recipients and to donors and recipients where the cause of infertility in the donors was either a tubal or male factor. Data were further stratified according to use of ICSI or not. RESULT(S): For infertile oocyte donors the clinical pregnancy rate per transfer was 60% (6/10) for couples with unexplained infertility vs. 52.5% (32/61) for couples with male factor vs. 48.6% (67/138) for couples with tubal factor. The respective live delivery rates were 60%, 45.9%, and 42.8%, respectively. The implantation rates for these 3 groups were 41.7% (10/24) vs. 30.3% (50/165) vs. 27.9% (105/377). For their respective recipients, the clinical pregnancy rate per transfer was 60% (9/15) for recipients using donors with unexplained infertility vs. 51.3% (40/78) for male factor vs. 60.1% (86/143) for tubal factor. The respective live delivery rates were 53.3%, 37.2%, and 53.1%, respectively. The implantation rates were 33.3% (14/42) vs. 27.0% (62/230) vs. 34.2% (151/441) (p=NS, chi-square). There was a generalized trend for higher pregnancy rates per transfer using conventional oocyte insemination vs. ICSI. There was a 12.5% failed fertilization rate in the unexplained infertility group using conventional insemination. CONCLUSION(S): It does not appear that a defective oocyte, resulting in an embryo of poor implantation potential, is a common cause of unexplained infertility. This conclusion is evidenced by not only failing to show a difference with donors with unexplained infertility with their respective recipients but not with other donors or recipients receiving oocytes from donors with tubal factor or male factor. SUPPORT: None

Perinatal outcome of twice-frozen-thawed embryo transfers: a clinical follow-up study

We evaluated our clinical data on refrozen-thawed ETs (92 cycles) and found that human embryos were capable of withstanding two freeze-thaw cycles, resulting in normal live births after transfer at a rate similar to that of primary frozen-thawed embryos. This is the first follow-up study to present perinatal outcomes of children born after embryo re-cryopreservation, and our results should encourage clinicians to explore the possibility of performing the refreezing procedure.

What is a normal thyroid stimulating hormone (TSH) level? Effects of stricter TSH thresholds on pregnancy outcomes after IVF

OBJECTIVE: To determine if there was a difference in pregnancy outcomes of IVF patients using diagnostic thresholds of TSH of 2.5 or 4.5mU/L. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: Outcomes from the first cycle of all fresh IVF patients with an embryo transfer from 2005-2008 within 1 yr of TSH screening at a single center were studied. Patients with hyperthyroidism (TSH<0.40), hyperprolactinemia, cycles using donor oocyte, PGD, or those lacking delivery follow-up were excluded. Clinical endpoints were rates of clinical pregnancy (gestational sac), miscarriage (loss after gestational sac), and live birth. RESULTS: We identified 1,055 patients with an average age of 36.7 ± 4.8 years with a mean TSH of 2.1 ± 1.6 (median 3.9; range 0.4-23.8). There was no correlation between patient age and TSH, and no difference in ages between abnormal and normal TSH groups using either threshold. TSH thresholds of ≥2.5mU/L resulted in classification of 24% of patients as abnormal (normal: median, interquartile range 1.5, 1.2-1.9mU/L vs. abnormal: 3.2, 2.8-3.8mU/L). TSH thresholds of ≥4.5mU/L resulted in classification of 5.3% of patients as abnormal (normal: 1.7, 1.3-2.3mU/L vs. abnormal: 5.1,4.4-6.7mU/L.) There was no difference in the clinical pregnancy rate with TSH >2.5 vs. <2.5mU/L (52% vs. 47%), live delivery (39% vs. 34%), or miscarriage rates (13% vs 13%). With TSH > 4.5 vs. <4.5mU/L, there was no difference in the clinical pregnancy rate (54% vs. 48%), live delivery (43% vs. 34%), or miscarriage rates (9% vs. 13%). CONCLUSION: While lowering the TSH threshold to 2.5mU/L would result in a nearly 5-fold increase in the number of women being classified as abnormal, no difference in the rates of clinical pregnancy, delivery, or miscarriage were observed. The lack of differences in clinical outcomes using a lower TSH threshold contributes to the current debate on the relative merits of screening, of lowering the upper limit of normal for TSH, and the utility of treating subclinical hypothyroidism.

