Cumulative Live-Birth Rates after In Vitro Fertilization
Cumulative Live-Birth Rates after In Vitro Fertilization
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DOI：
10.1056/nejmoa0803072
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发表时间：
2009-01-15
影响因子：
158.5
通讯作者：
Penzias, Alan S.
中科院分区：
文献类型：
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作者：
Malizia, Beth A.;Hacker, Michele R.;Penzias, Alan S.
背景体外受精(IVF)治疗的结果传统上被报道为每个体外受精周期的妊娠率。然而，一对夫妇最关心的是整个治疗过程中活产的机会。方法我们估计了2000至2005年间在一家大型中心接受首次新鲜胚胎、非供体体外受精周期的患者的累积活产率。对夫妇进行跟踪，直到停止治疗或生下活产婴儿。分析根据母亲的年龄进行分层，并使用乐观和保守的方法进行。结果在6164例接受14,248个周期治疗的患者中，乐观分析6个周期后的累计活产率为72%(95%可信区间，70~74)，保守分析为51%(95%可信区间，49~52)。在年龄<35岁的患者中，6个周期后的符合率分别为86%(95%CI，83~88)和65%(95%CI，~67)。在40岁以上的患者中，相应的发生率分别为42%(95%可信区间，37~47)和23%(95%可信区间，21~25)。累积活产率随年龄增长而下降，年龄分层曲线(35岁与40岁)之间有显著差异(P<；0.001)。结论体外受精可以在很大程度上克服年轻女性的不孕症，但不能扭转生育力随年龄下降的趋势。
BACKGROUND Outcomes of in vitro fertilization ( IVF) treatment are traditionally reported as pregnancies per IVF cycle. However, a couple's primary concern is the chance of a live birth over an entire treatment course.METHODS We estimated cumulative live- birth rates among patients undergoing their first fresh-embryo, nondonor IVF cycle between 2000 and 2005 at one large center. Couples were followed until either discontinuation of treatment or delivery of a live- born infant. Analyses were stratified according to maternal age and performed with the use of both optimistic and conservative methods. Optimistic methods assumed that patients who did not return for subsequent IVF cycles would have the same chance of a pregnancy resulting in a live birth as patients who continued treatment; conservative methods assumed no live births among patients who did not return.RESULTS Among 6164 patients undergoing 14,248 cycles, the cumulative live- birth rate after 6 cycles was 72% ( 95% confidence interval [ CI], 70 to 74) with the optimistic analysis and 51% ( 95% CI, 49 to 52) with the conservative analysis. Among patients who were younger than 35 years of age, the corresponding rates after six cycles were 86% ( 95% CI, 83 to 88) and 65% ( 95% CI, 64 to 67). Among patients who were 40 years of age or older, the corresponding rates were 42% ( 95% CI, 37 to 47) and 23% ( 95% CI, 21 to 25). The cumulative live- birth rate decreased with increasing age, and the age-stratified curves (< 35 vs. = 40 years) were significantly different from one another ( P< 0.001).CONCLUSIONS Our results indicate that IVF may largely overcome infertility in younger women, but it does not reverse the age- dependent decline in fertility.