scholarly journals Predicting the Likelihood of Live Birth in Assisted Reproductive Technology According to the Number of Oocytes Retrieved and Female Age Using a Generalized Additive Model: A Retrospective Cohort Analysis of 17,948 Cycles

2021 ◽  
Vol 12 ◽  
Author(s):  
Haiyan Zhu ◽  
Chenqiong Zhao ◽  
Peiwen Xiao ◽  
Songying Zhang
Keyword(s):  
Assisted Reproductive Technology ◽  
Live Birth ◽  
Retrospective Cohort ◽  
Birth Rate ◽  
Generalized Additive Model ◽  
Cohort Analysis ◽  
Additive Model ◽  
Live Birth Rate ◽  
Reproductive Technology ◽  
Retrospective Cohort Analysis

CapsuleWe designed a predictive reference model to evaluate how many stimulation cycles are needed for a patient to achieve an ideal live birth rate using assisted reproductive technology.ObjectiveTo develop a counseling tool for women who wish to undergo assisted reproductive technology (ART) treatment to predict the likelihood of live birth based on age and number of oocytes retrieved.MethodsThis was a 6-year population-based retrospective cohort analysis using individual patient ART data. Between 2012 and 2017, 17,948 women were analyzed from their single ovarian stimulation cycle until they had a live birth or had used all their embryos. All consecutive women between 20 and 49 years old undergoing their ovarian stimulation cycles for ART in our center were enrolled. The cumulative live birth rate (CLBR) was defined as the delivery of a live neonate born during fresh or subsequent frozen–thawed embryo transfer cycles. Only the first delivery was considered in the analysis. Binary logistic regression was performed to identify and adjust for factors known to affect the CLBR independently. A generalized additive model was used to build a predictive model of CLBR according to the woman’s age and the number of oocytes retrieved.ResultsAn evidenced-based counseling tool was created to predict the probability of an individual woman having a live birth, based on her age and the number of oocytes retrieved in ART cycles. The model was verified by 10 times 10-fold cross-validation using the preprocessed data, and 100 area under the curve (AUC) values for receiver operating characteristic (ROC) curves were obtained on the test set. The mean AUC value was 0.7394. Our model predicts different CLBRs ranging from nearly 90% to less than 20% for women aged 20–49 years with at least 22 oocytes retrieved. The CLBRs of women aged 20–28 years were very similar, nearly on one trend line with a certain number of oocytes retrieved. Differences in the CLBR began to appear by the age of 29 years; these increased gradually in women aged >35 years.ConclusionA predictive model of the CLBR was designed to serve as a guide for physicians and for patients considering ART treatment. The number of oocytes needed to be retrieved to achieve a live birth depends on the woman’s age.

scholarly journals Status of racial disparities between black and white women undergoing assisted reproductive technology in the US

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
David B. Seifer ◽  
Burcin Simsek ◽  
Ethan Wantman ◽  
Alexander M. Kotlyar
Keyword(s):  
Black Women ◽  
Assisted Reproductive Technology ◽  
Live Birth ◽  
Birth Rate ◽  
White Women ◽  
Live Birth Rate ◽  
Reproductive Technology ◽  
Cumulative Live Birth Rate ◽  
Cumulative Live Birth ◽  
The Us

Abstract Background Numerous studies have demonstrated substantial differences in assisted reproductive technology outcomes between black non-Hispanic and white non-Hispanic women. We sought to determine if disparities in assisted reproductive technology outcomes between cycles from black non-Hispanic and white non-Hispanic women have changed and to identify factors that may have influenced change and determine racial differences in cumulative live birth rates. Methods This is a retrospective cohort study of the SARTCORS database outcomes for 2014–2016 compared with those previously reported in 2004–2006 and 1999/2000. Patient demographics, etiology of infertility, and cycle outcomes were compared between black non-hispanic and white non-hispanic patients. Categorical values were compared using Chi-squared testing. Continuous variables were compared using t-test. Multiple logistic regression was used to assess confounders. Results We analyzed 122,721 autologous, fresh, non-donor embryo cycles from 2014 to 2016 of which 13,717 cycles from black and 109,004 cycles from white women. The proportion of cycles from black women increased from 6.5 to 8.4%. Cycles from black women were almost 3 times more likely to have tubal and/or uterine factor and body mass index ≥30 kg/m2. Multivariate logistic regression demonstrated that black women had a lower live birth rate (OR 0.71;P < 0.001) and a lower cumulative live birth rate for their initial cycle (OR 0.64; P < 0.001) independent of age, parity, body mass index, etiology of infertility, ovarian reserve, cycle cancellation, past spontaneous abortions, use of intra-cytoplasmic sperm injection or number of embryos transferred. A lower proportion of cycles in black women were represented among non-mandated states (P < 0.001) and cycles in black women were associated with higher clinical live birth rates in mandated states (P = 0.006). Conclusions Disparities in assisted reproductive technology outcomes in the US have persisted for black women over the last 15 years. Limited access to state mandated insurance may be contributory. Race has continued to be an independent prognostic factor for live birth and cumulative live birth rate from assisted reproductive technology in the US.

scholarly journals Fertility-Sparing Treatment and Assisted Reproductive Technology In Patients With Endometrial Carcinoma And Endometrial Hyperplasia: Pregnancy Outcomes After Embryo Transfer

2021 ◽  
Author(s):  
Hilary Friedlander ◽  
Jennifer Blakemore ◽  
David McCulloh ◽  
M. Fino
Keyword(s):  
Endometrial Carcinoma ◽  
Assisted Reproductive Technology ◽  
Embryo Transfer ◽  
Live Birth ◽  
Pregnancy Outcomes ◽  
Endometrial Hyperplasia ◽  
Birth Rate ◽  
Live Birth Rate ◽  
Reproductive Technology ◽  
Fertility Sparing