A comparative analysis of assisted reproductive technology cycles in Australia and New Zealand 2004-2007

There are different funding arrangements for fertility treatments between New Zealand (NZ) and Australia. In NZ, there are two options for patients accessing treatment: either meeting specified criteria for age, no smoking and BMI for publicly funding or funding their own treatment. This differs from Australia, which has no explicit eligibility criteria restricting access to fertility treatment. An analysis of assisted reproductive technology (ART) in Australia and NZ was undertaken to consider the impact of these different funding approaches. Data were extracted from the Australian and New Zealand Assisted Reproduction Database between 2004 and 2007. A total of 116 111 autologous fresh cycles were included. In Australia, more cycles were in women aged 40 years or older compared with those in NZ (23.5 versus 16.0%, P < 0.01). Single embryo transfer was more common in NZ than that in Australia, in women < 35 years of age (75.1 versus 59.6%, P < 0.01). In women <35 years, the crude rates of clinical pregnancy (37.5 versus 31.2%, P < 0.01) and live delivery (31.6 versus 26%, P < 0.01) following fresh ART cycles were significantly higher in NZ than that in Australia. These differences in outcomes persisted in older age groups. The purpose of the criteria used in NZ to access public funding for fertility treatments is to optimize pregnancy outcomes. This approach has resulted in a healthier population of women undergoing treatment and may explain the improved pregnancy outcomes seen in NZ couples who undergo fertility treatments.

Transfer of a selected single blastocyst optimizes the chance of a healthy term baby: a retrospective population based study in Australia 2004-2007

The practice of single embryo transfer (SET) is highly accepted by clinicians in Australia. This study investigates whether the SET of blastocysts results in optimal perinatal outcomes. This retrospective population-based study included 34 035 single or double embryo transfer cycles in women who had their first fresh autologous treatment in Australia during 2004-2007. Pregnancy, live delivery and 'healthy baby' (live born term singleton of > or = 2500 g birthweight and survived for at least 28 days without a notified/reported congenital anomaly) rates per transfer cycle were compared in four groups: selective single embryo transfer (SSET), unselective single embryo transfer (USSET), selective double embryo transfer (SDET) and unselective double embryo transfer (USDET). Live delivery and 'healthy baby' rates per transfer following SSET were further compared by number of embryos available. The analysis was stratified by woman's age and stage of embryo development. The highest rates of live delivery and 'healthy baby' per transfer cycle (46.2 and 38.0%) were achieved with transfer of a single blastocyst in women aged younger than 35 years. In women aged younger than 40 years, SSET had a significantly higher rate of 'healthy baby' per transfer cycle than did SDET regardless of stage of embryo development. In woman aged younger than 35 years who had SSET, there was no significant difference in live delivery and 'healthy baby' rates per transfer cycle whether two, three, four or five embryos were available. For all of these women, SSET of a cleavage embryo had significantly lower rates of live delivery and 'healthy baby' per transfer cycle compared with SSET of a blastocyst where only two blastocysts were available. Consultation with the patient with respect to the advantage of extended culture and selective single blastocyst transfer will result in better success rates following assisted reproductive technology treatment in Australia.

Better perinatal outcomes following transfer of fresh blastocysts and blastocysts cultured from thawed cleavage embryos: a population-based study

Fresh embryo transfer results in higher live birth rates, while thawed embryo transfer appears to result in healthier babies. This study aims to investigate the association between the transfer of fresh or thawed embryos at the cleavage or blastocyst stage and the perinatal outcomes. This analysis is a retrospective population-based study of 150 376 autologous embryo transfer cycles in Australia during 2002-2006. The rates of pregnancy, live delivery and 'healthy baby' delivery (a single baby born live at term, weighing >or=2500 g, surviving for at least 28 days post birth and not having congenital anomalies) were compared after transfer of fresh cleavage embryos, fresh blastocysts, thawed cleavage embryos, blastocysts from thawed cleavage embryos and thawed blastocysts. The live delivery rate was significantly higher for transfer of fresh blastocysts (27.9%) than for blastocysts cultured from thawed cleavage embryos (22.0%), fresh cleavage embryos (21.7%), thawed blastocysts (16.3%) and thawed cleavage embryos (15.2%). Compared with the transfer of fresh blastocysts, the likelihood of a 'healthy baby' was significantly lower for blastocysts from thawed cleavage embryos [adjusted odds ratios (AOR) 0.73, 95% confidence intervals (CI) 0.65-0.82], fresh cleavage embryos (AOR 0.67, 95% CI 0.64-0.69), thawed blastocysts (AOR 0.57, 95% CI 0.53-0.62) and thawed cleavage embryos (AOR 0.53, 95% CI 0.51-0.56). Of thaw cycles, transfers of thawed blastocysts (AOR 0.79, 95% CI 0.70-0.89) and thawed cleavage embryos (AOR 0.71, 95% CI 0.63-0.79) had significantly lower odds of 'healthy baby' than transfer of blastocysts from thawed cleavage embryos. These data suggest that an optimum practice model to maximize the outcomes of the birth of a 'healthy baby' is the transfer of blastocysts and the freezing of cleavage embryos in fresh cycles and subsequent transfer of blastocysts cultured from these thawed cleavage embryos.

