Objective To examine the effect of body mass index (BMI) on IVF outcomes in fresh autologous cycles. Design Retrospective cohort study. Setting Not applicable. Patient(s) A total of 239,127 fresh IVF ...cycles from the 2008–2010 Society for Assisted Reproductive Technology registry were stratified into cohorts based on World Health Organization BMI guidelines. Cycles reporting normal BMI (18.5–24.9 kg/m2 ) were used as the reference group (REF). Subanalyses were performed on cycles reporting purely polycystic ovary syndrome (PCOS)–related infertility and those with purely male-factor infertility (34,137 and 89,354 cycles, respectively). Intervention(s) None. Main Outcome Measure(s) Implantation rate, clinical pregnancy rate, pregnancy loss rate, and live birth rate. Result(s) Success rates and adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for all pregnancy outcomes were most favorable in cohorts with low and normal BMIs and progressively worsened as BMI increased. Obesity also had a negative impact on IVF outcomes in cycles performed for PCOS and male-factor infertility, although it did not always reach statistical significance. Conclusion(s) Success rates in fresh autologous cycles, including those done for specifically PCOS or male-factor infertility, are highest in those with low and normal BMIs. Furthermore, there is a progressive and statistically significant worsening of outcomes in groups with higher BMIs. More research is needed to determine the causes and extent of the influence of BMI on IVF success rates in other patient populations.
To assess in vitro fertilization (IVF) and pregnancy outcomes in patients having their first frozen embryo transfer (FET) after a freeze-all cycle versus similar patients having their first fresh ...embryo transfer (ET).
Retrospective cohort study.
None.
Registry data on 82,935 patient cycles from the Society for Assisted Reproductive Technology (SART).
All first fresh autologous IVF cycles were analyzed and compared to first FET cycles after a freeze-all first IVF stimulation. The cycles were subdivided into cohorts based upon the number of oocytes retrieved (OR): 1–5 (low), 6–14 (intermediate), and 15+ (high responders). Univariate analyses were performed on cycle characteristics, and multivariable regression analyses were performed on outcome data.
Clinical pregnancy rate (CPR) and live-birth rate (LBR).
Of the 82,935 cycles analyzed, 69,102 patients had their first fresh transfer, and 13,833 had a first FET. High responders were found to have a higher CPR and LBR in the FET cycles compared with the fresh ET cycles (61.5 vs. 57.4%; 52.0 vs. 48.9%). In intermediate responders, both CPR and LBR were higher after fresh ET compared with FET (49.6% vs. 44.2%; 41.2 vs. 35.3%). Similarly, in low responders, CPR and LBR were higher after fresh compared with FET (33.2% vs. 15.9%; 25.9% vs. 11.5%).
A freeze-all strategy is beneficial in high responders but not in intermediate or low responders, thus refuting the idea that freeze-all cycles are preferable for all patients.
Congelar todos los embriones en Fecundación in vitro es beneficioso en las altas respondedoras, pero no en las respuestas intermedias o bajas: un análisis de 82.935 ciclos del registro de la Sociedad para los Tratamientos de Reproducción Asistida
Valorar los resultados reproductivos tras FIV en pacientes que realizaron su primera transferencia embrionaria de embriones congelados (TEC) tras un ciclo de “congelar todo” los embriones, versus pacientes con características similares y que realizaron su primera transferencia embrionaria en fresco.
Estudio retrospectivo de cohorte.
Ninguno.
Datos registrados de 82.953 ciclos de pacientes en la Sociedad para los Tratamientos de Reproducción Asistida (SART).
Todos los primeros ciclos autólogos de FIV en fresco fueron analizados y comparados con la primera transferencia embrionaria de embriones congelados de los ciclos en los que se congelaron todos los embriones en un primer ciclo. Los ciclos fueron subdivididos en cohortes basados en el número de ovocito obtenidos: 1-5 (bajo), 6-14 (intermedio) y más de 15 (alta respuesta). Para las características del ciclo se realizó un análisis univariante, mientras que para los resultados reproductivos se realizó una regresión multivariable.
Tasa de gestación clínica y tasa de recién nacido vivo (RNV).
De los 82.935 ciclos analizados, 69.102 pacientes tuvieron su primera transferencia de embriones en fresco, mientras que 13.883, tuvieron su primera transferencia de embriones congelados después de un ciclo de “congelar todo”. En las pacientes con una alta respuesta, se ha observado una tasa de gestación y de RNV mayor tras la transferencia de los embriones congelados comparado con los ciclos de transferencia de embriones en fresco (61,5 vs 57,4%; 52 vs 48,9%). En el grupo de pacientes con una respuesta intermedia, tanto la tasa de gestación como la de RNV han sido mayores tras transferencia en fresco comparado con la transferencia de embriones congelados (49,6% vs 44,2%; 41,2 vs 35,3%). De manera similar, en el grupo de baja respuesta, tanto la tasa de gestación como la de RNV han sido más altas tras transferencia en fresco comparado con la transferencia de embriones congelados (33,2% vs 15,9%; 25,9% vs 11,5%).
