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Assisted Reproduction · Outcomes and Effectiveness

Live-Birth Rate Associated With Repeat In Vitro Fertilization Treatment Cycles

Smith ADAC, Tilling K, Nelson SM, Lawlor DA

Published December 22, 2015 JAMA
DOI 10.1001/jama.2015.17296 PMID 26717030 PMC PMC4934614

RRM Academy Synopsis

UK study puts adjusted IVF live-birth rate at 65.3% by six cycles

A prospective UK study of 156,947 women starting IVF gives a prognosis-adjusted estimate that 65.3% had a baby by six cycles. The estimate assumes 30% of women who stopped had no chance of success. The first cycle ended in a live birth for about 30 out of 100.

Key Findings

  • The first IVF cycle led to a live birth in 29.5% (95% CI, 29.3%-29.7%) of 156,947 women. Per-cycle rates stayed above 20% through the fourth cycle.
  • The cumulative prognosis-adjusted live-birth rate was 65.3% (95% CI, 64.8%-65.8%) by the sixth cycle. The optimal estimate was 78.0% and the conservative estimate 46.8%. Only 1,162 sixth cycles were started.
  • In 133,379 women under 40 with their own oocytes, first-cycle success was 32.3% and six cycles reached a prognosis-adjusted 68.4%. At ages 40 to 42: 12.3% and 31.5%.
  • Per-cycle rates for women older than 42 were under 4%, or rested on too few live births to give confidence intervals.
  • Among women with a male cause of infertility who used ICSI, six cycles gave a prognosis-adjusted 71.3% (95% CI, 70.5%-72.1%). In women under 40, five cycles took a median of 2 years.

Interpretation

The study is a prospective cohort built from UK regulator records, so it shows what happened to women who started IVF between 2003 and 2010. The 65.3% figure depends on an assumption that 30% of women who stopped had no chance of a live birth. The authors' own data suggested about 3%. The two extreme assumptions give 78.0% and 46.8%. Few women reached later cycles. The study counted live births only and has no data on harms or on treatment abroad.

RRM Context

IVF bypasses the reproductive system without establishing why conception fails. The study records cause only as broad categories such as tubal, ovulatory, endometriosis and male cause. Restorative reproductive medicine looks for the cause in both partners and treats it. From published data, the authors estimated a live birth for 58% to 74% of women under 40 trying naturally for 12 menstrual cycles. They put six IVF cycles at up to $132,000, against $66,000 for three.

Our editorial summary of this paper, not the article's abstract.

Abstract

Importance

The likelihood of achieving a live birth with repeat in vitro fertilization (IVF) is unclear, yet treatment is commonly limited to 3 or 4 embryo transfers.

Objective

To determine the live-birth rate per initiated ovarian stimulation IVF cycle and with repeated cycles.

Design, Setting, and Participants

Prospective study of 156,947 UK women who received 257,398 IVF ovarian stimulation cycles between 2003 and 2010 and were followed up until June 2012.

Exposures

In vitro fertilization, with a cycle defined as an episode of ovarian stimulation and all subsequent separate fresh and frozen embryo transfers.

Main Outcomes and Measures

Live-birth rate per IVF cycle and the cumulative live-birth rates across all cycles in all women and by age and treatment type. Optimal, prognosis-adjusted, and conservative cumulative live-birth rates were estimated, reflecting 0%, 30%, and 100%, respectively, of women who discontinued due to poor prognosis and having a live-birth rate of 0 had they continued.

Results

Among the 156,947 women, the median age at start of treatment was 35 years (interquartile range, 32-38; range, 18-55), and the median duration of infertility for all 257,398 cycles was 4 years (interquartile range, 2-6; range, <1-29). In all women, the live-birth rate for the first cycle was 29.5% (95% CI, 29.3%-29.7%). This remained above 20% up to and including the fourth cycle. The cumulative prognosis-adjusted live-birth rate across all cycles continued to increase up to the ninth cycle, with 65.3% (95% CI, 64.8%-65.8%) of women achieving a live birth by the sixth cycle. In women younger than 40 years using their own oocytes, the live-birth rate for the first cycle was 32.3% (95% CI, 32.0%-32.5%) and remained above 20% up to and including the fourth cycle. Six cycles achieved a cumulative prognosis-adjusted live-birth rate of 68.4% (95% CI, 67.8%-68.9%). For women aged 40 to 42 years, the live-birth rate for the first cycle was 12.3% (95% CI, 11.8%-12.8%), with 6 cycles achieving a cumulative prognosis-adjusted live-birth rate of 31.5% (95% CI, 29.7%-33.3%). For women older than 42 years, all rates within each cycle were less than 4%. No age differential was observed among women using donor oocytes. Rates were lower for women with untreated male partner-related infertility compared with those with any other cause, but treatment with either intracytoplasmic sperm injection or sperm donation removed this difference.

Conclusions and Relevance

Among women in the United Kingdom undergoing IVF, the cumulative prognosis-adjusted live-birth rate after 6 cycles was 65.3%, with variations by age and treatment type. These findings support the efficacy of extending the number of IVF cycles beyond 3 or 4.

Topics

By this author

Related research

Assisted Reproduction › Outcomes and Effectiveness › Cumulative Versus Per Cycle Reporting
PMID 26717030 26717030 DOI 10.1001/jama.2015.17296 10.1001/jama.2015.17296 Smith ADAC et al. 2015, Smith ADAC 2015

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