National surveillance data confirm favorable outcome rates from embryo donation

OBJECTIVE: To ascertain whether favorable embryo donation (ED) outcome rates reported in small surveys are confirmed by national data collected by the Centers for Disease Control and Prevention (CDC). DESIGN: Analysis of data from the National ART Surveillance System (NASS) maintained by the CDC, and comparison with data from two prior surveys by National Embryo Donation Center (NEDC). MATERIALS AND METHODS: Clinics in the USA must report clinical information on ART procedures on line to CDC, including embryo source, whether pregnancy is achieved, and its outcome. Pregnancy, live delivery, and implantation rates were obtained for ED cycles initiated in 2004-06. These results were compared to rates from a survey of 7 programs previously published by NEDC, and to an additional informal survey of 24 ART centers. Clinic-specific results at 4 ART centers reporting both to CDC and NEDC were also compared. RESULTS: 2,224 ED cycles were reported to CDC with a pregnancy rate of 41.4%, a delivery rate of 33.9%, and an implantation rate of 19.6%.These are similar to the rates previously published by NEDC (44.7%, 35.5%, and 19.9%) and to the informal survey (pregnancy 42.1%, delivery 38.2%). During 2004-2006, the 4 clinics reported 260 ED cycles to NEDC and 268 cycles to CDC. There was 97% agreement between the two systems on the number of cycles, and 96% agreement on the number of live-birth deliveries. Only two significant discrepancies were found: one clinic failed to report to NEDC (but did report to CDC) nine transfers of low-quality embryos done gratis; a second clinic failed to report to CDC ten pregnancies that had miscarried, although they reported the cycles to both systems.Table 1Embryo Donation Outcomes, USA, 2004-06200420052006Donated Frozen Embryo Transfer Cycles666774784Number of Embryos Thawed277331843174Number of Embryos Transferred187020402049Pregnancies271319331Pregnancy Rate Per Embryo Transfer40.741.242.2Pregnancy losses (sacs lost)46 (51)59 (65)58 (64)Implantation Rate18.620.220.5Total deliveries (with at least one live-born)222259272Delivery Rate Per Esfer33.333.534.7Number of clinics167160170 Open table in a new tab CONCLUSIONS: National data from the CDC confirm the favorable outcomes previously reported by the NEDC. The in-depth information gathered by the NEDC provides evidence that the NASS data are of good quality.

A decision analysis of treatments for nonobstructive azoospermia associated with varicocele

To examine the economic impact of initial treatments for varicocele-associated nonobstructive azoospermia, specifically varicocelectomy versus microsurgical testicular sperm extraction (TESE) with IVF/intracytoplasmic sperm injection (ICSI). Decision analytic model based on 1) outcomes data from Society for Assisted Reproductive Technology (SART) database and peer-reviewed literature and 2) costing data from Medicare Resource-Based Relative Value Scale and sampling of high volume US IVF centers. Academic medical center. Simulation with a decision analytic model. Variation of successful spontaneous live delivery after varicocelectomy versus rate of successful live delivery after IVF/ICSI. Cost-effectiveness. Microsurgical TESE was more cost effective than varicocelectomy. In 1999, initial treatment with microsurgical TESE was more cost effective ($65,515) than varicocelectomy ($76,878). Relative cost-effectiveness was unchanged in 2005: $69,731 versus $79,576. The cost-effectiveness of both treatments improved in relation to projections by inflation. Sensitivity analyses suggest that the relative cost-effectiveness of TESE versus varicocelectomy can only be changed with either substantial improvement in spontaneous live delivery rates after varicocelectomy or with deterioration in IVF success rates. Microsurgical TESE appears to be more cost effective than varicocelectomy for treatment of varicocele-associated nonobstructive azoospermia when indirect costs are considered. The cost-effectiveness of both treatments has improved with time. These results may be tailored with institution-specific data to allow more individualized results.

