Cumulative pregnancy rates and selective drop-out off patients in in-vitro fertilization treatment

Abstract

The validity of the cumulative pregnancy rate (CPR) calculated by life-table approach, obtained in a transport in-vitro fertilization (IVF) programme, was tested by the determination of possible influence of selective drop-out of patients with a poor treatment prognosis. A cohort of 1211 patients who had a first IVF cycle was followed, and the CPR after three IVF cycles was assessed. First cycles of patients who discontinued treatment after failed IVF, and of those who did not achieve a pregnancy but proceeded to a subsequent cycle, were compared for fertilization rate and for occurrence of prognosticators of poor treatment outcome: oocyte yield < or =2, and replacement of <2 embryos. The CPR after three cycles was 54.9%. No differences were found in the first and second cycles of patients who continued treatment and those who dropped out. Selective drop-out of patients with a poor treatment prognosis was not found. Therefore, although calculations of CPR using life-table analysis generally overestimate the real probability of pregnancy after successive IVF cycles, the calculated CPR after three IVF cycles gives a reliable indication of the chance of occurrence of a pregnancy for the population studied.

Determinants of patients' experiences and satisfaction with fertility care

“…This is also described by others, who found that emotional support and a good relationship between staff and patient was a major determinant of patient satisfaction (15,28,33). Considering the high drop-out rates (i.e., 17%-65%) known to exist in IVF/ICSI treatment, it would probably prove worthwhile for clinics to invest in better emotional support to enable couples to go through treatment cycles confidently (36)(37)(38)(39)(40)(41)(42). Global differences in reimbursement of fertility care could hamper adoption of such beneficial organizational elements.…”

A prospective investigation into the reasons why insured United States patients drop out of in vitro fertilization treatment

“…A 1997 study from the Netherlands, where assisted reproductive technology costs are covered by insurance, determined that the cumulative dropout rate after three cycles was 62%, only 13.9% of which was due to active censoring (2). A subsequent study, also in the Netherlands, determined that there was no evidence for selective dropouts due to poor treatment prognosis (3).…”

The predictive value of antral follicle count remains unchanged across the menstrual cycle

“…Reproductive potential is reduced progressively between 35 and 40 years of age, and falls significantly after the age of 40 years (1,2). The reason for the age-related decrease in fecundity is thought to be twofold: 1) diminished quantity of oocytes; and 2) diminished oocyte quality (3).…”