La estrategia de congelar todos los embriones es beneficiosa en los ciclos con una alta respuesta, pero no en los que cursan con una respuesta intermedia o baja, refutando así la idea de que congelar todos los embriones sea de elección para todos los pacientes.
Objective To examine the effect of recipient body mass index (BMI) on IVF outcomes in fresh donor oocyte cycles. Design Retrospective cohort study. Setting Not applicable. Patient(s) A total of ...22,317 donor oocyte cycles from the 2008–2010 Society for Assisted Reproductive Technology Clinic Outcome Reporting System registry were stratified into cohorts based on World Health Organization BMI guidelines. Cycles reporting normal recipient BMI (18.5–24.9) were used as the reference group. Intervention(s) None. Main Outcome Measure(s) Implantation rate, clinical pregnancy rate (PR), pregnancy loss rate, live birth rate. Result(s) Success rates and adjusted odds ratios with 95% confidence intervals for all pregnancy outcomes were most favorable in cohorts of recipients with low and normal BMI, but progressively worsened as BMI increased. Conclusion(s) Success rates in recipient cycles are highest in those with low and normal BMI. Furthermore, there is a progressive and statistically significant worsening of outcomes in groups with higher BMI with respect to clinical pregnancy and live birth rate.
Objective To study the impact of controlled ovarian stimulation on ectopic pregnancy (EP) rate as a function of the number of oocytes retrieved, using donor IVF cycles as a control. Design ...Retrospective cohort study using a large national database. Setting Not applicable. Patient(s) Data from 109,140 cycles from the 2008–2010 SART registry, including 91,504 autologous cycles and 17,636 donor cycles in patients with non-tubal infertility. Intervention(s) Varying amounts of oocytes retrieved in autologous and donor IVF. Main Outcome Measure(s) Ectopic pregnancy rates. Result(s) In autologous cycles, the EP rate significantly increased as oocyte yield increased. This association was not found in oocyte recipients. Conclusion(s) In autologous IVF cycles, increasing oocyte yield is correlated with a significantly increased EP rate. This association is not found in oocyte recipients, indicating that the increased EP rate may be due to the supraphysiologic hormone levels achieved with controlled ovarian hyperstimulation.
Purpose
To develop an innovative machine learning (ML) model that predicts personalized risk of primary ovarian insufficiency (POI) after chemotherapy for reproductive-aged women. Currently, ...individualized prediction of a patient’s risk of POI is challenging.
Methods
Authors of published studies examining POI after gonadotoxic therapy were contacted, and six authors shared their de-identified data (
N
= 435). A composite outcome for POI was determined for each patient and validated by 3 authors. The primary dataset was partitioned into training and test sets; random forest binary classifiers were trained, and mean prediction scores were computed. Institutional data collected from a cross-sectional survey of cancer survivors (
N
= 117) was used as another independent validation set.
Results
Our model predicted individualized risk of POI with an accuracy of 88% (area under the ROC 0.87, 95% CI: 0.77–0.96;
p
< 0.001). Mean prediction scores for patients who developed POI and who did not were 0.60 and 0.38 (
t
-test
p
< 0.001), respectively. Highly weighted variables included age, chemotherapy dose, prior treatment, smoking, and baseline diminished ovarian reserve.
Conclusion
We developed an ML-based model to estimate personalized risk of POI after chemotherapy. Our web-based calculator will be a user-friendly decision aid for individualizing risk prediction in oncofertility consultations.
Objective To analyze donor oocyte cycles in the Society for Assisted Reproductive Technology (SART) registry to determine: 1) how many cycles complied with the 2009 American Society for Reproductive ...Medicine/SART embryo transfer guidelines; and 2) cycle outcomes according to the number of embryos transferred. For donor oocyte IVF with donor age <35 years, the consideration of single-embryo transfer was strongly recommended. Design Retrospective cohort study of United States national registry information. Setting Not applicable. Patient(s) A total of 13,393 donor-recipient cycles from 2011 to 2012. Intervention(s) Embryos transferred in donor IVF cycles. Main Outcome Measure(s) Percentage of compliant cycles, multiple pregnancy rate. Result(s) There were 3,157 donor cleavage-stage transfers and 10,236 donor blastocyst transfers. In the cleavage-stage cycles, 88% met compliance criteria. The multiple pregnancy rate (MPR) was significantly higher in the noncompliant cycles. In a subanalysis of compliant cleavage-stage cycles, 91% transferred two embryos and only 9% single embryos. In those patients transferring two embryos, the MPR was significantly higher (33% vs. 1%). In blastocyst transfers, only 28% of the cycles met compliance criteria. The MPR was significantly higher in the noncompliant blastocyst cohort at 53% (compared with 2% in compliant cycles). Conclusion(s) The majority of donor cleavage-stage transfers are compliant with current guidelines, but the transfer of two embryos results in a significantly higher MPR compared with single-embryo transfer. The majority of donor blastocyst cycles are noncompliant, which appears to be driving an unacceptably high MPR in these cycles.
