Predicting personalized cumulative live birth following in vitro fertilization

David J. McLernon* (Corresponding Author), Edwin-Amalraj Raja, James P. Toner, Valerie L. Baker, Kevin J. Doody, David B. Seifer, Amy E. Sparks, Ethan Wantman, Paul C. Lin, Siladitya Bhattacharya, Bradley J. Van Voorhis

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

17 Citations (Scopus)
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Abstract

Objective 
To develop in vitro fertilization (IVF) prediction models to estimate the individualized chance of cumulative live birth at two time points: pretreatment (i.e., before starting the first complete cycle of IVF) and posttreatment (i.e., before starting the second complete cycle of IVF in those couples whose first complete cycle was unsuccessful). 
Design 
Population-based cohort study. 
Setting 
National data from the Society for Assisted Reproductive Technology (SART) Clinic Outcome Reporting System. 
Patient(s) 
Based on 88,614 women who commenced IVF treatment using their own eggs and partner’s sperm in SART member clinics. 
Intervention(s) 
Not applicable. 
Main Outcome 
Measure(s) The pretreatment model estimated the cumulative chance of a live birth over a maximum of three complete cycles of IVF, whereas the posttreatment model did so over the second and third complete cycles. One complete cycle included all fresh and frozen embryo transfers resulting from one episode of ovarian stimulation. We considered the first live birth episode, including singletons and multiple births. 
Result(s) 
Pretreatment predictors included woman’s age (35 years vs. 25 years, adjusted odds ratio 0.69, 95% confidence interval 0.66–0.73) and body mass index (35 kg/m2 vs. 25 kg/m2, adjusted odds ratio 0.75, 95% confidence interval 0.72–0.78). The posttreatment model additionally included the number of eggs from the first complete cycle (15 vs. 9 eggs, adjusted odds ratio 1.10, 95% confidence interval 1.03–1.18). According to the pretreatment model, a nulliparous woman aged 34 years with a body mass index of 23.3 kg/m2, male partner infertility, and an antimüllerian hormone level of 3 ng/mL has a 61.7% chance of having a live birth over her first complete cycle of IVF (and a cumulative chance over three complete cycles of 88.8%). If a live birth is not achieved, according to the posttreatment model, her chance of having a live birth over the second complete cycle 1 year later (age 35 years, number of eggs 7) is 42.9%. The C-statistic for all models was between 0.71 and 0.73. 
Conclusion(s) 
The focus of previous IVF prediction models based on US data has been cumulative live birth excluding cycles involving frozen embryos. These novel prediction models provide clinically relevant estimates that could help clinicians and couples plan IVF treatment at different points in time.
Original languageEnglish
Pages (from-to)326-338
Number of pages13
JournalFertility and Sterility
Volume117
Issue number2
Early online date19 Oct 2021
DOIs
Publication statusPublished - 1 Feb 2022

Bibliographical note

Acknowledgments
SART thanks all its members for providing clinical information to the SART CORS database for use by patients and researchers. Without the efforts of our members, this research would not have been possible. The authors thank Barbara Luke, Sc.D., M.P.H. and Morton Brown, Ph.D. for cleaning and coding the dataset for analysis before sending it to D.J.M., E.A.R., and S.B.

Keywords

  • Cumulative live birth
  • IVF
  • prediction

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