Objectives: To estimate cumulative live birth rates (CLBRs) following repeated assisted reproductive technology (ART) ovarian stimulation cycles, including all fresh and frozen/thaw embryo transfers (complete cycles).
Design, setting and participants: Prospective follow-up of 56 652 women commencing ART in Australian and New Zealand during 2009–2012, and followed until 2014 or the first treatment-dependent live birth.
Main outcome measures: CLBRs and cycle-specific live birth rates were calculated for up to eight cycles, stratified by the age of the women (< 30, 30–34, 35–39, 40–44, > 44 years). Conservative CLBRs assumed that women discontinuing treatment had no chance of achieving a live birth if had they continued treatment; optimal CLBRs assumed that they would have had the same chance as women who continued treatment.
Results: The overall CLBR was 32.7% (95% CI, 32.2–33.1%) in the first cycle, rising by the eighth cycle to 54.3% (95% CI, 53.9–54.7%) (conservative) and 77.2% (95% CI, 76.5–77.9%) (optimal). The CLBR decreased with age and number of complete cycles. For women who commenced ART treatment before 30 years of age, the CLBR for the first complete cycle was 43.7% (95% CI, 42.6–44.7%), rising to 69.2% (95% CI, 68.2–70.1%) (conservative) and 92.8% (95% CI, 91.6–94.0) (optimal) for the seventh cycle. For women aged 40–44 years, the CLBR was 10.7% (95% CI, 10.1–11.3%) for the first complete cycle, rising to 21.0% (95% CI, 20.2–21.8%) (conservative) and 37.9% (95% CI, 35.9–39.9%) (optimal) for the eighth cycle.
Conclusion: CLBRs based on complete cycles are meaningful estimates of ART success, reflecting contemporary clinical practice and encouraging safe practice. These estimates can be used when counselling patients and to inform public policy on ART treatment.
- 1. Inhorn MC, Patrizio P. Infertility around the globe: new thinking on gender, reproductive technologies and global movements in the 21st century. Hum Reprod Update 2015; 21: 411-426.
- 2. Herbert DL, Lucke JC, Dobson AJ. Infertility, medical advice and treatment with fertility hormones and/or in vitro fertilisation: a population perspective from the Australian Longitudinal Study on Women’s Health. Aust N Z J Public Health 2009; 33: 358-364.
- 3. Dyer S, Chambers GM, de Mouzon J, et al. International Committee for Monitoring Assisted Reproductive Technologies world report: assisted reproductive technology 2008, 2009 and 2010. Hum Reprod 2016; 31: 1588-1609.
- 4. Harris K, Fitzgerald O, Paul R, et al. Assisted reproduction technology in Australia and New Zealand 2014. Sydney: National Perinatal Epidemiology and Statistics Unit, University of New South Wales, 2016. https://npesu.unsw.edu.au/sites/default/files/npesu/data_collection/Assisted%20reproductive%20technology%20in%20Australia%20and%20New%20Zealand%202014_0.pdf (accessed May 2017).
- 5. Centers for Disease Control and Prevention, American Society for Reproductive Medicine, Society for Assisted Reproductive Technology. 2013 Assisted reproductive technology fertility clinic success rates report. Atlanta: US Department of Health and Human Services, 2015. https://www.cdc.gov/art/pdf/2013-report/art-2013-fertility-clinic-report.pdf (accessed May 2017).
- 6. Kupka MS, D’Hooghe T, Ferraretti AP, et al. Assisted reproductive technology in Europe, 2011: results generated from European registers by ESHRE. Hum Reprod 2016; 31: 1638-1652.
- 7. Chambers GM, Wand H, Macaldowie A, et al. Population trends and live birth rates associated with common ART treatment strategies. Hum Reprod 2016; 31: 2632-2641.
- 8. The Practice Committee of the American Society for Reproductive Medicine. Multiple pregnancy associated with infertility therapy. Fertil Steril 2006; 86 (5 Suppl 1): S106-S110.
- 9. Cutting R, Morroll D, Roberts SA, et al. Elective single embryo transfer: guidelines for practice British Fertility Society and Association of Clinical Embryologists. Hum Fertil 2008; 11: 131-146.
- 10. Maheshwari A, McLernon D, Bhattacharya S. Cumulative live birth rate: time for a consensus? Hum Reprod 2015; 30: 2703-2707.
- 11. Moragianni VA, Penzias AS. Cumulative live-birth rates after assisted reproductive technology. Curr Opin Obstet Gynecol 2010; 22: 189-192.
- 12. Gameiro S, Boivin J, Peronace L, et al. Why do patients discontinue fertility treatment? A systematic review of reasons and predictors of discontinuation in fertility treatment. Hum Reprod Update 2012; 18: 652-669.
- 13. McLernon DJ, Maheshwari A, Lee AJ, Bhattacharya S. Cumulative live birth rates after one or more complete cycles of IVF: a population-based study of linked cycle data from 178 898 women. Hum Reprod 2016; 31: 572-581.
- 14. Smith AC, Tilling K, Nelson SM, et al. Live-birth rate associated with repeat in vitro fertilization treatment cycles. JAMA 2015; 314: 2654-2662.
- 15. Malizia BA, Hacker MR, Penzias AS. Cumulative live-birth rates after in vitro fertilization. N Engl J Med 2009; 360: 236-243.
- 16. Stern JE, Brown MB, Luke B, et al. Calculating cumulative live-birth rates from linked cycles of assisted reproductive technology (ART): data from the Massachusetts SART CORS. Fertil Steril 2010; 94: 1334-1340.
- 17. van Loendersloot LL, van Wely M, Limpens J, et al. Predictive factors in in vitro fertilization (IVF): a systematic review and meta-analysis. Hum Reprod Update 2010; 16: 577-589.
- 18. Chambers GM, Zhu R, Hoang V, et al. A reduction in public funding for fertility treatment: an econometric analysis of access to treatment and savings to government. BMC Health Serv Res 2012; 12: 142.
- 19. Chambers GM, Hoang VP, Sullivan EA, et al. The impact of consumer affordability on access to assisted reproductive technologies and embryo transfer practices: an international analysis. Fertil Steril 2014; 101: 191-198.e4.
- 20. Hamilton BH, McManus B. The effects of insurance mandates on choices and outcomes in infertility treatment markets. Health Econ 2012; 21: 994-1016.
- 21. Chambers GM, Sullivan EA, Ishihara O, et al. The economic impact of assisted reproductive technology: a review of selected developed countries. Fertil Steril 2009; 91: 2281-2294.
- 22. Chambers GM, Illingworth PJ, Sullivan EA. Assisted reproductive technology: public funding and the voluntary shift to single embryo transfer in Australia. Med J Aust 2011; 195: 594-598. <MJA full text>
- 23. Farquhar CM, Wang YA, Sullivan EA. A comparative analysis of assisted reproductive technology cycles in Australia and New Zealand 2004–2007. Hum Reprod 2010; 25: 2281-2289.
Publication of your online response is subject to the Medical Journal of Australia's editorial discretion. You will be notified by email within five working days should your response be accepted.