Treatment-independent live birth after in-vitro fertilisation: a retrospective cohort study of 2,133 women
Treatment-independent live birth after in-vitro fertilisation: a retrospective cohort study of 2,133 women
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DOI：
10.1093/humrep/dez099
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发表时间：
2019-08-01
影响因子：
6.1
通讯作者：
McLernon, David J.
中科院分区：
文献类型：
--
作者：
ElMokhallalati, Yousuf;van Eekelen, Rik;McLernon, David J.
研究问题IVF（包括ICSI）治疗后非治疗依赖性活产的机会是多少？概要回答在5年的随访中，治疗失败的妇女中治疗独立的活产率为17%，而在IVF后活产的妇女中为15%。已知的情况有限数量的研究调查了IVF完成后治疗独立的受孕机会，但其中大多数是基于应答率低和样本量有限的调查。研究设计，规模，持续时间这是一项以人群为基础的回顾性队列研究，纳入了2133名在1998年至2011年期间在单一地区IVF单位接受IVF治疗的妇女，并在最后一次IVF或ICSI治疗周期后随访最短1年，最长15年。她在1998年至2011年期间参加了阿伯丁生育诊所并接受了试管婴儿治疗。所有妇女的临床和诊断信息与治疗和妊娠结局数据相关。共有2133名妇女被分为两组：（i）在成功的IVF或ICSI治疗后实现活产的妇女（n=1060）和（ii）治疗不成功的妇女，即未妊娠或妊娠失败的妇女（n=1073）。从末次胚胎移植之日起对两组进行随访，直至首次非治疗依赖性活产或2012年12月31日，以先发生者为准。主要结局是随访1年、2.5年、5年和10年时的非治疗依赖性活产率。考克斯回归用于确定各组中与治疗无关的活产相关的因素。主要结果和机会的作用在5年的随访中，IVF或ICSI治疗不成功的妇女的治疗无关的活产率为17%（95%CI，15-19%），而治疗导致活产的妇女的治疗无关的活产率为15%（95%CI，12-17%）。在两组中，与ICSI相比，不孕持续时间较短，女性年龄较小和IVF与实现治疗独立活产的机会较高相关。在治疗失败的妇女中，输卵管因素不孕症患者的IVF后活产机会减少。三个或三个以上以前的IVF或ICSI胚胎移植与治疗独立的活产的机会较低成功治疗women.Limitations，理由回避这项研究是在一个单一的生育中心进行，这可能会损害调查结果的普遍性。此外，数据是不可用的妇女的使用避孕或积极尝试怀孕，这两者都可能影响治疗独立的活产率。更广泛的影响的调查结果这项研究提供了一个更好的了解治疗独立的活产后，完成体外受精或ICSI治疗的长期预后。研究资助/竞争兴趣（S）这项工作是由首席科学家办公室博士后培训奖学金资助的卫生服务研究和公共研究的健康（参考PDF/12/06）。这里表达的观点是作者的观点，不一定是首席科学家办公室的观点。提交人没有利益冲突。试验登记号不适用。
STUDY QUESTION What is the chance of a treatment-independent live birth following IVF (including ICSI) treatment?SUMMARY ANSWER Over 5years 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 2133 women who received IVF treatment between 1998 and 2011 at a single regional IVF Unit and were followed for a minimum of 1year and maximum of 15years after their last IVF or ICSI treatment cycle.PARTICIPANTS/MATERIALS, SETTING, METHODS This study included all women, residing in the north-east of the UK, who attended the Aberdeen Fertility Clinic and received IVF treatment between 1998 and 2011. Clinical and diagnostic information of all women was linked with treatment and pregnancy outcome data. A total of 2133 women were divided into two groups: (i) those who achieved a live birth following successful IVF or ICSI treatment (n=1060) and (ii) those in whom treatment was unsuccessful i.e. resulted in either no pregnancy or pregnancy loss (n=1073). The two groups were followed from the date of the last embryo transfer until the first treatment-independent live birth or 31 December 2012, whichever came first. The primary outcome was the treatment-independent live birth rate at 1, 2.5, 5 and 10years 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 5years 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 generalizability 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 that are associated with it.STUDY FUNDING/COMPETING INTEREST(S) 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 authors have no competing interests.TRIAL REGISTRATION NUMBER Not applicable.