Predicting the chances of a live birth after one or more complete cycles of in vitro fertilisation: population based study of linked cycle data from 113 873 women

David J McLernon, Ewout W Steyerberg, Egbert R te Velde, Amanda J Lee, Siladitya Bhattacharya

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Abstract

Objective To develop a prediction model to estimate the chances of a live birth over multiple complete cycles of in vitro fertilisation (IVF) based on a couple’s specific characteristics and treatment information.

Design Population based cohort study.

Setting All licensed IVF clinics in the UK. National data from the Human Fertilisation and Embryology Authority register.

Participants All 253 417 women who started IVF (including intracytoplasmic sperm injection) treatment in the UK from 1999 to 2008 using their own eggs and partner’s sperm.

Main outcome measure Two clinical prediction models were developed to estimate the individualised cumulative chance of a first live birth over a maximum of six complete cycles of IVF—one model using information available before starting treatment and the other based on additional information collected during the first IVF attempt. A complete cycle is defined as all fresh and frozen-thawed embryo transfers arising from one episode of ovarian stimulation.

Results After exclusions, 113 873 women with 184 269 complete cycles were included, of whom 33 154 (29.1%) had a live birth after their first complete cycle and 48 925 (43.0%) after six complete cycles. Key pretreatment predictors of live birth were the woman’s age (31 v 37 years; adjusted odds ratio 1.66, 95% confidence interval 1.62 to 1.71) and duration of infertility (3 v 6 years; 1.09, 1.08 to 1.10). Post-treatment predictors included number of eggs collected (13 v 5 eggs; 1.29, 1.27 to 1.32), cryopreservation of embryos (1.91, 1.86 to 1.96), the woman’s age (1.53, 1.49 to 1.58), and stage of embryos transferred (eg, double blastocyst v double cleavage; 1.79, 1.67 to 1.91). Pretreatment, a 30 year old woman with two years of unexplained primary infertility has a 46% chance of having a live birth from the first complete cycle of IVF and a 79% chance over three complete cycles. If she then has five eggs collected in her first complete cycle followed by a single cleavage stage embryo transfer (with no embryos left for freezing) her chances change to 28% and 56%, respectively.

Conclusions This study provides an individualised estimate of a couple’s cumulative chances of having a baby over a complete package of IVF both before treatment and after the first fresh embryo transfer. This novel resource may help couples plan their treatment and prepare emotionally and financially for their IVF journey.
Original languageEnglish
Article numberi5735
JournalBMJ
Volume355
DOIs
Publication statusPublished - 16 Nov 2016

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Live Birth
Fertilization in Vitro
Eggs
Embryo Transfer
Population
Embryonic Structures
Infertility
Therapeutics
Birth Order
Embryology
Intracytoplasmic Sperm Injections
Ovulation Induction
Cryopreservation
Blastocyst
Fertilization
Freezing
Spermatozoa
Cohort Studies
Odds Ratio
Outcome Assessment (Health Care)

Cite this

@article{357f8984c05c4849990eca34c7951c16,
title = "Predicting the chances of a live birth after one or more complete cycles of in vitro fertilisation: population based study of linked cycle data from 113 873 women",
abstract = "Objective To develop a prediction model to estimate the chances of a live birth over multiple complete cycles of in vitro fertilisation (IVF) based on a couple’s specific characteristics and treatment information.Design Population based cohort study.Setting All licensed IVF clinics in the UK. National data from the Human Fertilisation and Embryology Authority register.Participants All 253 417 women who started IVF (including intracytoplasmic sperm injection) treatment in the UK from 1999 to 2008 using their own eggs and partner’s sperm.Main outcome measure Two clinical prediction models were developed to estimate the individualised cumulative chance of a first live birth over a maximum of six complete cycles of IVF—one model using information available before starting treatment and the other based on additional information collected during the first IVF attempt. A complete cycle is defined as all fresh and frozen-thawed embryo transfers arising from one episode of ovarian stimulation.Results After exclusions, 113 873 women with 184 269 complete cycles were included, of whom 33 154 (29.1{\%}) had a live birth after their first complete cycle and 48 925 (43.0{\%}) after six complete cycles. Key pretreatment predictors of live birth were the woman’s age (31 v 37 years; adjusted odds ratio 1.66, 95{\%} confidence interval 1.62 to 1.71) and duration of infertility (3 v 6 years; 1.09, 1.08 to 1.10). Post-treatment predictors included number of eggs collected (13 v 5 eggs; 1.29, 1.27 to 1.32), cryopreservation of embryos (1.91, 1.86 to 1.96), the woman’s age (1.53, 1.49 to 1.58), and stage of embryos transferred (eg, double blastocyst v double cleavage; 1.79, 1.67 to 1.91). Pretreatment, a 30 year old woman with two years of unexplained primary infertility has a 46{\%} chance of having a live birth from the first complete cycle of IVF and a 79{\%} chance over three complete cycles. If she then has five eggs collected in her first complete cycle followed by a single cleavage stage embryo transfer (with no embryos left for freezing) her chances change to 28{\%} and 56{\%}, respectively.Conclusions This study provides an individualised estimate of a couple’s cumulative chances of having a baby over a complete package of IVF both before treatment and after the first fresh embryo transfer. This novel resource may help couples plan their treatment and prepare emotionally and financially for their IVF journey.",
author = "McLernon, {David J} and Steyerberg, {Ewout W} and {te Velde}, {Egbert R} and Lee, {Amanda J} and Siladitya Bhattacharya",
note = "Funding: This work was supported by a Chief Scientist Office postdoctoral training fellowship in health services research and health of the public research (ref PDF/12/06). The views expressed here are those of the authors and not necessarily those of the Chief Scientist Office. The funder did not have any role in the study design; the collection, analysis, and interpretation of data; the writing of the report; nor the decision to submit the paper for publication. DJM had full access to all the data in the study and had final responsibility for the decision to submit for publication.",
year = "2016",
month = "11",
day = "16",
doi = "10.1136/bmj.i5735",
language = "English",
volume = "355",
journal = "BMJ",
issn = "0959-8146",
publisher = "BMJ Publishing Group",

