Cumulative live-birth rates after in vitro fertilization.

BACKGROUND Outcomes of in vitro fertilization (IVF) treatment are traditionally reported as pregnancies per IVF cycle. However, a couple's primary concern is the chance of a live birth over an entire treatment course. METHODS We estimated cumulative live-birth rates among patients undergoing their first fresh-embryo, nondonor IVF cycle between 2000 and 2005 at one large center. Couples were followed until either discontinuation of treatment or delivery of a live-born infant. Analyses were stratified according to maternal age and performed with the use of both optimistic and conservative methods. Optimistic methods assumed that patients who did not return for subsequent IVF cycles would have the same chance of a pregnancy resulting in a live birth as patients who continued treatment; conservative methods assumed no live births among patients who did not return. RESULTS Among 6164 patients undergoing 14,248 cycles, the cumulative live-birth rate after 6 cycles was 72% (95% confidence interval [CI], 70 to 74) with the optimistic analysis and 51% (95% CI, 49 to 52) with the conservative analysis. Among patients who were younger than 35 years of age, the corresponding rates after six cycles were 86% (95% CI, 83 to 88) and 65% (95% CI, 64 to 67). Among patients who were 40 years of age or older, the corresponding rates were 42% (95% CI, 37 to 47) and 23% (95% CI, 21 to 25). The cumulative live-birth rate decreased with increasing age, and the age-stratified curves (< 35 vs. > or = 40 years) were significantly different from one another (P<0.001). CONCLUSIONS Our results indicate that IVF may largely overcome infertility in younger women, but it does not reverse the age-dependent decline in fertility.

[1]  C. Tietze Reproductive span and rate of reproduction among Hutterite women. , 1957, Fertility and sterility.

[2]  D G Altman,et al.  Survival probabilities (the Kaplan-Meier method) , 1998, BMJ.

[3]  G. Serour,et al.  Number of embryos for transfer after IVF and ICSI: a Cochrane review. , 2005, Human reproduction.

[4]  Cindy Farquhar,et al.  Assisted hatching on assisted conception (IVF and ICSI). , 2009, The Cochrane database of systematic reviews.

[5]  M. Hornstein,et al.  Disparities in access to infertility services in a state with mandated insurance coverage. , 2005, Fertility and sterility.

[6]  J. Kumagai,et al.  Upper limit of the number of IVF‐ET treatment cycles in different age groups, predicted by cumulative take‐home baby rate , 2001, Acta obstetricia et gynecologica Scandinavica.

[7]  M. Eijkemans,et al.  Cumulative live birth rates following IVF in 41- to 43-year-old women presenting with favourable ovarian reserve characteristics. , 2007, Reproductive biomedicine online.

[8]  D. Cahill,et al.  Expectations of assisted conception for infertility. , 1992 .

[9]  P. Royston,et al.  Cumulative conception and livebirth rates after in-vitro fertilisation , 1992, The Lancet.

[10]  J. Land,et al.  Patient dropout in an assisted reproductive technology program: implications for pregnancy rates. , 1997, Fertility and sterility.

[11]  M. Hacker,et al.  Assessment of day-3 morphology and euploidy for individual chromosomes in embryos that develop to the blastocyst stage. , 2009, Fertility and Sterility.

[12]  N. Klein,et al.  Assisted reproductive technology practice patterns and the impact of embryo transfer guidelines in the United States. , 2007, Fertility and sterility.

[13]  S. Elizur,et al.  Cumulative live birth rate following in vitro fertilization: Study of 5310 cycles , 2006, Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology.

[14]  C. Gnoth,et al.  Time to pregnancy: results of the German prospective study and impact on the management of infertility , 2003 .

[15]  H. Jones,et al.  Cumulative pregnancy rates for in vitro fertilization. , 1986, Fertility and sterility.

[16]  C. Bergh,et al.  Cumulative probability of live birth after three in vitro fertilization/intracytoplasmic sperm injection cycles. , 2002, Fertility and sterility.

[17]  Tarun Jain,et al.  Insurance coverage and outcomes of in vitro fertilization. , 2002, The New England journal of medicine.

[18]  E. Clegg,et al.  Estimates of human fertility and pregnancy loss. , 1996, Fertility and sterility.

[19]  S. Campbell,et al.  Cumulative conception and live-birth rates after in vitro fertilization with and without the use of long, short, and ultrashort regimens of the gonadotropin-releasing hormone agonist buserelin. , 1994, American journal of obstetrics and gynecology.

[20]  A. Guttmacher Factors affecting normal expectancy of conception. , 1956, Journal of the American Medical Association.

[21]  J. Habbema,et al.  Predicting ongoing pregnancy chances after IVF and ICSI: a national prospective study. , 2007, Human reproduction.

[22]  R. Dickey,et al.  Effect of diagnosis, age, sperm quality, and number of preovulatory follicles on the outcome of multiple cycles of clomiphene citrate-intrauterine insemination. , 2002, Fertility and sterility.

[23]  M. Regan,et al.  One last chance for pregnancy: a review of 2,705 in vitro fertilization cycles initiated in women age 40 years and above. , 2005, Fertility and sterility.

[24]  C. Farquhar,et al.  Assisted hatching on assisted conception (IVF & ICSI). , 2005, The Cochrane database of systematic reviews.

[25]  A. Wetzels,et al.  Cumulative probability of achieving an ongoing pregnancy after in-vitro fertilization and intracytoplasmic sperm injection according to a woman's age, subfertility diagnosis and primary or secondary subfertility. , 2000, Human reproduction.

[26]  John L Frattarelli,et al.  Basal and cycle androgen levels correlate with in vitro fertilization stimulation parameters but do not predict pregnancy outcome. , 2006, Fertility and sterility.

[27]  Seang Tan,et al.  Cumulative probability of clinical pregnancy and live birth after a multiple cycle IVF package: a more realistic assessment of overall and age‐specific success rates? , 1999, British journal of obstetrics and gynaecology.

[28]  L. V. D. van der Westerlaken,et al.  Cumulative live birth rates in cohorts of patients treated with in vitro fertilization or intracytoplasmic sperm injection. , 2005, Fertility and sterility.

[29]  V. Goossens,et al.  Assisted reproductive technology in Europe, 2004: results generated from European registers by ESHRE. , 2008, Human reproduction.