Cumulative Live-Birth Rates Increase Through Nine IVF Cycles

Summary and Comment |
December 22, 2015

Cumulative Live-Birth Rates Increase Through Nine IVF Cycles

  1. Robert W. Rebar, MD

But will couples need or want to persevere for so long?

  1. Robert W. Rebar, MD

With the growing use and success of in vitro fertilization (IVF) comes a question: Are more cycles better? To determine the extent to which repeated IVF cycles increase the likelihood of live birth (defined as an infant born alive after 24 weeks' gestation and surviving longer than 1 month), investigators in the U.K. used data from 257,000 ovarian stimulation cycles initiated between 2003 and 2010 in 157,000 women (median age treatment initiation, 35; median duration of infertility, 4 years). Live-birth outcome data were analyzed through June 2012. One IVF cycle was defined as all fresh and frozen embryo transfers resulting from one episode of ovarian stimulation.

The live-birth rate for the first cycle was 29.5%. The cumulative live-birth rate was 65.3% after the sixth cycle and continued to rise more modestly across nine cycles. Live-birth rates decreased with age, with women aged 40 to 42 achieving a cumulative rate of 31.5% with six cycles. For women older than 42, the live-birth rate within each cycle was <4%.

Comment

The authors suggest that these findings support extending the number of IVF cycles beyond three or four. As an editorialist notes, such data are not available in the otherwise robust U.S. National Assisted Reproductive Technology Surveillance System data from the CDC because they are collected on a per-cycle, rather than a per-couple, basis. While these U.K. data are impressive — and demonstrate how successful IVF has become — just how useful are they? The cost of IVF is sufficiently high and the emotional and physical toll sufficiently great that it's difficult to imagine many women enduring six, let alone nine, ovarian stimulation cycles. With the improvement in survival rates for cryopreserved embryos, most couples who will conceive do so long before six cycles.

Editor Disclosures at Time of Publication

  • Disclosures for Robert W. Rebar, MD at time of publication Editorial Boards Contraception (Deputy Editor); EndoText (Section Editor) Leadership positions in professional societies American Society for Reproductive Medicine (Member Practice Committee)

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