}

TY - JOUR

T1 - Predicting the chances of a live birth after one or more complete cycles of in vitro fertilisation

T2 - population based study of linked cycle data from 113 873 women

AU - McLernon, David J

AU - Steyerberg, Ewout W

AU - te Velde, Egbert R

AU - Lee, Amanda J

AU - Bhattacharya, Siladitya

N1 - Funding: This work was supported by a Chief Scientist Office postdoctoral training fellowship in health services research and health of the public research (ref PDF/12/06). The views expressed here are those of the authors and not necessarily those of the Chief Scientist Office. The funder did not have any role in the study design; the collection, analysis, and interpretation of data; the writing of the report; nor the decision to submit the paper for publication. DJM had full access to all the data in the study and had final responsibility for the decision to submit for publication.

PY - 2016/11/16

Y1 - 2016/11/16

N2 - Objective To develop a prediction model to estimate the chances of a live birth over multiple complete cycles of in vitro fertilisation (IVF) based on a couple’s specific characteristics and treatment information.Design Population based cohort study.Setting All licensed IVF clinics in the UK. National data from the Human Fertilisation and Embryology Authority register.Participants All 253 417 women who started IVF (including intracytoplasmic sperm injection) treatment in the UK from 1999 to 2008 using their own eggs and partner’s sperm.Main outcome measure Two clinical prediction models were developed to estimate the individualised cumulative chance of a first live birth over a maximum of six complete cycles of IVF—one model using information available before starting treatment and the other based on additional information collected during the first IVF attempt. A complete cycle is defined as all fresh and frozen-thawed embryo transfers arising from one episode of ovarian stimulation.Results After exclusions, 113 873 women with 184 269 complete cycles were included, of whom 33 154 (29.1%) had a live birth after their first complete cycle and 48 925 (43.0%) after six complete cycles. Key pretreatment predictors of live birth were the woman’s age (31 v 37 years; adjusted odds ratio 1.66, 95% confidence interval 1.62 to 1.71) and duration of infertility (3 v 6 years; 1.09, 1.08 to 1.10). Post-treatment predictors included number of eggs collected (13 v 5 eggs; 1.29, 1.27 to 1.32), cryopreservation of embryos (1.91, 1.86 to 1.96), the woman’s age (1.53, 1.49 to 1.58), and stage of embryos transferred (eg, double blastocyst v double cleavage; 1.79, 1.67 to 1.91). Pretreatment, a 30 year old woman with two years of unexplained primary infertility has a 46% chance of having a live birth from the first complete cycle of IVF and a 79% chance over three complete cycles. If she then has five eggs collected in her first complete cycle followed by a single cleavage stage embryo transfer (with no embryos left for freezing) her chances change to 28% and 56%, respectively.Conclusions This study provides an individualised estimate of a couple’s cumulative chances of having a baby over a complete package of IVF both before treatment and after the first fresh embryo transfer. This novel resource may help couples plan their treatment and prepare emotionally and financially for their IVF journey.

AB - Objective To develop a prediction model to estimate the chances of a live birth over multiple complete cycles of in vitro fertilisation (IVF) based on a couple’s specific characteristics and treatment information.Design Population based cohort study.Setting All licensed IVF clinics in the UK. National data from the Human Fertilisation and Embryology Authority register.Participants All 253 417 women who started IVF (including intracytoplasmic sperm injection) treatment in the UK from 1999 to 2008 using their own eggs and partner’s sperm.Main outcome measure Two clinical prediction models were developed to estimate the individualised cumulative chance of a first live birth over a maximum of six complete cycles of IVF—one model using information available before starting treatment and the other based on additional information collected during the first IVF attempt. A complete cycle is defined as all fresh and frozen-thawed embryo transfers arising from one episode of ovarian stimulation.Results After exclusions, 113 873 women with 184 269 complete cycles were included, of whom 33 154 (29.1%) had a live birth after their first complete cycle and 48 925 (43.0%) after six complete cycles. Key pretreatment predictors of live birth were the woman’s age (31 v 37 years; adjusted odds ratio 1.66, 95% confidence interval 1.62 to 1.71) and duration of infertility (3 v 6 years; 1.09, 1.08 to 1.10). Post-treatment predictors included number of eggs collected (13 v 5 eggs; 1.29, 1.27 to 1.32), cryopreservation of embryos (1.91, 1.86 to 1.96), the woman’s age (1.53, 1.49 to 1.58), and stage of embryos transferred (eg, double blastocyst v double cleavage; 1.79, 1.67 to 1.91). Pretreatment, a 30 year old woman with two years of unexplained primary infertility has a 46% chance of having a live birth from the first complete cycle of IVF and a 79% chance over three complete cycles. If she then has five eggs collected in her first complete cycle followed by a single cleavage stage embryo transfer (with no embryos left for freezing) her chances change to 28% and 56%, respectively.Conclusions This study provides an individualised estimate of a couple’s cumulative chances of having a baby over a complete package of IVF both before treatment and after the first fresh embryo transfer. This novel resource may help couples plan their treatment and prepare emotionally and financially for their IVF journey.

U2 - 10.1136/bmj.i5735

DO - 10.1136/bmj.i5735

M3 - Article

VL - 355

JO - BMJ

JF - BMJ

SN - 0959-8146

M1 - i5735

ER -