Abstract Purpose: To evaluate pregnancy outcomes following embryo transfer in patients with endometrial carcinoma (EMCA) or endometrial hyperplasia (EH) who elected for fertility-sparing treatment (FST). Methods: This retrospective cohort study at a large urban university-affiliated fertility center included all patients who underwent embryo transfer after fertility-sparing treatment for EMCA or EH between January 2003 and December 2018. Primary outcomes included embryo transfer results and a live birth rate (defined as number of live births per number of transfers).Results: There were 14 patients, 3 with EMCA and 11 with EH, who met criteria for inclusion with a combined total of 40 embryo transfers. An analysis of observed outcomes by sub-group, compared to the expected outcomes at our center (patients without EMCA/EH matched for age, embryo transfer type and number, and utilization of PGT-A) showed that patients with EMCA/EH after FST had a significantly lower live birth rate than expected (Z = -5.04, df =39, p < 0.01). A sub-group analysis of the 14 euploid embryo transfers resulted in a live birth rate of 21.4% compared to an expected rate of 62.8% (Z = -3.32, df = 13, p < 0.001).Conclusions: Among patients with EMCA/EH who required assisted reproductive technology, live birth rates were lower than expected following embryo transfer when compared to patients without EMCA/EH at our center. Further evaluation of the impact of the diagnosis, treatment and repeated cavity instrumentation for FST is necessary to create an individualized and optimized approach for this unique patient population

scholarly journals Effects Of Hormonal Supplements In Women With Poor Ovarian Response Undergoing Assisted Reproductive Technology

2019 ◽  
pp. 1 ◽  
Author(s):  
Silan Melis Bozan ◽  
Gurkan Bozdag
Keyword(s):  
Growth Hormone ◽  
Assisted Reproductive Technology ◽  
Live Birth ◽  
Birth Rate ◽  
Live Birth Rate ◽  
Ovarian Response ◽  
Reproductive Technology ◽  
Poor Responders ◽  
Poor Ovarian Response ◽  
Technology Cycles

<p>Poor ovarian response remains one of the major challenges of assisted reproductive technology. Over the years, various interventions have been proposed to improve reproductive outcomes in poor responders, yet few have been shown to be beneficial. Recent studies indicate that hormonal pretreatments might increase clinical pregnancy rate, live birth rate and the number of oocytes retrieved in women with poor ovarian response undergoing assisted reproductive technology. Areas covered: Following extensive research of the up to date literature, this review aims to cover current considerations and controversies regarding the use of hormonal supplements such as dehydroepiandrosterone, transdermal testosterone and growth hormone. Expert opinion: There is limited data for the validity of using growth hormone and androgens or androgen modulating agents during assisted reproductive technology cycles in women suffering from poor ovarian response. However, there is a need to support the available data with further randomized controlled trials seeking for live birth rate as the primary outcome.</p>

Assisted reproductive technology outcomes in childhood cancer survivors: A report from the Childhood Cancer Survivor Study.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 10528-10528
Author(s):  
Kimberly W. Keefe ◽  
Andrea Lanes ◽  
Kayla Stratton ◽  
Daniel M. Green ◽  
Eric Jessen Chow ◽  
...  
Keyword(s):  
Childhood Cancer ◽  
Assisted Reproductive Technology ◽  
Live Birth ◽  
Cancer Survivor ◽  
Ovarian Stimulation ◽  
Birth Rate ◽  
Live Birth Rate ◽  
Reproductive Technology ◽  
Female Survivors ◽  
Childhood Cancer Survivor Study

10528 Background: Some treatment exposures for childhood cancer reduce ovarian reserve. Registry-based evaluation has not been conducted for assisted reproductive technology (ART) outcomes of female survivors. Methods: The Childhood Cancer Survivor Study, a retrospective cohort of five-year survivors and siblings, was linked to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS), which captures nationwide, CDC-required reporting of ART outcomes. We assessed live birth rate and relative risk (RR, 95% CI) as a function of treatment exposure, using generalized estimating equation to account for multiple ovarian stimulations per subject. Results: Among 9885 female survivors, 137 (1.4%; median age at diagnosis 10 years, range 0-20; 11 years of follow-up, 2-11) underwent 243 ART cycles (mean 1.8 cycles) and among 2419 siblings, 33 (1.4%) underwent 60 ART cycles (mean 1.8). Median age at autologous egg retrieval was 30 years (19-44) for survivors and 34 (24-43) for siblings. In the subset using autologous eggs (Table), 99 survivors underwent 155 ovarian stimulation cycles that resulted in 113 embryo transfers and 49 live births for a live birth rate of 32% per ovarian stimulation and 43% per transfer. Sibling live birth rate was 38% (p = 0.39 compared to survivors) per autologous ovarian stimulation and 53% (p = 0.33) per transfer. 38 survivors and 1 sibling underwent egg donor ovarian stimulation cycles. Two survivors used autologous eggs with gestational carriers and one cycle resulted in live birth. Cranial radiation therapy (RT) [RR 0.48 (0.27-0.87) p = 0.02] and pelvic RT [0.30 (0.14-0.66) p = 0.002], compared with no RT, resulted in lower RR of live birth in survivors. The likelihood of live birth after ART in survivors was not impacted by alkylator exposure [CED < 8000 mg/m2 vs. none: 1.14 (0.65-2.02); CED >8000 mg/m2 vs none: 1.07 (0.06-1.91)]. Conclusions: While live birth rates among survivors were lower compared with siblings, differences were not statistically significant. Pelvic and cranial RT were associated with a decreased likelihood of live birth, with no association with alkylator exposure identified. [Table: see text]

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