03 / Cumulative live birth rate following freeze-only versus conventional fresh transfer cycles: a population-based cohort study

Abstract Background For patients embarking on in vitro fertilization (IVF) or Intracytoplasmic sperm injection (ICSI), one of the most concerned problems is their chance of a live-birth. The cumulative live birth rate (CLBR) after IVF has been reported in recent years; however these studies were all about conventional IVF strategy, the CLBRs following freeze-all strategy has not been reported. Methods This was a retrospective cohort study. A total of 20687 women undergoing their first and following IVF cycles during the period from January 1, 2007 through March 31, 2016 were included in this study. The primary Outcomes of the present study were presented in three types: the live birth rate per complete cycle, the conservative CLBR and the optimal CLBR. Results The CLBR increased from 50.74% for the first complete cycle to 64.41% after seven complete cycles,and varied by age category. The CLBR after five complete cycles declined from 77.11% for women younger than 31 years, to 8.63% for women older than 40 years. The predictors of live birth over multiple complete cycles for patients embarking on IVF following freeze-all strategy were women’s age and causes of infertility. In the model constructed for patients finishing the first complete cycle, the number of oocyte retrieved at complete cycle one also played an important predictive role. Conclusions Among women undergoing IVF following freeze-all strategy, the CLBR after seven complete IVF cycles was 84.77% if there were no barriers to continue the IVF treatment, with variation by age. Two prediction models were developed to estimate their probability of having a baby over multiple complete IVF cycles with freeze-all strategy among patients before starting IVF and patients after the first complete cycle, which is critical for patients to make treatment decisions and preparations physically, emotionally and financially.

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P–761 Can modified luteal support in fresh cycle after agonist trigger “rescue” the cumulative live birth rate (CLBR) in high responders

Human Reproduction ◽

10.1093/humrep/deab130.760 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

D Chowdhury ◽

Y Kopeika

Keyword(s):

Live Birth ◽

Birth Rate ◽

Live Birth Rate ◽

Cumulative Live Birth Rate ◽

Luteal Support ◽

Cumulative Live Birth ◽

Multiple Variables ◽

High Responders ◽

Agonist Trigger ◽

Fresh Transfer

Abstract Study question Can modified luteal support in fresh cycle “rescue” the cumulative live birth rate (CLBR) in high responders who receive agonist trigger? Summary answer Live birth rate in high responders who had agonist trigger in fresh cycle was significantly reduced despite modified luteal support. What is known already Previous studies, including small randomised controlled trials, claimed that good live birth rate could be achieved at fresh transfer in “high responders” who had GnRHa trigger with modified luteal phase support. However, majority of these studies exclude the true high responders (patients with 20 and above oocytes) and average number of collected eggs reported in many of these studies in the range of 9 to 12. The data on outcome of fresh transfer in true high responders is very limited. Study design, size, duration A prospective observational study was conducted in 407 patients, aged 23–42 years who were expected to be at risk of high response (AFC>18, AMH>20 pmol/l) undergoing controlled ovarian stimulation between 2014–2019 triggered either with HCG or GnRH agonist. Live birth rate (LBR) in a fresh and subsequent 3 frozen transfers were compared in groups with different triggers and freeze all. Participants/materials, setting, methods Patients were stimulated in short antagonist protocol. The trigger was chosen based on the background characteristics, peak oestradiol and clinician discretion. Triggering was achieved either with 0.5 mg buserelin (GnRHa) 0.5mgin 230 patients (A) or with 250 mcg of hCG(H) in 177 patients. Modified luteal support included vaginal progesterone, oral oestrogen and 1500 iu of hCG on the day of egg retrieval. The later was omitted with more than 20 oocytes. Main results and the role of chance The mean age, AFC, number of previous cycles, number of embryos transferred were 33.3, 22.4, 0.26 and 1.2 respectively and did not have significant difference between different triggers. Whereas AMH (53 pmol/l (A) vs 43.1 pmol/l (H), P = 0.003), peak oestradiol (15140.74 (A) vs 9738.59 (H), P = 5.59X10–14), and number of oocytes collected (21 vs.17, P = 5.63X10–7) were significantly higher in GnRHa group. Seventeen patients in buserelin group had elective freeze all. Ovarian Hyperstimulation Syndrome (OHSS) rate was 3.9% in buserelin group (more then half of these cases had a bolus of hCG at egg collection; most were mild/moderate). On the other hand, hCG group had 2.5% of OHSS (all severe). Live birth rate in fresh cycle was 31% in hCG and 21% in GnRHa groups. If freeze all was undertaken in fresh cycle after GnRHa trigger, then LBR in the first frozen cycle of this group was 53% (P = 0.003, fresh vs frozen GnRHa group). CLBR was not different between GnRHa and hCG groups (51%). However, this was significantly lower than CLBR in GnRHa trigger freeze all group 76% (P = 0.03) Limitations, reasons for caution The limitation of this study is its non-randomised nature. However, since it is one of the biggest studies for high responders it has a power to minimise bias by adjusting for multiple variables. Wider implications of the findings: Proceeding with fresh transfer in high responders after GnRHa trigger with modified luteal support not only maintains the risk of OHSS (equivalent to hCG group) but also significantly impairs the LBR not compensated even after 3 subsequent frozen embryo transfers. Therefore, freeze-all approach should be preferred in this group. Trial registration number NA

