Conception rate after in vitro fertilization in patients who conceived in a previous cycle

Does gravidity influence the success of in vitro fertilization-embryo transfer cycles?

OBJECTIVE

To evaluate the influence of gravidity on the results of in vitro fertilization (IVF)-embryo transfer (ET) cycles.

PATIENTS AND METHODS

All consecutive women aged <35 years admitted to our IVF unit from January 2002 to December 2004 were enrolled in the study. Only patients undergoing one of their first three IVF cycle attempts were included. Gravidity, ovarian stimulation characteristics, number of oocytes retrieved, number of embryo transferred and clinical pregnancy rate were assessed.

RESULTS

Three hundred and forty-two consecutive IVF cycles were evaluated. One hundred and sixty-one cycles were from nulligravidas and 181 from women with a history of at least one previous clinical pregnancy. Forty-eight (29.8%) clinical pregnancies were observed in the nulligravida group and 56 (30.9%) in the gravida group. There were no differences between nulligravidas and gravidas in causes of infertility, length of ovarian stimulation, peak estradiol and progesterone levels, number of oocytes retrieved, fertilization rate and number of embryos transferred. Gravidas were significantly older (30.4 vs. 27.6 years, p < 0.001) and used more gonadotropin ampoules (36.1 vs. 31.8, p < 0.004) compared with the nulligravidas.

CONCLUSIONS

Patient gravidity has no influence on the likelihood of achieving pregnancy in IVF-ET cycles.

Pregnancy outcome in in vitro fertilization decreases to a plateau with repeated cycles

Clinical pregnancy rate (CPR) and implantation rate (IR) in 1,177 patients who had 1,788 fresh, nondonor, nonPGD IVF cycles were highest in cycle 1, significantly declined in cycle 2, and reached a plateau for cycles 3-5 at a rate lower than in cycle 2. In patients >38 years of age CPR and IR in cycles 1 and 2 were significantly lower than in younger patients, but there was no decline in CPR or IR with advancing IVF attempts.

Previous miscarriages influence IVF and intracytoplasmatic sperm injection pregnancy outcome

Previous conceptions are one predictor for the outcome of assisted reproductive technology procedures. Approximately 18-34% of clinical pregnancies following assisted reproduction procedures result in spontaneous abortion. The risk of such pregnancy loss is believed to increase with women's age, previous miscarriages and use of frozen-thawed embryos. This study analyses German IVF Registry data to examine the impact of previous miscarriages on the outcome of assisted reproduction procedures. The data set consists of a total of 174,909 assisted reproduction procedures performed between January 1998 and December 2000. Multiple logistic regression is used to assess the correlation between women's age, spousal/partner change, and infertility diagnosis. It is demonstrated that any previous miscarriage will increase the treatment-dependent miscarriage rate in assisted reproduction procedures. A significantly higher impact is shown for one previous miscarriage achieved by assisted reproduction procedures compared with spontaneous conception. Partner change is shown to have no specific impact on the treatment dependent miscarriage rate, whereas a statistically significant increase in miscarriages in all assisted reproduction procedures was found among women older than 34 years of age. Overall, the highest rate of treatment-dependent miscarriages was seen in assisted reproduction procedures with cryopreserved embryo transfer.

Impact of reproductive history on in vitro fertilization and intracytoplasmic sperm injection outcome: evidence from the German IVF Registry

OBJECTIVE

To evaluate the effect of reproductive history on the outcome of different procedures in assisted reproductive technologies (ART) comparing IVF, ICSI, and cryopreserved embryo transfer (CPE).

DESIGN

Prospective registration of ART cycles and their outcomes.

SETTING

One hundred three reproductive programs in Germany.

PATIENT(S)

Women undergoing 174,909 ART procedures from January 1998 through December 2000.

INTERVENTION(S)

Data analysis of reproductive history collected by the German IVF Registry; multiple logistic regression modeling of success rates.

MAIN OUTCOME MEASURE(S)

Effect of type of conception and outcome of previous pregnancies, duration of infertility, female's age, and type of ART on clinical pregnancy rate per retrieval. Odds ratios with 95% CIs are reported.

RESULT(S)

More than one previous pregnancy was negatively correlated with outcome of IVF, ICSI, or CPE. This association disappeared when female age was restricted to a maximum of 35 years. A previous pregnancy achieved by spontaneous conception had less impact on outcome of IVF, ICSI or CPE outcome than did a previous assisted conception. Previous live births and miscarriages demonstrated a statistically significant increase compared with ectopic pregnancies and induced abortions.

