scholarly journals Improvements in IVF in women of advanced age

2016 ◽  
Vol 230 (1) ◽  
pp. F1-F6 ◽  
Author(s):  
Norbert Gleicher ◽  
Vitaly A Kushnir ◽  
David F Albertini ◽  
David H Barad
Keyword(s):  
Older Women ◽  
Live Birth ◽  
Private Insurance ◽  
Patient Choice ◽  
Insurance Companies ◽  
Published Data ◽  
Birth Rates ◽  
Ivf Outcomes ◽  
Live Birth Rates ◽  
Donor Oocytes

Women above age 40 years in the US now represent the most rapidly growing age group having children. Patients undergoing in vitro fertilization (IVF) are rapidly aging in parallel. Especially where egg donations are legal, donation cycles, therefore, multiply more rapidly than autologous IVF cycles. The donor oocytes, however, are hardly ever a preferred patient choice. Since with use of own eggs, live birth rates decline with advancing age but remain stable (and higher) with donor eggs, older patients always face the difficult and very personal choice between poorer chances with own and better chances with donor oocytes. Physician contribution to this decision should in our opinion be restricted to accurate outcome information for both options. Achievable pregnancy and live birth rates in older women are, however, frequently underestimated, thereby mistakenly biasing fertility providers, private insurance companies and even regulatory government agencies. Restriction on access to IVF for older women is then often the consequence. In this review, we summarize the limited published data on best treatments of ‘older’ ovaries, while also addressing treatment approaches that should be avoided in older women. This focused review, therefore, to a degree is subjective. Research addressing aging ovaries in IVF has been disappointingly sparse, and has in our opinion too heavily concentrated on methods of embryo selection (ES), which, especially in older women, not only fail to improve IVF outcomes, but actually, negatively affect live birth chances. We conclude that, aside from breakthroughs in gamete creation, only pharmacological interventions into early (small growing follicle stages) follicle maturation will offer new potential to positively impact oocyte and embryo quality and, therefore, IVF outcomes. Research, therefore, should be accordingly redirected.

O-170 Predictive value of cytoplasmic granulation patterns during IVF in MII oocytes from young donors

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
J Hu ◽  
E Molinari ◽  
S Darmon ◽  
D F Albertini ◽  
D H Barad ◽  
...  
Keyword(s):  
Cohort Study ◽  
Live Birth ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Developmental Competence ◽  
Birth Rates ◽  
Predictive Values ◽  
Ivf Outcomes ◽  
Live Birth Rates ◽  
Donor Oocytes

Abstract Study question Do ooplasm granulation patterns of donor MII oocytes have similar predictive values for in vitro fertilization (IVF) outcomes as they have in older infertile women? Summary answer Ooplasm granulation patterns of donor MII oocytes are predictive for IVF outcomes in young oocyte donors even more pronounced than in older poor prognosis patients. What is known already Cytoplasmic granules had been noticed for years, with data mostly focused on central granulation. Dispersed granulations were mentioned but lacked analysis. Study design, size, duration A retrospective cohort study during 2017-2020. Participants/materials, setting, methods We investigated 776 fresh and 381 vitrified-thawed MII oocytes from carefully selected young donors (mean, 26.7±2.7; range, 21-35 years) and determined cytoplasmic granulation patterns during intracytoplasmic sperm injection as fine, central, uneven, dispersed and peripheral (see only in thawed oocytes). Fertilization, pregnancy and live-birth rates in fresh and thawed donor oocytes were analyzed Main results and the role of chance In fresh donor oocytes: 2PN rates significantly trended down from 96.3% to 90.7%, 89.2%, 66.7% from fine to central, uneven, dispersed granulations; overall pregnancy rates trended down from 48.8% to 29.0%, 19.0% and 6.4%, as did live birth rates (42.1%, 21.6%, 12.5%, 6.4%), from fine to uneven, central and dispersed granulations. Known-pregnancy and known-live-birth analyses showed similar findings. Thawed donor oocytes demonstrated similar trends, though with significantly worse outcomes than fresh oocytes. Peripheral granulation, unique to vitrification and thawing, always demonstrated the worst IVF outcomes. Interestingly, granulation patterns were mostly disassociated from morphologic embryo grades in fresh and thawed donor oocytes. Limitations, reasons for caution As a retrospective cohort study, some cases had to be excluded for lack of information. The scoring system may have diluted the real contribution of an oocyte when two or more embryos were transferred. Wider implications of the findings Ooplasm granulation patterns have predictive values for fertilization, pregnancy and live birth in IVF cycles, supporting integration of them into embryo selection, and suggesting that ooplasm granulation patterns reflect intrinsic features of oocytes that relate to oocyte quality, cytoplasmic maturity and developmental competence, but are largely independent of clinical co-variables. Trial registration number NA

scholarly journals Worldwide decline of IVF birth rates and its probable causes

2019 ◽  
Vol 2019 (3) ◽  
Author(s):  
N Gleicher ◽  
V A Kushnir ◽  
D H Barad
Keyword(s):  
New Zealand ◽  
Live Birth ◽  
Outcome Expectations ◽  
Single Embryo Transfer ◽  
Birth Rates ◽  
Preimplantation Genetic Testing ◽  
Ivf Outcomes ◽  
Live Birth Rates ◽  
The Usa ◽  
Mild Stimulation