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O-137 Salpingectomy versus neosalpingostomy in women with hydrosalpinx: a prospective cohort study with long-term follow-up

Human Reproduction ◽

10.1093/humrep/deab126.068 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

L Yan ◽

C Zhu ◽

G Liang ◽

C He ◽

Y Liang ◽

...

Keyword(s):

Cohort Study ◽

In Vitro Fertilization ◽

Live Birth ◽

Birth Rate ◽

Live Birth Rate ◽

Cumulative Live Birth Rate ◽

Vitro Fertilization ◽

Cumulative Live Birth ◽

Natural Conception

Abstract Study question What is the comparative effectiveness between salpingectomy and neosalpingostomy in the treatment of bilateral severe hydrosalpinx? Summary answer In women with bilateral severe hydrosalpinx, salpingectomy combined with In Vitro Fertilization (IVF) treatment resulted in a higher cumulative live birth rate than neosalpingostomy. What is known already Hydrosalpinx accounts for 25% to 35% of female subfertility and has a negative effect on pregnancy rates in women who undergo IVF. So far salpingectomy before in vitro fertilization treatment has been suggested for the treatment of hydrosalpinx in order to improve the chance of a live birth. Previous studies have reported a pooled live birth rate of 25% through natural conception after neosalpingostomy and an ongoing pregnancy rate of 55.8% after salpingectomy with IVF. Direct comparison of the cumulative live birth rate after salpingectomy versus neosalpingostomy, both followed by IVF is lacking. Study design, size, duration We performed a single center, prospective comparative cohort study in the International Peace Maternity and Child Health Hospital affiliated to Shanghai Jiao Tong University School of Medicine, China. We studied women diagnosed with tubal subfertility with bilateral hydrosalpinx between January 2005 and December 2012. Based on a shared decision approach, they had bilateral salpingectomy or neosalpingostomy followed by IVF. They were annually followed up until July 2020 for the occurrence of live birth. Participants/materials, setting, methods Out of 113 women, 55 had bilateral salpingectomy and 58 had bilateral neosalpingostomy. Primary outcome was cumulative live birth rate, defined as the cumulative birth rate of the first living neonate through either natural conception or in vitro fertilization. Both intention-to-treat (ITT) and per-protocol (PP) analysis were processed. Cox proportional hazards regression model with potential variables was performed to identify predictors of successful live birth. Main results and the role of chance Baseline characteristics were comparable between two groups. There were 42 live births in the salpingectomy and 36 in the neosalpingostomy group. When the result of IVF was incorporated (55/55 in salpingectomy group and 25/58 in neosalpingostomy group underwent IVF), salpingectomy resulted in a higher cumulative live birth rate (85.3% vs 76.0%; hazard ratio of the whole survival curve, 2.18; 95% CI, 1.37 - 3.45; P = 0.001), a lower risk of ectopic pregnancy (1.8% vs 20.7%; risk ratio, 0.07; 95% CI, 0.01 - 0.57; P = 0.013), and a shorter time to live birth (19 [14,27] versus 36 [17,76] months, P = 0.001).The number of live birth rates after natural conception was 0% (0/55) in the salpingectomy group and 28% (16/58) in neosalpingostomy group.The results of PP analyses were comparable with the ITT analyses apart from the biochemical pregnancy rate and the overall live birth rate, they were higher (the former: 76% (42/55) versus 58% (29/50), P = 0.045; the latter: 76% (42/55) versus 56% (28/50), P = 0.027) in salpingectomy group. Limitations, reasons for caution This is an observational study. The small sample size along with the data was obtained from a cohort study in a single center. Wider implications of the findings In women with confirmed bilateral severe hydrosalpinx, salpingectomy followed by IVF results in a higher cumulative live birth rate and decreases the risk of EP as compared to neosalpingostomy. However, neosalpingostomy is the only option to achieve a live birth by natural conception that should be discussed with patients preoperatively. Trial registration number not applicable