CONCLUSION(S)

Reproductive history must be considered when counseling subfertile couples. Female age, method of conception, and previous pregnancy outcome have a significant effect on IVF, ICSI, and CPE outcome.

Effect of repeated assisted reproductive technology on ovarian response

PURPOSE OF REVIEW

Based on current rates of success, many infertile couples who desire pregnancy have to undergo repeated cycles of assisted reproductive technology. Concern has been raised that repeated cycles of assisted reproductive technology may have a detrimental effect on future ovarian response and function, as well as pregnancy. This review summarizes current knowledge of the effects of repeated assisted reproductive technology, highlighting recent publications.

RECENT FINDINGS

The available published evidence so far indicates that the follicular response and the number of oocytes retrieved appears to be maintained with repeated treatment and the only significant decline in ovarian response is because of an increase in female age. Similarly pregnancy and live birth rates decline to a small degree only up to cycle 3 or 4, with increasing female age again being the prime determinant. Encouraging patients to undertake repeated treatment without undue delay leads to improved cumulative rates of pregnancy and live birth. Current evidence does not indicate that ovarian stimulation leads to an increased risk of ovarian malignancy.

SUMMARY

Couples should be counselled from the outset that assisted reproductive technology treatment is a continuum and a number of treatment cycles may be necessary. At present, there is little indication that repeated cycles have a detrimental effect on ovarian function, although the outcome of further research is awaited.

Early pregnancy loss in in vitro fertilization (IVF) is a positive predictor of subsequent IVF success

OBJECTIVE

To determine the significance of biochemical pregnancy losses and clinical spontaneous abortion (SAB) on outcomes of future IVF cycles.

DESIGN

Retrospective cohort study.

SETTING

Academic IVF program.

PATIENT(S)

Women with a history of unsuccessful IVF attempts undergoing IVF.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Clinical pregnancy rate.

RESULT(S)

Patients with an early pregnancy loss had a greater ongoing clinical pregnancy rate in the immediate next cycle when compared with those women who had a negative pregnancy test (37.3% vs. 27.3%). Patients with a history of a biochemical pregnancy or a clinical spontaneous abortion had an ongoing clinical pregnancy rate in the next cycle of 38.4% and 42.3%, respectively, compared with 27.3% in women who had a history of a negative pregnancy test. The cumulative pregnancy rate after the first IVF attempt was 54.1% in patients with a previous biochemical pregnancy loss, 61.4% in those with a previous clinical SAB, and 46.5% in women with a previous negative pregnancy test.

CONCLUSION(S)

Women who experience an early pregnancy loss after IVF have a greater likelihood of success in subsequent IVF cycles when compared with patients who fail to conceive.

Dramatic declines in implantation and pregnancy rates in patients who undergo repeated cycles of in vitro fertilization with blastocyst transfer after one or more failed attempts

OBJECTIVE

To compare the outcome of second and third cycles of in vitro fertilization with blastocyst transfer to the outcome of first attempts at IVF with blastocyst transfer.

DESIGN

Retrospective study.

SETTING

Private ART center.

PATIENT(S)

Three hundred and four patients undergoing treatment with in vitro fertilization with blastocyst transfer, 87 of which underwent at least one cycle of re-treatment after failing to achieve pregnancy in their first cycle.

INTERVENTION(S)

Bipronucleate oocytes were grown for up to 144 hours and subsequently transferred when at least one embryo attained the expanded blastocyst stage.

MAIN OUTCOME MEASURE(S)

Pregnancy and implantation rates.

RESULT(S)

Pregnancy rates per retrieval were significantly higher for patients undergoing their first cycle of in vitro fertilization with blastocyst transfer (36%) compared to those undergoing their second (19%) or their third (9%) cycles of treatment. Implantation rates per embryo were also higher for first cycles of in vitro fertilization with blastocyst transfer (30%) compared to second (18%) or third cycles (8%).

CONCLUSION(S)

Pregnancy and implantation rates decline dramatically in repeated cycles of in vitro fertilization with blastocyst transfer following one or more unsuccessful cycles of in vitro fertilization with blastocyst transfer.

Spontaneous conception after a successful attempt at in vitro fertilization/intracytoplasmic sperm injection

OBJECTIVE

To determine the incidence of spontaneous pregnancy in women who were not actively undergoing therapy after a successful attempt at IVF/intracytoplasmic sperm injection and to characterize its pattern of occurrence.

DESIGN

Retrospective postal questionnaire.

SETTING

An assisted reproduction unit at a university-based teaching hospital.

