Boyle, P. C., de Groot, T., Andralojc, K. M., & Parnell, T. A. (2018). Healthy Singleton Pregnancies From Restorative Reproductive Medicine (RRM) After Failed IVF. Frontiers in Medicine, 5, 210. https://doi.org/10.3389/fmed.2018.00210
Boyle PC, de Groot T, Andralojc KM, Parnell TA. Healthy Singleton Pregnancies From Restorative Reproductive Medicine (RRM) After Failed IVF. Front Med (Lausanne). 2018;5:210. doi:10.3389/fmed.2018.00210
Boyle, Phil C., et al. "Healthy Singleton Pregnancies From Restorative Reproductive Medicine (RRM) After Failed IVF." Frontiers in Medicine, vol. 5, 2018, pp. 210.
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Radboud Institute for Molecular Life Sciences01yb10j39
About 3 in 10 couples had a live birth with RRM after failed IVF
About 3 out of 10 couples had a live birth within 24 months of restorative reproductive medicine (RRM) care, by life-table analysis of 403 couples with earlier IVF at two Irish clinics. Among the 74 deliveries, one was a twin pregnancy and none were triplets.
Key Findings
Of 403 couples, 74 had a live birth: 32.1% by life-table analysis and 18.4% crude. The women averaged 37.2 years of age, 5.8 years of infertility and 2.1 earlier IVF attempts.
Age, years of trying and number of previous IVF attempts were not significantly correlated with live birth rates; women aged 38–40 had an adjusted rate of 28.1% (crude 14.8%).
The authors compared the 38–40 adjusted rate of 28.1% with 17.5% after one more IVF cycle for women with 2 failed attempts in a linked-cycle study of over 200,000 patients.
One twin pregnancy occurred (1.4%), with no triplets or very low birth weight; singletons had low birth weight in 5.5% (4 of 73) and preterm birth in 8.2% (6 of 73).
The authors estimated potential health care savings from avoidable multiple pregnancies at £205,672, applying published UK costs to the twin and triplet rates HFEA reported for IVF.
Interpretation
The study is a cohort analysis of couples who began RRM treatment after IVF between January 2004 and January 2010. Live birth per couple was the main outcome, with follow-up of up to 2 years. Life-table analysis produces the adjusted figures, and the crude figures divide live births by all 403 couples. Five physicians trained in NaProTechnology delivered the care. The authors note that comparison with repeated IVF cycles is complicated, and they call for further study that compares the two directly.
RRM Context
The program studied used NaProTechnology with the Creighton Model fertility chart to time tests and treatment. Restorative reproductive medicine identifies and corrects the conditions behind infertility, and conception can then occur through intercourse. IVF bypasses those conditions without establishing why conception has not occurred. Both partners had tests as indicated.
Our editorial summary of this paper, not the article's abstract.
Abstract
Objectives
To determine the live birth rate for patients who chose to undergo treatment with Restorative Reproductive Medicine (RRM) after previous IVF (includes ICSI). To look at birth outcomes with RRM after IVF, particularly rates of twin and higher order pregnancies, premature birth, low birth weight, and potential cost savings achieved with RRM.
Setting
Two outpatient clinics in Ireland providing advanced RRM treatment of infertility.
Materials and Methods
All patients presenting between January 2004 and January 2010, with a history of infertility and previous IVF treatment were included if they proceeded beyond the initial consultation and began treatment. Main outcome is live birth per couple calculated using life table analysis.
Results
403 patients met the study criteria, among which 74 had a subsequent live birth. These women had significant negative predictive characteristics for healthy live birth including: advanced reproductive age (average 37.2 years), an average of 5.8 years of infertility with 2.1 (range 1-9) previous IVF attempts, with only 5% having previously had a live birth from IVF. Despite these undesirable prognostic indicators, the overall RRM live birth rate was 32.1% (crude 18.4%). Women aged 35-38 had a live birth rate of 37.5% (crude 23.6%) and older women over 40 had a live birth rate of 27.4% (crude 16.0%). The average birth weight was 3374g (7lb 7oz) with 92% being born at 37+ weeks and no very low birth weight babies. There was only one twin pregnancy in the study population; the potential health care savings for avoidable multiple pregnancies in these patients was estimated at £205 672 (USD$284 915).
Conclusions
Patients who have already tried IVF can achieve comparable live birth outcomes with RRM compared to another cycle of IVF. RRM has a low risk of twin or multiple births, and very good neonatal outcomes with a potential cost savings to the health care system.
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