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Analysis of cumulative Live Birth Rate (cLBR) after up to five IVF/ICSI treatments in relationship to the number of the complete cycle

10.26226/morressier.573c1513d462b80296c987a3 ◽

2016 ◽

Author(s):

Andrea Borini

Keyword(s):

Live Birth ◽

Birth Rate ◽

Live Birth Rate ◽

Cumulative Live Birth Rate ◽

Complete Cycle ◽

Cumulative Live Birth

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Cumulative live birth rate after preimplantation genetic screening in repeated implantation failure: is there still a place for replacing genetically uncreened embryos?

10.26226/morressier.5912d9ead462b8029238629f ◽

2017 ◽

Author(s):

Marta Devesa Rodriguez de la Rua

Keyword(s):

Live Birth ◽

Genetic Screening ◽

Birth Rate ◽

Live Birth Rate ◽

Preimplantation Genetic Screening ◽

Implantation Failure ◽

Cumulative Live Birth Rate ◽

Repeated Implantation Failure ◽

Cumulative Live Birth

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Comparing the cumulative live birth rate of cleavage-stage versus blastocyst-stage embryo transfers between IVF cycles: a study protocol for a multicentre randomised controlled superiority trial (the ToF trial)

BMJ Open ◽

10.1136/bmjopen-2020-042395 ◽

2021 ◽

Vol 11 (1) ◽

pp. e042395

Author(s):

Simone Cornelisse ◽

Liliana Ramos ◽

Brigitte Arends ◽

Janneke J Brink-van der Vlugt ◽

Jan Peter de Bruin ◽

...

Keyword(s):

Embryo Transfer ◽

Live Birth ◽

Birth Rate ◽

Live Birth Rate ◽

Oocyte Retrieval ◽

Blastocyst Stage ◽

Cleavage Stage ◽

Cumulative Live Birth Rate ◽

Cumulative Live Birth ◽

Superiority Trial

IntroductionIn vitro fertilisation (IVF) has evolved as an intervention of choice to help couples with infertility to conceive. In the last decade, a strategy change in the day of embryo transfer has been developed. Many IVF centres choose nowadays to transfer at later stages of embryo development, for example, transferring embryos at blastocyst stage instead of cleavage stage. However, it still is not known which embryo transfer policy in IVF is more efficient in terms of cumulative live birth rate (cLBR), following a fresh and the subsequent frozen–thawed transfers after one oocyte retrieval. Furthermore, studies reporting on obstetric and neonatal outcomes from both transfer policies are limited.Methods and analysisWe have set up a multicentre randomised superiority trial in the Netherlands, named the Three or Fivetrial. We plan to include 1200 women with an indication for IVF with at least four embryos available on day 2 after the oocyte retrieval. Women are randomly allocated to either (1) control group: embryo transfer on day 3 and cryopreservation of supernumerary good-quality embryos on day 3 or 4, or (2) intervention group: embryo transfer on day 5 and cryopreservation of supernumerary good-quality embryos on day 5 or 6. The primary outcome is the cLBR per oocyte retrieval. Secondary outcomes include LBR following fresh transfer, multiple pregnancy rate and time until pregnancy leading a live birth. We will also assess the obstetric and neonatal outcomes, costs and patients’ treatment burden.Ethics and disseminationThe study protocol has been approved by the Central Committee on Research involving Human Subjects in the Netherlands in June 2018 (CCMO NL 64060.000.18). The results of this trial will be submitted for publication in international peer-reviewed and in open access journals.Trial registration numberNetherlands Trial Register (NL 6857).

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