Abstract With steadily improving pregnancy and live birth rates, IVF over approximately the first two and a half decades evolved into a highly successful treatment for female and male infertility, reaching peak live birth rates by 2001–2002. Plateauing rates, thereafter, actually started declining in most regions of the world. We here report worldwide IVF live birth rates between 2004 and 2016, defined as live births per fresh IVF/ICSI cycle started, and how the introduction of certain practice add-ons in timing was associated with changes in these live birth rates. We also attempted to define how rapid worldwide ‘industrialization’ (transition from a private practice model to an investor-driven industry) and ‘commoditization’ in IVF practice (primary competitive emphasis on revenue rather than IVF outcomes) affected IVF outcomes. The data presented here are based on published regional registry data from governments and/or specialty societies, covering the USA, Canada, the UK, Australia/New Zealand (combined), Latin America (as a block) and Japan. Changes in live birth rates were associated with introduction of new IVF practices, including mild stimulation, elective single embryo transfer (eSET), PGS (now renamed preimplantation genetic testing for aneuploidy), all-freeze cycles and embryo banking. Profound negative associations were observed with mild stimulation, extended embryo culture to blastocyst and eSET in Japan, Australia/New Zealand and Canada but to milder degrees also elsewhere. Effects of ‘industrialization’ suggested rising utilization of add-ons (‘commoditization’), increased IVF costs, reduced live birth rates and poorer patient satisfaction. Over the past decade and a half, IVF, therefore, has increasingly disappointed outcome expectations. Remarkably, neither the profession nor the public have paid attention to this development which, therefore, also has gone unexplained. It now urgently calls for evidence-based explanations.

scholarly journals PREDICTED LIVE BIRTH RATES (LBRS) FOR SINGLE THAWED EUPLOID EMBRYO TRANSFERS (STEETS) DO NOT DIFFER FOR FRESH AUTOLOGOUS, CRYOPRESERVED (CP), AND DONOR OOCYTES

2021 ◽  
Vol 116 (3) ◽  
pp. e255
Author(s):  
Hilary S. Friedlander ◽  
Nicole D. Yoder ◽  
Sarah D. Cascante ◽  
David H. McCulloh ◽  
Frederick L. Licciardi
Keyword(s):  
Live Birth ◽  
Birth Rates ◽  
Live Birth Rates ◽  
Donor Oocytes ◽  
Euploid Embryo

scholarly journals The impact of adenomyosis on IVF outcomes: a prospective cohort study

2021 ◽  
Vol 2021 (2) ◽  
Author(s):  
Chloe Higgins ◽  
Hugo Fernandes ◽  
Fabricio Da Silva Costa ◽  
Wellington P Martins ◽  
Beverley Vollenhoven ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Live Birth ◽  
Prospective Cohort ◽  
Clinical Pregnancy ◽  
Confounding Factors ◽  
Birth Rates ◽  
Ivf Outcomes ◽  
Live Birth Rates ◽  
Detrimental Impact

Abstract STUDY QUESTION Does the presence of adenomyosis in women treated with IVF alter IVF outcomes? SUMMARY ANSWER Adenomyosis does not significantly alter IVF outcomes when adjusted for confounding factors including maternal age and smoking status. WHAT IS KNOWN ALREADY Studies evaluating adenomyosis and its impact on infertility, particularly when focusing on IVF, remain controversial. Many studies report that adenomyosis has a detrimental effect on IVF outcomes, however age is strongly related with both the prevalence of adenomyosis and worse reproductive outcomes. STUDY DESIGN, SIZE, DURATION A prospective cohort study of women undergoing 4002 IVF cycles who had undergone a screening ultrasound assessing features of adenomyosis from 1 January 2016 to 31 March 2018 at a multi-site private fertility clinic. Of these women, 1228 fulfilled the inclusion criteria and commenced an IVF cycle, with a subset of 715 women undergoing an embryo transfer (ET). Women were defined as having adenomyosis if there was sonographic evidence of adenomyosis on ultrasound as per the Morphological Uterus Sonographic Assessment criteria, and were then compared to women without. PARTICIPANTS/MATERIALS, SETTING, METHODS All women at a private multi-site IVF clinic who underwent a standardised ultrasound to identify features of adenomyosis and also commenced an IVF cycle were assessed for their outcomes. These included clinical pregnancy (defined as the presence of a gestational sac on ultrasound at 7 weeks’ gestation), clinical pregnancy loss, number of cancelled cycles, number of useful embryos for transfer or freezing and live birth rates. As a secondary aim, initiated stimulation cycles and those that had an ET were analysed separately to determine when an effect of adenomyosis on IVF might occur: during stimulation or transfer. MAIN RESULTS AND THE ROLE OF CHANCE When adjusting for confounders, women with and without sonographic features of adenomyosis had no significant differences in most of their IVF outcomes including live birth rates. LIMITATIONS, REASONS FOR CAUTION Adenomyosis had a detrimental impact on IVF outcomes prior to adjusting for confounding factors. No allowance was made for the possibility that confounding factors may merely reduce the effect size of adenomyosis on IVF outcomes. Second, despite a power calculation, the study was underpowered as not all fresh cycles led to an ET. WIDER IMPLICATIONS OF THE FINDINGS This is one of the largest studies to evaluate adenomyosis and IVF outcomes, while also importantly adjusting for confounding factors. The results suggest that adenomyosis does not have the detrimental impact on IVF that has previously been suggested, possibly reducing the importance of screening for and treating this entity. STUDY FUNDING/COMPETING INTEREST(S) The study received no external funding. The authors declare no conflicts of interest. TRIAL REGISTRATION NUMBER ACTRN12617000796381.

Cumulative live birth rates in in-vitro fertilization

2019 ◽  
Vol 71 (3) ◽  
Author(s):  
Panagiotis Drakopoulos ◽  
Joaquín Errázuriz ◽  
Samuel Santos-Ribeiro ◽  
Herman Tournaye ◽  
Alberto Vaiarelli ◽  
...  
Keyword(s):  
In Vitro Fertilization ◽  
Live Birth ◽  
Birth Rates ◽  
Vitro Fertilization ◽  
Live Birth Rates ◽  
Cumulative Live Birth
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