Oocyte donation has optimized our understanding of ovarian stimulation. Increasing the follicle-stimulating hormone (FSH) dose has been shown to adversely affect live birth rates in autologous ...cycles. Our objective is to assess whether this relationship holds true within the donor/recipient population.
Retrospective cohort study.
Not applicable.
Data from 2014−2016 included 8,627 fresh donor cycles.
None.
Live birth, clinical pregnancy, and miscarriage rates.
The mean donor age ± standard deviation (SD) was 25.8 ± 2.8 years. Donors underwent a median of 16 days (interquartile range IQR 12, 19) of stimulation with a median (IQR) total FSH dose and daily dose of 2,350.0 (1,800.0, 3,025.0) and 153.8 (113.2, 205.0) IU, respectively. The live birth rate was 56.7% per transfer. For every 500-unit increase in FSH dose, there was a 3% reduction in the odds of a live birth (odds ratio OR 0.97; 95% confidence interval 0.95, 0.99), and a 3% reduction in the odds of a clinical pregnancy (OR 0.97; 95% confidence interval 0.95, 0.99). Days of stimulation and average daily dose were not significantly associated with live birth or clinical pregnancy. No significant association was found between miscarriage rates and total FSH dose, days of stimulation, or average daily dose.
This is a novel report of a negative association of total FSH dosage on fresh IVF live births, performed in the donor population to control for oocyte source and endometrial receptivity.
La dosis total de hormona foliculoestimulante está negativamente correlacionada con los recién nacidos en un modelo de donante/receptora con transferencia en fresco: un análisis de 8,627 ciclos del Registro de la Sociedad de Tecnología en Reproducción Asistida.
La donación de ovocitos ha optimizado nuestra comprensión de la estimulación ovárica. Se ha demostrado que el aumento de la dosis de la hormona foliculoestimulante (FSH) afecta adversamente las tasas de nacido vivo en ciclos autólogos. Nuestro objetivo es evaluar si esta relación se mantiene cierta en la población donante/receptora.
Estudio de cohorte retrospectivo.
No aplicable.
Datos de 2014-2016 que incluyeron 8,627 ciclos de donación en fresco.
Ninguna.
Tasas de nacido vivo, embarazo clínico y aborto.
La edad media de las donantes ± la desviación estándar (SD) fue 25.8 ± 2.8 años. Las donantes se sometieron a una media de 16 días (rango intercuartílico IQR 12, 19) de estimulación, con una media (IQR) de dosis total de FSH y de dosis diaria de 2,350.0 (1,800.0, 3,025.0) y 153.8 (113.2, 205.0) UI, respectivamente. La tasa de nacido vivo fue de 56.7% por transferencia. Por cada 500 unidades de incremento en la dosis de FSH, hubo un 3% de reducción en la probabilidad de nacido vivo (razón de probabilidad OR 0.97; intervalo de confianza del 95% de 0.95, 0.99) y un 3% de reducción en la probabilidad de embarazo clínico (OR 0.97; intervalo de confianza del 95% de 0.95, 0.99). Los días de estimulación y la dosis diaria promedio no estaban significativamente asociados con nacido vivo o embarazo clínico. No se encontró asociación significativa entre tasas de aborto y dosis total de FSH, días de estimulación o dosis diaria promedio.
Este es un estudio novedoso sobre la asociación de la dosis total de FSH con nacidos vivos en FIV en fresco, realizado en la población de donantes para controlar la fuente de ovocitos y la receptividad endometrial.
