What is the most relevant standard of success in assisted reproduction? The singleton, term gestation, live birth rate per cycle initiated: the BESST endpoint for assisted reproduction

Abstract

Assisted reproduction programmes do not report success consistently. Rates vary with the definition used. Success must reflect delivery of healthy babies, and the burden of treatment to couples. We report the singleton, term gestation, live birth rate of a baby per assisted reproductive technology cycle initiated for a large IVF programme. We defined assisted reproductive technology cycles as those initiated with the intention of oocyte collection. We examined cycles conducted through Monash IVF in 2001. All women with positive pregnancy tests had first trimester ultrasonography. Obstetric outcomes were recorded. All babies had neonatal examinations conducted by paediatricians. A total of 644 positive pregnancy tests were recorded in 2600 cycles; 509 showed fetal heart motion. Of 448 deliveries, 328 were singleton and 120 were multiple. There were 290 singleton deliveries at term gestation. In 2001, a couple had an 11.1% chance of delivering a singleton, term gestation, live baby per assisted reproductive technology cycle begun. We suggest that delivery of a single, term gestation, live baby per cycle initiated is the most relevant standard of success. This statistic was 11.1% at Monash IVF. We encourage programmes to report this BESST (Birth Emphasizing a Successful Singleton at Term) outcome.

Stillbirth Rates in Singletons, Twins and Triplets in Sweden, 1869 to 2001

“…Recently, a radical new way of measuring the success of IVF clinics has been proposed. The goal is to prevent twin and higher multiple gestations and to minimize the number of prematures and stillbirths (Min et al, 2004). They also suggest the establishment of a new definition of a successful outcome in ART as appropriate and that the delivery of a single healthy baby per ART cycle initiated is the most relevant standard of success.…”

Social egg freezing: for better, not for worse

“…A broad discussion on this topic has already taken place. For regular IVF, a good standard appears to be the term singleton live birth rate per initiated ART cycle (Min et al, 2004) or alternatively the live birth rate per ovarian stimulation started (Griesinger et al, 2004), whereby the percentage of multiple pregnancies is specified.…”

The interface between assisted reproductive technologies and genetics: technical, social, ethical and legal issues

“…17 Infertility has been described as 'a failure to conceive after at least one year of unprotected coitus'. 18 The definition of the concepts of infertility, subfertility and sterility has however raised discussion.…”

“…73 The provision of 'delivery of a single, term gestation, live baby per cycle initiated' has been introduced as a new standard of success for IVF clinics. 17 Also, preterm singleton live births are proposed to be noted then. 74 …”