Reducing the incidence of twins from IVF treatments: predictive modelling from a retrospective cohort

Roberts, Stephen A.; McGowan, Linda; Hirst, WM; Vail, Andy; Rutherford, Anthony J.; Lieberman, Brian A.; Brison, Daniel R.

doi:10.1093/humrep/deq352

Cited by 36 publications

(26 citation statements)

References 32 publications

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“…Embryo cryopreservation has the potential to reduce multiple gestation rates through an eSET paradigm in which embryos from the same stimulation are transferred, one at a time, in subsequent cycles. Repeat SET was shown to be equivalent to or outperform repeat DET in the towardSET Collaboration predictive model in terms of cumulative live birth rate and the risk of twins, provided that loss of viability due to freeze-thaw was moderate or less [26]. Dizygotic twinning was also eliminated in the repeat SET model, whereas the repeat DET model predicted a 20.9 % twin rate with a lower overall live birth rate (39.0 % vs. 41.4 %; [26]).…”

Section: Discussionmentioning

confidence: 99%

“…Repeat SET was shown to be equivalent to or outperform repeat DET in the towardSET Collaboration predictive model in terms of cumulative live birth rate and the risk of twins, provided that loss of viability due to freeze-thaw was moderate or less [26]. Dizygotic twinning was also eliminated in the repeat SET model, whereas the repeat DET model predicted a 20.9 % twin rate with a lower overall live birth rate (39.0 % vs. 41.4 %; [26]). Moreover, there is accumulating evidence that both pregnancy rates [1,27,[30][31][32] and obstetric and neonatal outcomes [11,19] may be improved in cryopreserved cycles, specifically due to uncoupling the processes of COH and embryo transfer.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of twin live birth following cryopreserved double embryo transfer on day 3

Kaser

Missmer

Correia

et al. 2013

J Assist Reprod Genet

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Purpose To determine embryo and cycle-specific parameters associated with twin live birth in day 3 cryopreserved double embryo transfer (DET) cycles, and to propose a new prediction model for external validation. Methods All cycles with autologous or donor cryopreserved DET of day 3 embryos from 2002 to 2011 at a single academic institution with a singleton or twin live birth were included (n=207). Patient characteristics, post-thaw embryo morphology and freeze-thaw parameters were compared between patients with a single and twin live birth. Results Demographic characteristics were similar, except that patients delivering twins were younger at age of cryopreserved embryo transfer (CET), fewer were parous and more were anovulatory. Duration of embryo storage, time in culture post-thaw, endometrial thickness and use of assisted hatching were comparable. Six predictors of twin delivery were identified: patient age <35 year at CET, intact survival of the lead embryo, resumption of mitosis, 7-8 viable cells in the non-lead embryo, transfer of a lead embryo with ≥7 cells and a sum of ≥14 viable cells in the two transferred embryos. Regression modeling predicted a step-wise increase in the probability of twins with addition of each predictor; with all six present, the risk of twins was predicted to be 53 % and with none present, the risk decreased to 6 %. Conclusions The six identified variables associated with twin live birth following day 3 cryopreserved DET have been applied to derive a prediction model for estimating the risk of twin delivery. External validation of the model is required prior to clinical application.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Predictors of twin live birth following cryopreserved double embryo transfer on day 3

Kaser

Missmer

Correia

et al. 2013

J Assist Reprod Genet

View full text Add to dashboard Cite

show abstract

“…However, what really matters to the infertile couples under IVF treatment is whether there will be a success or not after a completed treatment cycle which includes fresh plus cryopreserved embryos transferred from one stimulated cycle. Few studies (Roberts et al, 2011) have been done to address this question. Therefore, our study concentrated on the chance of achieving a pregnancy after the completed treatment cycle per couple treated and only considered the candidate variables collected before embryo transfer of the fresh cycle.…”

Section: Introductionmentioning

confidence: 99%

Factors predicting the cumulative outcome of IVF/ICSI treatment: a multivariable analysis of 2450 patients

Cai

Wan

Huang³

et al. 2011

Human Reproduction

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background: Knowing predictors of pregnancy in IVF is helpful for clinicians to individualize the treatment plans and improve patient counseling and for patients to decide whether to undergo infertility treatment. The aim of the study was to identify independent predictors of the chance of clinical pregnancy after a completed IVF/ICSI cycle (fresh plus cryopreserved embryos transferred from one stimulated cycle) and to compare the predictive value of important predictors identified. results:The following nine independent predictors were included in the final multivariable model: total number of good-quality embryos, total number of embryos, age, antral follicle count, fertilization rate, duration of infertility, endometrial thickness, number of 10 -14-mm follicles and progesterone level on the day of hCG injection. The model was cross-validated internally in the training data and validated externally in an independent data with robust performance. The stratified analysis demonstrated that the total number of good-quality embryos was a better predictor of clinical pregnancy chance after a completed IVF/ICSI cycle than age for women ,40 years, whereas age was a better predictor for women ≥40 years. The restricted cubic spline analysis revealed the relationship between the total number of good-quality embryos and log-odds of achieving a clinical pregnancy was nonlinear.conclusions: Quality and quantity of the whole embryos are the two most important predictors of the cumulative outcome in IVF/ ICSI among independent predictors indentified. The importance of embryo quality on cumulative outcome in IVF/ICSI increases with increasing age.

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“…Recent retrospective studies [16,23] shows that elective single embryo transfer after replacement of thawed embryos results in similar pregnancy rates and a significant decrease in multiple pregnancy rates.…”

Section: Discussionmentioning

confidence: 99%

Contribution of cryopreservation in a mandatory SET policy: analysis of 5 years of application of law in an academic IVF center

Salame

Devreker

Imbert

et al. 2011

J Assist Reprod Genet

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Objective To analyse treatment outcomes after SET law enforcement and to evaluate the contribution of cryopreservation in a SET policy. Material Embryo transfer cycles performed after the law enforcement (SET period) was retrospectively compared to the cycles performed before the law enforcement (DET period).Results Pregnancy and delivery rates after fresh transfer of SET and DET periods were comparable (31.7% versus 33.3% and 24.5% versus 26.2%, respectively, NS). Overall twin delivery rate is significantly decreased after the law enforcement (11.3% versus 22.4%, p<0.001) but not in patients aged 36 to 39 years (20.3% versus 24%, NS). Frozen-thawed embryo cycles allowed similar cumulative pregnancy rate (30.6%, NS). Taking into account all frozen embryos still to be transferred, SET period offers a better overall pregnancy rate than the DET period (36.1% versus 32.3%, p<0.01). ConclusionsThe Belgian law allowed a dramatic reduction of twin deliveries especially for patients under 36 years. Cryopreservation maintains a similar cumulative pregnancy rate.

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Reducing the incidence of twins from IVF treatments: predictive modelling from a retrospective cohort

Cited by 36 publications

References 32 publications

Predictors of twin live birth following cryopreserved double embryo transfer on day 3

Predictors of twin live birth following cryopreserved double embryo transfer on day 3

Factors predicting the cumulative outcome of IVF/ICSI treatment: a multivariable analysis of 2450 patients

Contribution of cryopreservation in a mandatory SET policy: analysis of 5 years of application of law in an academic IVF center

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