Cumulative birth rates with linked assisted reproductive technology cycles.
Cumulative birth rates with linked assisted reproductive technology cycles.
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DOI：
10.1056/nejmoa1110238
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发表时间：
2012-06-28
期刊：
影响因子：
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通讯作者：
Stern JE
中科院分区：
文献类型：
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作者：
Luke B;Brown MB;Wantman E;Lederman A;Gibbons W;Schattman GL;Lobo RA;Leach RE;Stern JE
传统上，辅助生殖技术治疗后的活产率是按周期报告的。对于接受持续治疗的女性来说，累积成功率是更重要的衡量标准。我们将辅助生殖技术协会临床结果报告系统数据库中 2004 年至 2009 年期间辅助生殖技术周期的数据与个体妇女联系起来，以估计累积活产率。保守估计认为，没有返回接受治疗的妇女不会活产；最佳估计假设这些妇女的活产率与继续接受治疗的妇女的活产率相似。数据来自 246,740 名女性，共 471,208 个周期和 140,859 名活产婴儿。随着母亲年龄的增加和自体卵母细胞（而非供体卵母细胞）周期数的增加，活产率下降。到第三个周期，对自体卵母细胞活产率的保守估计和最佳估计分别从 31 岁以下女性的 63.3% 和 74.6% 下降到 41 岁或 42 岁女性的 18.6% 和 27.8%，以及 43 岁或以上女性的 6.6% 和 11.3%。当使用供体卵母细胞时，所有年龄段的比率分别高于 60% 和 80%。囊胚胚胎（移植第 5 或 6 天）的发生率高于卵裂胚胎（移植第 2 或 3 天）的发生率。在第三个周期，当使用新鲜自体卵母细胞时，卵裂胚胎移植的累积活产率保守估计为42.7%，最佳估计为65.3%，囊胚胚胎移植的累积活产率保守估计为52.4%和80.7%。我们的研究结果表明，当患者和胚胎特征良好时，通过辅助生殖技术可以实现接近自然生育力的活产率。使用自体卵母细胞时，老年女性的活产率低于年轻女性，但与使用捐赠卵母细胞时的年轻女性的活产率相似。 （由美国国立卫生研究院和辅助生殖技术协会资助。）
Live-birth rates after treatment with assisted reproductive technology have traditionally been reported on a per-cycle basis. For women receiving continued treatment, cumulative success rates are a more important measure. We linked data from cycles of assisted reproductive technology in the Society for Assisted Reproductive Technology Clinic Outcome Reporting System database for the period from 2004 through 2009 to individual women in order to estimate cumulative live-birth rates. Conservative estimates assumed that women who did not return for treatment would not have a live birth; optimal estimates assumed that these women would have live-birth rates similar to those for women continuing treatment. The data were from 246,740 women, with 471,208 cycles and 140,859 live births. Live-birth rates declined with increasing maternal age and increasing cycle number with autologous, but not donor, oocytes. By the third cycle, the conservative and optimal estimates of live-birth rates with autologous oocytes had declined from 63.3% and 74.6%, respectively, for women younger than 31 years of age to 18.6% and 27.8% for those 41 or 42 years of age and to 6.6% and 11.3% for those 43 years of age or older. When donor oocytes were used, the rates were higher than 60% and 80%, respectively, for all ages. Rates were higher with blastocyst embryos (day of transfer, 5 or 6) than with cleavage embryos (day of transfer, 2 or 3). At the third cycle, the conservative and optimal estimates of cumulative live-birth rates were, respectively, 42.7% and 65.3% for transfer of cleavage embryos and 52.4% and 80.7% for transfer of blastocyst embryos when fresh autologous oocytes were used. Our results indicate that live-birth rates approaching natural fecundity can be achieved by means of assisted reproductive technology when there are favorable patient and embryo characteristics. Live-birth rates among older women are lower than those among younger women when autologous oocytes are used but are similar to the rates among young women when donor oocytes are used. (Funded by the National Institutes of Health and the Society for Assisted Reproductive Technology.)