Objective To determine whether IVF clinics are compliant with American Society for Reproductive Medicine (ASRM) and Society for Assisted Reproductive Technology (SART) (ASRM/SART) guidelines and ...assess the multiple pregnancy outcomes according to the number of embryos transferred. Design Retrospective cohort study. Setting Not applicable. Patient(s) Data from 59,689 fresh first autologous IVF cycles from the 2011–2012 SART registry. Intervention(s) None. Main Outcome Measure(s) Percentage of compliant cycles, multiple pregnancy rate (PR). Result(s) Between 2011 and 2012, a total of 59,689 fresh first autologous cycles were analyzed. Among cleavage-stage ET cycles, the noncompliance rate ranged from 10%–27.4% depending on the age group. The multiple PR was significantly increased in noncompliant cycles involving patients <35 years (38.1% vs. 28.7%) and 35–37 years (35.4% vs. 24.5%) compared with compliant cycles. Among blastocyst-stage ET cycles, the highest rate of noncompliance was seen in patients <35 years old (71%), which resulted in a statistically higher multiple PR (48.3% vs. 2.8%) compared with compliant cycles. Far fewer cycles were noncompliant in patients 35–40 years of age. In a subanalysis of compliant cycles, transferring two blastocyst embryos in patients 35–37 years and 38–40 years resulted in a higher live birth rate compared with the transfer of one embryo (50.4% vs. 40.9% and 42.1% vs. 30.0%, respectively) but the multiple PR was also significantly higher (40.5% vs. 1.7% and 34.0% vs. 2.0%, respectively). Conclusion(s) Most first fresh autologous IVF cycles performed from 2011–2012 were compliant with ASRM/SART guidelines, except those that involved a blastocyst ET in patients <35 years. Despite compliance, cycles that involved the transfer of >1 embryo resulted in a high multiple PR, whereas noncompliant cycles resulted in an even more remarkable multiple PR for both cleavage and blastocyst-stage embryos. Clinics need to be more compliant with ET limits and ASRM/SART need to consider revising their guidelines to limit the number of blastocyst transfer to one in patients ≤40 years of age undergoing their first IVF cycle. Furthermore, decreasing the number of cleavage-stage embryos transferred in patients ≤40 years of age should also be considered.
Purpose
In December 2019, the American Society for Reproductive Medicine designated ovarian tissue cryopreservation (OTC) as no longer experimental and an alternative to oocyte cryopreservation (OC) ...for women receiving gonadotoxic therapy. Anticipating increased use of OTC, we compare the cost-effectiveness of OC versus OTC for fertility preservation in oncofertility patients.
Methods
A cost-effectiveness model to compare OC versus OTC was built from a payer perspective. Costs and probabilities were derived from the literature. The primary outcome for effectiveness was the percentage of patients who achieved live birth. Strategies were compared using incremental cost-effectiveness ratios (ICER). All inputs were varied widely in sensitivity analyses.
Results
In the base case, the estimated cost for OC was $16,588 and for OTC $10,032, with 1.56% achieving live birth after OC, and 1.0% after OTC. OC was more costly but more effective than OTC, with an ICER of $1,163,954 per live birth. In sensitivity analyses, OC was less expensive than OTC if utilization was greater than 63%, cost of OC prior to chemotherapy was less than $8100, cost of laparoscopy was greater than $13,700, or standardized discounted costs were used.
Conclusions
With current published prices and utilization, OC is more costly but more effective than OTC. OC becomes cost-saving with increased utilization, when cost of OC prior to chemotherapy is markedly low, cost of laparoscopy is high, or standardized discounted oncofertility pricing is assumed. We identify the critical thresholds of OC and OTC that should be met to deliver more cost-effective care for oncofertility patients.
Background
To evaluate the association of patient and IVF cycle characteristics with blastulation rate and formation of high-quality blastocysts
Results
We analyzed autologous blastocyst cycles from ...2013 to 2017. Cycles were subdivided into low (< 33%), intermediate (33–66%), and high (> 66%) blastulation rates. Embryo quality was assigned by embryologists using Gardner Criteria. R statistical package was used, and the blastulation groups were compared using analysis of variance (ANOVA) for continuous variables and chi-squared tests for categorical variables. The Bonferroni correction was used to adjust for multiple comparisons. One hundred seventeen IVF cycles met our inclusion criteria. Of these, 20 (17.1%) had low, 74 (63.2%) had intermediate, and 23 (19.7%) had high blastulation rates. Low blastulation rate was associated with a lower number of blastocysts, including fewer high-quality blastocysts. The mean number of oocytes retrieved was highest (18.1) in the group with the lowest blastulation rate, and lowest (13.4) in those with the highest blastulation rate, although this did not reach statistical significance. There were no significant differences between blastulation rates and age, gravidity, prior live birth, anti-mullerian hormone, estradiol and progesterone levels on the day of ovulation trigger, follicle-stimulating hormone dose, or fertility diagnosis.
Conclusions
High blastulation rate is associated with a greater number of blastocysts, including a greater number of high-quality blastocysts. Higher oocyte yield, however, is not associated with improved blastulation rates. Blastulation rates, blastocyst number, and quality remain difficult to predict based on cycle characteristics alone, and oocyte yield may not be an accurate predictor of either outcome.
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