Live-Birth Rate Associated With Repeat In Vitro Fertilization Treatment Cycles.
Live-Birth Rate Associated With Repeat In Vitro Fertilization Treatment Cycles.
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与重复体外受精治疗周期相关的活产率。
DOI：
10.1001/jama.2015.17296
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发表时间：
2015-12-22
期刊：
影响因子：
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通讯作者：
Lawlor DA
中科院分区：
文献类型：
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作者：
Smith ADAC;Tilling K;Nelson SM;Lawlor DA
通过重复体外受精（IVF）实现活产的可能性尚不清楚，但治疗通常限于三到四个胚胎移植。确定每个启动的IVF周期和重复周期的活产率。这项前瞻性研究涉及156，947名英国女性，她们在2003年至2010年期间接受了257，398个IVF卵巢刺激周期，并随访至2012年6月。IVF，一个周期定义为一次卵巢刺激和所有后续单独的新鲜和冷冻胚胎移植。每个IVF周期的活产率以及所有女性在所有周期中的累积活产率，并按年龄和治疗类型分类。估计了最佳的、经病情调整的和保守的累积活产率，反映了0%、30%和100%的妇女因预后不良而中止治疗，如果继续治疗，活产率为零。在所有妇女中，第一周期的活产率为29.5%（95%CI：29.3，29.7）。这一比例在第四个周期（包括第四个周期）之前一直保持在20%以上。所有周期中累积的月经调整活产率继续增加，直到第九个周期，65.3%（64.8，65.8）的妇女在第六个周期实现了活产。在40岁以下使用自己的卵母细胞的女性中，第一个周期的活产率为32.3%（32.0，32.5），直到第四个周期（包括第四个周期）仍保持在20%以上。6个周期的累积经阴道分娩调整的活产率为68.4%（67.8，68.9）。对于40-42岁的女性，第一个周期的活产率为12.3%（95%CI：11.8，12.8），六个周期的累积月经调整活产率为31.5%（29.7，33.3）。对于42岁以上的妇女，每个周期内的所有比率均低于4%。在使用供体卵母细胞的妇女中没有观察到年龄差异。与任何其他原因相比，未接受治疗的男性因素不育患者的比率较低，但细胞质内精子注射或精子捐献治疗消除了这种差异。在接受IVF的英国女性中，六个周期后累积的经阴道分娩调整的活产率为65.3%，年龄和治疗类型不同。这些发现支持将IVF周期数延长到三个或四个以上的有效性。
The likelihood of achieving a live-birth with repeat in-vitro fertilisation (IVF) is unclear, yet treatment is commonly limited to three or four embryo transfers. To determine the live-birth rate per initiated IVF cycle and with repeated cycles. Prospective study of 156,947 UK women who received 257,398 IVF ovarian stimulation cycles between 2003 and 2010 and were followed until June 2012. IVF, with a cycle defined as an episode of ovarian stimulation and all subsequent separate fresh and frozen embryo transfers. 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% of women discontinuing due to poor prognosis and having a live-birth rate of zero had they continued. 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, with 65.3% (64.8, 65.8) of women achieving a live-birth by the sixth cycle. In women younger than 40 using their own oocytes, the live-birth rate for the first cycle was 32.3% (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% (67.8, 68.9). For women aged 40-42, the live-birth rate for the first cycle was 12.3% (95%CI: 11.8, 12.8), with six cycles achieving a cumulative prognosis-adjusted live-birth rate of 31.5% (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 in those with untreated male factor infertility compared to those with any other cause, but treatment with either intra-cytoplasmic sperm injection or sperm donation removed this difference. Among women in the UK undergoing IVF, the cumulative prognosis-adjusted live-birth rate after six cycles was 65.3%, with variations by age and treatment type. These findings support the efficacy of extending the number of IVF cycles beyond three or four.