Assisted reproductive technology in Australia and New Zealand: cumulative live birth rates as measures of success

Abstract

Objectives: To estimate cumulative live birth rates (CLBRs) following repeated assisted reproductive technology (ART) ovarian stimulation cycles, including all fresh and frozen/thaw embryo transfers (complete cycles). Design, setting and participants: Prospective follow‐up of 56 652 women commencing ART in Australian and New Zealand during 2009–2012, and followed until 2014 or the first treatment‐dependent live birth. Main outcome measures: CLBRs and cycle‐specific live birth rates were calculated for up to eight cycles, stratified by the age of the women (< 30, 30–34, 35–39, 40–44, > 44 years). Conservative CLBRs assumed that women discontinuing treatment had no chance of achieving a live birth if had they continued treatment; optimal CLBRs assumed that they would have had the same chance as women who continued treatment. Results: The overall CLBR was 32.7% (95% CI, 32.2–33.1%) in the first cycle, rising by the eighth cycle to 54.3% (95% CI, 53.9–54.7%) (conservative) and 77.2% (95% CI, 76.5–77.9%) (optimal). The CLBR decreased with age and number of complete cycles. For women who commenced ART treatment before 30 years of age, the CLBR for the first complete cycle was 43.7% (95% CI, 42.6–44.7%), rising to 69.2% (95% CI, 68.2–70.1%) (conservative) and 92.8% (95% CI, 91.6–94.0) (optimal) for the seventh cycle. For women aged 40–44 years, the CLBR was 10.7% (95% CI, 10.1–11.3%) for the first complete cycle, rising to 21.0% (95% CI, 20.2–21.8%) (conservative) and 37.9% (95% CI, 35.9–39.9%) (optimal) for the eighth cycle. Conclusion: CLBRs based on complete cycles are meaningful estimates of ART success, reflecting contemporary clinical practice and encouraging safe practice. These estimates can be used when counselling patients and to inform public policy on ART treatment.

Quality of information about success rates provided on assisted reproductive technology clinic websites in Australia and New Zealand

“…Points were also awarded if the added chance offered by frozen embryos was explained; the cumulative chance of success for more than one stimulated cycle was stated; age‐specific data were available (as female age is the single most important determinant of ART success, this item was awarded two points); information about individual factors that influence chance of success was included; and the risks of multiple embryo transfer were described. These items were based on evidence about their impact on the chance of having a healthy baby with ART …”

When “facts” are not facts: what does p value really mean, and how does it deceive us?

“…(2) Consistency across studies properly performed in different scenarios and at different times. For example, the association between age and infertility was also supported by national ART surveillance data in the U.S. and Australia/New Zealand [12,13], among many other regions. Note that bias in the original study cannot be addressed by simply repeating it, without correcting fallacies and errors in its design and interpretation.…”

The MJA 2017: the year in review, and looking forward to 2018

“…We published the study by Georgina Chambers and colleagues on the cumulative success rates for women undergoing assisted reproductive technology in Australia and New Zealand, a prospective follow-up of 56 652 women based on the analysis of complete ovarian stimulation cycles; these results are now informing public policy. 9 We also published novel information about the cause and manner of premature deaths of nursing home residents, a report in which Joseph Ibrahim and colleagues noted that the incidence of deaths among nursing home residents that resulted from injuries, violence and other external events increased during 2001e2012. Most incidents were unintentional and falls-related, while the largest proportions of deaths attributed to suicide (55 cases, 38%) or resident-to-resident assault (14 cases, 41%) were among people aged 85e94 years.…”