Cumulative probabilities of live birth across multiple complete IVF/ICSI cycles: a call for attention

Abstract

Purpose To call attention to the fact that cumulative live birth (LB) proportions exhibit an inverted pattern to that displayed by each individual oocyte retrieval cycle (ORC-specific LB proportions) as well as when grouping together all the ORCs undergone by a woman (TNORC-specific LB proportions). Methods A retrospective study of 1433 infertile women that had a LB using autologous fresh or frozen embryos and/or dropped out of IVF/ICSI treatment after completing a maximum number of three treatment cycles. Generalized Estimating Equations (GEE) and standard and landmark Kaplan-Meier survival analyses were applied. Results A standard Kaplan-Meier analysis indicated that cumulative LB proportions rose as number of ORCs increased (0.320, 0.484, and 0.550 at ORC 1, 2, and 3, respectively). In contrast, landmark ORC-specific LB proportions showed an inverted pattern (0.320, 0.242, and 0.127 at ORC 1, 2, and 3, respectively). GEE models revealed that women's clinical outcomes decreased as TNORCs increased. In particular, compared to women that experienced just one ORC, women that underwent two and three ORCs displayed higher incidences of cycle cancellations before either oocyte retrieval or embryo transfer, and clinical pregnancy losses, and lower odds of LB. Conclusion Infertile women should be informed that cumulative LB probabilities exhibit an inverted pattern to that displayed by each individual ORC as well as when grouping together all the ORCs undergone by a woman.

A predictive model for women’s assisted fecundity before starting the first IVF/ICSI treatment cycle

“…We have previously reported that cumulative LB probabilities exhibit an inverted pattern to that displayed by each individual consecutive ORC. In particular, whereas cumulative LB probabilities increase as number of ORC rises, cycle-specific LB probabilities decrease at each consecutive ORC [2]. Women should be informed about this inverse relationship before embarking in an IVF/ICSI treatment journey.…”

“…Women should be informed about this inverse relationship before embarking in an IVF/ICSI treatment journey. Otherwise, cumulative probabilities may incentivize infertile women, specifically those with low or zero-assisted fecundity, to have more treatment cycles after one or more unsuccessful attempts [2]. In the present study, we have introduced a logistic regression model that may predict women's assisted fecundity before starting the first IVF/ICSI cycle, i.e., whether women may expect to have a LB at the first treatment cycle or will likely have to wait longer for having a LB.…”

“…This fact may incentivize infertile women to have more treatment cycles after one or more unsuccessful attempts and, therefore, may bias the women's decisionmaking process [2], particularly, in those women displaying low or zero fecundity ("fecundity" is clinically defined as the capacity to have a LB [3]). In order to counteract this potential bias, we have recently proposed that, in addition to be informed about their cumulative LB probabilities across multiple IVF/ICSI cycles, infertile women should know before starting the first IVF/ICSI treatment that their cycle-specific probabilities of achieving a LB decrease as number of ORC increases [2]. Infertile women may be also interested to know before starting the first IVF/ICSI treatment cycle whether they have a high or low capacity to have a LB using assisted reproductive technology.…”

Oocyte activation deficiency and assisted oocyte activation: mechanisms, obstacles and prospects for clinical application

“…Total fertilization failure (TFF) occurs in 1–5% of ICSI cases ( Kyono et al , 2012 ; Montag et al , 2012 ; Vanden Meerschaut et al , 2014b ; Kashir et al , 2018 ; Basirat et al , 2019 ; Bassiri et al , 2020 ). Moreover, associations have been identified between embryo grading and congenital malformations, endocrine profile changes and deficient hearing in ICSI-conceived babies ( Abel et al , 2019 ; Belva et al , 2019 ; Yasemin Sert et al , 2019), while age, antimullerian hormone levels and antral follicle counts are associated with live birth rates following ICSI, with other hormones currently under investigation ( Metello et al , 2019 ; Zheng et al , 2019 ; Song et al , 2020 ; Tarín et al , 2020 ; Tiegs et al , 2020 ; Wang et al , 2020 ; Ye et al , 2020 ; Zanetti et al , 2020 ). The use of ART however does not seem linked to an increase in the risk of autism spectrum disorder or preeclampsia ( Diop et al , 2019 ; Kennedy et al , 2019 ).…”