PATIENT(S)

Five hundred thirteen replies were received from 530 questionnaires mailed.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Spontaneous pregnancy. Women who did and did not conceive spontaneously after successful IVF treatment were compared in terms of their age, duration of infertility, previous reproductive history, and indication for treatment at the time of assisted reproduction.

RESULT(S)

The rate of spontaneous conception among the survey respondents was 20.7%. Younger women (</=34 years of age) had a higher rate of spontaneous conception, as did those with a shorter duration of infertility. Women with unexplained infertility and endometriosis also were more likely to conceive. Few of those who had undergone intracytoplasmic sperm injection conceived, whereas 21.6% of those whose partners had had sperm quality sufficient for IVF later conceived spontaneously.

CONCLUSION(S)

The chances of spontaneous conception after successful ART therapy are significant in some groups of patients. This has implications for the practice of assisted reproduction and the obstetric care of patients who conceive with treatment. Contraceptive advice may need to be provided to couples who undergo IVF/intracytoplasmic sperm injection.

Spontaneous conception after the birth of infants conceived through in vitro fertilization treatment

OBJECTIVE

To investigate the incidence of spontaneous conception after the birth of infants conceived through IVF in couples with subfertility caused by endometriosis, a mild male factor, or unexplained factors, and to identify clinical conditions related to the occurrence of spontaneous conception.

DESIGN

Retrospective analysis.

SETTING

Department of Obstetrics and Gynecology, Akita University School of Medicine, Akita, Japan.

PATIENT(S)

One hundred forty-two women who conceived through IVF and 25 of the 142 women who subsequently conceived spontaneously.

INTERVENTION(S)

Patient characteristics and IVF data were obtained from hospital records, and follow-up data were collected through telephone interviews.

MAIN OUTCOME MEASURE(S)

Cumulative conception rate.

RESULT(S)

The cumulative conception rate at 60 months after the delivery of infants conceived through IVF was 18%, with most conceptions occurring within 2 years of delivery. Proportional hazard analysis indicated that patient age was the most important clinical variable related to the occurrence of spontaneous conception.

CONCLUSION(S)

This study provides information that will be useful in counseling subfertile couples who have conceived through the use of IVF.

Oocyte donation: does a previous attempt affect a subsequent attempt?

OBJECTIVE

To analyze the effect of a previous donor oocyte cycle on the outcome of subsequent attempts.

DESIGN

Retrospective study.

SETTING

Oocyte donation program at The New York Hospital/Cornell Medical Center.

PATIENT(S)

Two hundred sixty-seven patients undergoing 354 fresh cycles of oocyte donation.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Clinical outcomes were divided into groups based on the attempt number of each cycle for each patient. Results were calculated for each recipient cycle.

RESULT(S)

A clinical pregnancy rate of 56.2% and ongoing pregnancy/delivery rate per retrieval of 50.3% were noted. No statistically significant differences in clinical outcomes were found between the first, second, and third attempts. A significant increase was noted in the ongoing pregnancy/delivery rate per recipient cycle for the second attempt in those patients who had a delivery after the first attempt compared with those who did not.

CONCLUSION(S)

We demonstrated an overall clinical pregnancy rate of 56.2% and an ongoing pregnancy/delivery rate of 50.3% per retrieval. Outcome for the second attempt was associated with success or failure during an initial attempt at oocyte donation.

Coculture of embryos on homologous endometrial cells in patients with repeated failures of implantation

OBJECTIVE

To evaluate the value of coculture of embryos on endometrial cells in patients with repeated failures of implantation.

DESIGN

A retrospective comparison of pregnancy rates between IVF-ET with coculture and standard culture methods.

PATIENTS

Ninety patients with repeated failures of transfer (range 4 to 11) underwent IVF-ET for a variety of disorders.

METHOD

Embryos were cocultured on homologous endometrial cells and transferred on day 4 after retrieval of oocytes.

RESULTS

The overall pregnancy rate for these patients was 21% per transfer versus 8% in previous IVF-ET cycles. A higher percentage (28%) was obtained for women < 39 years of age or on transfer of at least one morula (32.5% pregnancy per transfer).

CONCLUSION

Coculture of embryos on homologous endometrial cells is both safe and ethical. It appears to be a valuable approach for the selection of a good quality embryo before transfer. The technique should prove to be of benefit to patients with repeated failures of implantation and also may be of value for assessing the respective responsibility of endometrium and embryo in these repeated failures. However, the mechanisms underlying this improvement need to be determined to simplify the procedure.