Logarithmic curves depicting initial level and rise of serum beta human chorionic gonadotropin and live delivery outcomes with in vitro fertilization: An analysis of 6021 pregnancies

To correlate the live delivery rate with the initial level and rise of serum beta-hCG. Retrospective cohort analysis. Large private academic center for assisted reproductive technologies and infertility. Records of all patients from 1999 to 2005 undergoing IVF with detectable early serum beta-hCG after ET. None. Live delivery rate. Data from 6021 pregnancies were analyzed. Initial beta-hCG was predictive for delivery rate for all patients and for each age group. After controlling for the first beta-hCG, there were higher loss rates as age increased. Percent rise in second beta-hCG drawn 2 days later added predictive value. A decline in beta-hCG almost always resulted in a failure to deliver. There was a progressive increase in delivery rate as the percent rise in beta-hCG went from 0 to 100%; however, there was no further enhancement in delivery rates beyond the 100% rise point. While a better rise in beta-hCG was a good prognostic factor in all age groups, the differences in outcomes for the different age groups remained, even after controlling for first beta-hCG and percent rise. Initial level and rise in beta-hCG predicts live delivery rate, with oocyte age providing additional predictive value. The established logarithmic curves should provide convenient reference tools for tracking outcomes and counseling patients.

Age-specific success rate for women undertaking their first assisted reproduction technology treatment using their own oocytes in Australia, 2002-2005

Woman's age is an independent factor determining the success of assisted reproductive technology treatment. This study presents the age-specific success rate of first autologous fresh treatment in Australia during 2002-2005. This is a retrospective population-based study of 36,412 initiated first autologous fresh cycles conducted in Australian clinics during 2002-2005. Pregnancy and live delivery rates per initiated cycle were determined for each age. The overall live delivery rate per initiated cycle was 20.4% with the highest success rate in women aged between 22 and 36 years. Male factor only infertility had a higher live delivery rate (22.0%) than female factor only infertility (19.2%). Advancing woman's age was associated with a decline in success rate. For women > or = 30 years, each additional 1 year in age was associated with an 11% (99% CI: 10-12%) reduction in the chance of achieving pregnancy and a 13% (99% CI: 12-14%) reduction in the chance of a live delivery. If women aged 35 years or older would have had their first autologous fresh treatment 1 year earlier, 15% extra live deliveries would be expected. This study suggested that women aged 35 years or older should be encouraged to seek early fertility assessment and treatment where clinically indicated.

Treatment options and pregnancy outcome in women with idiopathic recurrent miscarriage: a randomized placebo-controlled study.

To compare the use of enoxaparin alone with combination therapy of prednisone, aspirin and progesterone in the treatment of women with idiopathic recurrent miscarriage (IRM) in terms of live births and pregnancy outcome. A prospective, randomized, single-blinded, placebo-controlled trial was conducted at a tertiary referral obstetric hospital. The participants were 170 women with a diagnosis of IRM. Women were recruited after full investigative screening. Women with > or =3 fetal losses and after exclusion of all known causes of recurrent miscarriage were randomly allocated to receive either enoxaparin alone, combination treatment consisting of prednisone, aspirin, and progesterone or placebo. Rates of live births, antenatal complications, delivery and neonatal outcomes were recorded prospectively. Data were statistically analyzed as appropriate. Ten patients were dropped out after random assignment. Eighty-one percent of the enoxaparin (46/57) group and 85% of the combination-treated group (45/53) were delivered of live infants compared to 48% (24/50) of the placebo (P < 0.05). Women who were treated with combination therapy had a 4.2% higher live birth rate than enoxaparin group. This difference was not significant. Miscarriage rates were significantly lower in the treated groups compared with placebo (P < 0.05). There were no significant differences in late obstetric complications or neonatal mortality between groups. A combination treatment consisting of high-dose, low-duration prednisone, progesterone and aspirin might be an effective treatment as enoxaparin alone. Both regimens were associated with a good pregnancy outcome.

