FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 360:236-243 January 15, 2009 Number 3 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Supplementary Material Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background Outcomes of in vitro fertilization (IVF) treatment are traditionally reported as pregnancies per IVF cycle. However, a couple's primary concern is the chance of a live birth over an entire treatment course.

Methods We estimated cumulative live-birth rates among patients undergoing their first fresh-embryo, nondonor IVF cycle between 2000 and 2005 at one large center. Couples were followed until either discontinuation of treatment or delivery of a live-born infant. Analyses were stratified according to maternal age and performed with the use of both optimistic and conservative methods. Optimistic methods assumed that patients who did not return for subsequent IVF cycles would have the same chance of a pregnancy resulting in a live birth as patients who continued treatment; conservative methods assumed no live births among patients who did not return.

Results Among 6164 patients undergoing 14,248 cycles, the cumulative live-birth rate after 6 cycles was 72% (95% confidence interval [CI], 70 to 74) with the optimistic analysis and 51% (95% CI, 49 to 52) with the conservative analysis. Among patients who were younger than 35 years of age, the corresponding rates after six cycles were 86% (95% CI, 83 to 88) and 65% (95% CI, 64 to 67). Among patients who were 40 years of age or older, the corresponding rates were 42% (95% CI, 37 to 47) and 23% (95% CI, 21 to 25). The cumulative live-birth rate decreased with increasing age, and the age-stratified curves (<35 vs. 40 years) were significantly different from one another (P<0.001).

Conclusions Our results indicate that IVF may largely overcome infertility in younger women, but it does not reverse the age-dependent decline in fertility.

Source Information

From Boston IVF, Waltham, MA (B.A.M., A.S.P.); and the Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center and Harvard Medical School — both in Boston (B.A.M., M.R.H., A.S.P.).

Address reprint requests to Dr. Penzias at Boston IVF, 130 Second Ave., Waltham, MA 02451, or at apenzias{at}bidmc.harvard.edu.

Full Text of this Article

This article has been cited by other articles:

• Brandes, M., Hamilton, C.J.C.M., de Bruin, J.P., Nelen, W.L.D.M., Kremer, J.A.M. (2010). The relative contribution of IVF to the total ongoing pregnancy rate in a subfertile cohort. Hum Reprod 25: 118-126 [Abstract] [Full Text]  
• Brandes, M., van der Steen, J.O.M., Bokdam, S.B., Hamilton, C.J.C.M., de Bruin, J.P., Nelen, W.L.D.M., Kremer, J.A.M. (2009). When and why do subfertile couples discontinue their fertility care? A longitudinal cohort study in a secondary care subfertility population. Hum Reprod 24: 3127-3135 [Abstract] [Full Text]  
• Verpoest, W., Haentjens, P., De Rycke, M., Staessen, C., Sermon, K., Bonduelle, M., Devroey, P., Liebaers, I. (2009). Cumulative reproductive outcome after preimplantation genetic diagnosis: a report on 1498 couples. Hum Reprod 24: 2951-2959 [Abstract] [Full Text]  
• Thurin-Kjellberg, A., Olivius, C., Bergh, C. (2009). Cumulative Live-Birth Rates in a Trial of Single-Embryo or Double-Embryo Transfer. NEJM 361: 1812-1813 [Full Text]  
• Siassakos, D., Amber, S., Wardle, P. (2009). Author's reply. The Obstetrician and Gynaecologist 11: 148-149 [Full Text]  
• (2009). All you need to read in the other general journals. BMJ 338: b176-b176 [Full Text]  
• (2009). Cumulative Live-Birth Rates After IVF. JWatch General 2009: 4-4 [Full Text]  
• (2009). Live-Birth Rate as a Measure of IVF Success. JWatch Women's Health 2009: 1-1 [Full Text]