Treatment-independent live birth after in-vitro fertilisation

a retrospective cohort study of 2,133 women

Yousuf Elmokhallalati, Rik van Eekelen, Siladitya Bhattacharya, David J. McLernon (Corresponding Author)

Research output: Contribution to journalArticle

Abstract

Study question: What is the chance of a treatment-independent live birth following IVF (including ICSI) treatment? Summary answer: Over five years of follow-up, the treatment-independent live birth rate was 17% in unsuccessfully treated women and 15% in those who had a live birth after IVF.

What is known already: A limited number of studies have investigated the chance of treatment-independent conception following completion of IVF, but most of them have been based on surveys with poor response rates and limited sample sizes.

Study design, size, duration: This is a population-based, retrospective cohort study of 2,133 women who received IVF treatment between 1998 and 2011 at a single regional IVF Unit and were followed for a minimum of one year and maximum of 15 years after their last IVF or ICSI treatment cycle.

Participants/materials, setting, methods: This study included all women, residing in the North-East of Scotland, who attended the Aberdeen Fertility Clinic and received IVF treatment between 1998 and 2011. Clinical and diagnostic information of all women were linked with treatment and pregnancy outcome data. A total of 2,133 women were divided into two groups: a) those who achieved a live birth following successful IVF or ICSI treatment (n=1,060); and b) those in whom treatment was unsuccessful i.e. resulted in either no pregnancy or pregnancy loss (n=1,073). The two groups were followed from the date of the last embryo transfer until the first treatment-independent live birth or 31st December 2012, whichever came first. The primary outcome was the treatment independent live birth rate at one, two and a half, five and ten years of follow up. Cox regression was used to determine factors associated with treatment-independent live birth in each group.

Main results and the role of chance:
Within five years of follow up, the treatment independent live birth rate was 17% (95% CI, 15%-19%) among women whose IVF or ICSI treatment was unsuccessful and 15% (95% CI, 12%-17%) among women whose treatment resulted in live birth. In both groups, shorter duration of infertility, younger female age and IVF as compared to ICSI were associated with a higher chance of achieving treatment independent live birth. Among unsuccessfully treated women, the chance of post-IVF live birth was reduced in those with tubal factor infertility. Three or more previous IVF or ICSI embryo transfers were associated with a lower chance of treatment-independent live birth among successfully treated women.

Limitations, reasons for caution: The study was conducted in a single fertility centre, which could compromise the generalisability of the findings. Moreover, data were unavailable on the women’s use of contraception or active attempts to get pregnant, both of which could influence treatment-independent live birth rates. 
Wider implications of the findings: This study provides a better understanding of the long term prognosis for treatment-independent live birth after completion of IVF or ICSI treatment. The results will inform women of their chances of a treatment-independent live birth following failed or successful treatment and the factors which are associated with it.
Original languageEnglish
Pages (from-to)1470-1478
Number of pages9
JournalHuman Reproduction
Volume34
Issue number8
Early online date15 Jul 2019
DOIs
Publication statusPublished - Aug 2019

Fingerprint

Live Birth
Fertilization in Vitro
Cohort Studies
Retrospective Studies
Intracytoplasmic Sperm Injections
Therapeutics
Birth Rate
Embryo Transfer
Fertility
Female Infertility
Pregnancy

Keywords

  • IVF/ICSI outcome
  • treatment independent live birth
  • infertility
  • live birth rate
  • duration of infertility
  • female age
  • POPULATION
  • ICSI outcome
  • SPONTANEOUS CONCEPTION
  • FOLLOW-UP
  • COUPLES
  • RATES
  • treatment-independent live birth
  • SPONTANEOUS PREGNANCIES
  • CYCLES
  • IVF
  • NATURAL CONCEPTION
  • INFERTILITY

ASJC Scopus subject areas

  • Obstetrics and Gynaecology
  • Reproductive Medicine

Cite this

Treatment-independent live birth after in-vitro fertilisation : a retrospective cohort study of 2,133 women. / Elmokhallalati, Yousuf; van Eekelen, Rik; Bhattacharya, Siladitya; McLernon, David J. (Corresponding Author).

In: Human Reproduction, Vol. 34, No. 8, 08.2019, p. 1470-1478.