Changes over time of testicular sperm extraction (TESE) with IVF/ICSI for treatment of male factor infertility

We examined the effectiveness of testicular sperm extraction (TESE) with in vitro fertilization and intracytoplasmic sperm injection (IVF/ICSI) over time. TESE with IVF/ICSI enhances the ability to treat male factor infertility. We examined temporal changes in TESE outcomes for all types of azoospermia, using live delivery and multiple gestation pregnancy rates as primary outcome measures. The Society for Assisted Reproductive Technology (SART) database was queried for TESE patient data in 1999, the earliest year for which robust SART data existed for TESE and in 2005, the most recent year for which SART data was available. The total number of fresh IVF cycles using autologous eggs with ICSI and cervical transfer were recorded, as were the number of cycles for TESE patients in whom sperm was successfully retrieved. The live delivery and multiple gestation pregnancy rates in each year were recorded. All statistical analyses were performed using the χ2 test. The total number of IVF cycles increased from 62,991 to 88,422 between 1999 to 2005. The percentage of IVF cycles undergone for male factor infertility however did not change significantly: 36.9% to 36.6% (P=0.375). Only 1.6% of such cycles used TESE with IVF/ICSI to treat male factor infertility in 1999 (1,029 cycles); this remained unchanged for 2005 (1,425 cycles). The live delivery rate for TESE cycles increased from 28.3% to 33.6% (P=0.042) in couples where sperm was successfully retrieved. While the multiple gestation pregnancy rate decreased from 37% to 31.9% for all IVF cycles, it did not do so for TESE cycles (29.6% to 28.0%, P=0.737). However, the percentage of cycles resulting in triplet or more infants in the latter group did decline from 5.8% to 2.1% (P=0.008). The utilization of both TESE and IVF treatments increased from 1999 to 2005. TESE with IVF/ICSI has improved in its ability to treat male factor infertility over time, with a higher live delivery rate. The overall number of multiple gestation pregnancies associated with TESE-driven IVF cycles however did not significantly change.

Pregnancy outcome following transfer of embryos with a maximum of 5 blastomeres on day 3 in women with elevated day 3 serum follicle stimulating hormone (FSH) levels

To evaluate a group of women having a single embryo transferred to determine the live delivery rate with a single embryo with 4 or 5 blastomeres and to determine if transferring 2 or 3 embryos with a maximum of 5 blastomeres in women with increased day 3 serum follicle stimulation hormone (FSH) improves the outcome. A previous study of single embryo transfers in women with elevated serum FSH showed a markedly higher pregnancy and implantation rate with embryos having 6–8 blastomeres compared to 4 or 5. Studies with embryos with 6–8 blastomeres did not show much improvement by transferring 2 or 3 embryos compared to 1. This retrospective analysis evaluates the effect of 2 or 3 embryos transferred compared to 1 when there was a maximum of 5 blastomeres in any given embryo. Women having in vitro fertilization-embryo transfer (IVF-ET) where their day 3 serum FSH was >12 mIU/mL were the subjects of the study. Clinical (ultrasound evidence of pregnancy at 8 weeks) and live delivery rates were then determined according to whether 1, 2, or 3 embryos were transferred. Only embryo transfers with embryos having a maximum of 5 blastomeres were evaluated in this study. There were 25 single transfers of 4 (n = 20) or 5 (n = 5) cell embryos. Clinical and delivered pregnancies were achieved in 2 of 25 (8%) similar to previous data. For 2 embryo transfers (n = 34) there were 6 clinical and live delivered pregnancies (17.6%). For 3 embryos transferred, there were 18 embryo transfers and there were 6 clinical (33.3%) and 5 delivered (27.8%) pregnancies per transfer. Thus there was only 1 miscarriage in 14 pregnancies (miscarriage rate of 7.1%). These data show that live deliveries are possible even with transfer of embryos with no more than 4 or 5 blastomeres in women aged ≤39 with elevated day 3 serum FSH. Although these embryos are less likely to implant compared to embryos with more blastomeres (based on previous data) it seems that the reason for lower implantation rates does not seem likely to be related to chromosome abnormalities since the miscarriage rate was so low.