Research output: Contribution to journalArticle

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abstract = "Study question: What is the chance of a treatment-independent live birth following IVF (including ICSI) treatment? Summary answer: Over five years of follow-up, the treatment-independent live birth rate was 17{\%} in unsuccessfully treated women and 15{\%} in those who had a live birth after IVF.What is known already: A limited number of studies have investigated the chance of treatment-independent conception following completion of IVF, but most of them have been based on surveys with poor response rates and limited sample sizes. Study design, size, duration: This is a population-based, retrospective cohort study of 2,133 women who received IVF treatment between 1998 and 2011 at a single regional IVF Unit and were followed for a minimum of one year and maximum of 15 years after their last IVF or ICSI treatment cycle.Participants/materials, setting, methods: This study included all women, residing in the North-East of Scotland, who attended the Aberdeen Fertility Clinic and received IVF treatment between 1998 and 2011. Clinical and diagnostic information of all women were linked with treatment and pregnancy outcome data. A total of 2,133 women were divided into two groups: a) those who achieved a live birth following successful IVF or ICSI treatment (n=1,060); and b) those in whom treatment was unsuccessful i.e. resulted in either no pregnancy or pregnancy loss (n=1,073). The two groups were followed from the date of the last embryo transfer until the first treatment-independent live birth or 31st December 2012, whichever came first. The primary outcome was the treatment independent live birth rate at one, two and a half, five and ten years of follow up. Cox regression was used to determine factors associated with treatment-independent live birth in each group.Main results and the role of chance: Within five years of follow up, the treatment independent live birth rate was 17{\%} (95{\%} CI, 15{\%}-19{\%}) among women whose IVF or ICSI treatment was unsuccessful and 15{\%} (95{\%} CI, 12{\%}-17{\%}) among women whose treatment resulted in live birth. In both groups, shorter duration of infertility, younger female age and IVF as compared to ICSI were associated with a higher chance of achieving treatment independent live birth. Among unsuccessfully treated women, the chance of post-IVF live birth was reduced in those with tubal factor infertility. Three or more previous IVF or ICSI embryo transfers were associated with a lower chance of treatment-independent live birth among successfully treated women.Limitations, reasons for caution: The study was conducted in a single fertility centre, which could compromise the generalisability of the findings. Moreover, data were unavailable on the women’s use of contraception or active attempts to get pregnant, both of which could influence treatment-independent live birth rates. Wider implications of the findings: This study provides a better understanding of the long term prognosis for treatment-independent live birth after completion of IVF or ICSI treatment. The results will inform women of their chances of a treatment-independent live birth following failed or successful treatment and the factors which are associated with it.",
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author = "Yousuf Elmokhallalati and {van Eekelen}, Rik and Siladitya Bhattacharya and McLernon, {David J.}",
note = "Acknowledgements We acknowledge the data management support of the Grampian Data Safe Haven (DaSH) and the associated financial support of NHS Research Scotland, through NHS Grampian investment in the Grampian DaSH. For more information, visit the DaSH website http://www.abdn.ac.uk/iahs/facilities/grampian-data-safe-haven.php. We would like to thank all the staff at Aberdeen Fertility Clinic for their help with database queries and case note searching. Funding This work was funded 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, in the collection, analysis, and interpretation of data, in the writing of the report nor in the decision to submit the paper for publication.",
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T1 - Treatment-independent live birth after in-vitro fertilisation

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AU - Elmokhallalati, Yousuf

AU - van Eekelen, Rik

AU - Bhattacharya, Siladitya

AU - McLernon, David J.

N1 - Acknowledgements We acknowledge the data management support of the Grampian Data Safe Haven (DaSH) and the associated financial support of NHS Research Scotland, through NHS Grampian investment in the Grampian DaSH. For more information, visit the DaSH website http://www.abdn.ac.uk/iahs/facilities/grampian-data-safe-haven.php. We would like to thank all the staff at Aberdeen Fertility Clinic for their help with database queries and case note searching. Funding This work was funded 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, in the collection, analysis, and interpretation of data, in the writing of the report nor in the decision to submit the paper for publication.

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N2 - Study question: What is the chance of a treatment-independent live birth following IVF (including ICSI) treatment? Summary answer: Over five years of follow-up, the treatment-independent live birth rate was 17% in unsuccessfully treated women and 15% in those who had a live birth after IVF.What is known already: A limited number of studies have investigated the chance of treatment-independent conception following completion of IVF, but most of them have been based on surveys with poor response rates and limited sample sizes. Study design, size, duration: This is a population-based, retrospective cohort study of 2,133 women who received IVF treatment between 1998 and 2011 at a single regional IVF Unit and were followed for a minimum of one year and maximum of 15 years after their last IVF or ICSI treatment cycle.Participants/materials, setting, methods: This study included all women, residing in the North-East of Scotland, who attended the Aberdeen Fertility Clinic and received IVF treatment between 1998 and 2011. Clinical and diagnostic information of all women were linked with treatment and pregnancy outcome data. A total of 2,133 women were divided into two groups: a) those who achieved a live birth following successful IVF or ICSI treatment (n=1,060); and b) those in whom treatment was unsuccessful i.e. resulted in either no pregnancy or pregnancy loss (n=1,073). The two groups were followed from the date of the last embryo transfer until the first treatment-independent live birth or 31st December 2012, whichever came first. The primary outcome was the treatment independent live birth rate at one, two and a half, five and ten years of follow up. Cox regression was used to determine factors associated with treatment-independent live birth in each group.Main results and the role of chance: Within five years of follow up, the treatment independent live birth rate was 17% (95% CI, 15%-19%) among women whose IVF or ICSI treatment was unsuccessful and 15% (95% CI, 12%-17%) among women whose treatment resulted in live birth. In both groups, shorter duration of infertility, younger female age and IVF as compared to ICSI were associated with a higher chance of achieving treatment independent live birth. Among unsuccessfully treated women, the chance of post-IVF live birth was reduced in those with tubal factor infertility. Three or more previous IVF or ICSI embryo transfers were associated with a lower chance of treatment-independent live birth among successfully treated women.Limitations, reasons for caution: The study was conducted in a single fertility centre, which could compromise the generalisability of the findings. Moreover, data were unavailable on the women’s use of contraception or active attempts to get pregnant, both of which could influence treatment-independent live birth rates. Wider implications of the findings: This study provides a better understanding of the long term prognosis for treatment-independent live birth after completion of IVF or ICSI treatment. The results will inform women of their chances of a treatment-independent live birth following failed or successful treatment and the factors which are associated with it.

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KW - FOLLOW-UP

KW - COUPLES

KW - RATES

KW - treatment-independent live birth

KW - SPONTANEOUS PREGNANCIES

KW - CYCLES

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KW - NATURAL CONCEPTION

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