Research question

How do cumulative live birth rates (CLBR), cumulative multiple live birth rates (CMLBR) and dropout rates over six IVF and intracytoplasmic sperm injection (ICSI) cycles change over time?

Design

Prospective longitudinal cohort (n = 16,073 patients; 48,946 cycles) starting a first fresh assisted reproductive technology cycle between 1 January 2014 and 31 December 2016, with follow-up until 31 December 2017. Outcomes between the periods 2014–2017 and 2009–2012 were compared.

Results

Conservative estimates of CLBR after six complete cycles were significantly higher in women younger than 35 years after every cycle: one to three, adjusted P-value [p adj] < 0.0001; four, p = 0.01; five, p adj = 0.03; six, p adj = 0.04) and after the first cycle in women aged 35–37 years (p adj = 0.04) in 2014–2017 versus 2009–2012. For an optimal estimate, the CLBR was significantly higher after the first three cycles in women younger than 35 years (all p adj < 0.0001) and after the first cycle in women aged 35–37 years (p adj = 0.04). The CMLBR rate decreased from 5.1% ± 0.19 (SE) to 4.1% ± 0.16 for the conservative estimate and from 8.6% ±0.37 (SE) to 6.7% ± 0.30 for the optimal estimate after six complete cycles for the whole cohort. Dropout rates of complete cycles were 26.5% 29.4%, 33.4%, 38.9% and 47.3% after the first to fifth cycle, respectively. Compared with 2009–2012, the dropout rate in the current period was significantly higher for the first (P < 0.0001) and second (P = 0.0124) cycle.

Conclusion

Over six complete IVF/ICSI cycles, CLBR and dropout rates increased and multiple live birth rates decreased when 2014–2017 was compared with 2009–2012.

中文翻译：

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六个完整 IVF/ICSI 周期中累积活产率和脱落率的演变：一项大型前瞻性队列研究

研究问题

六个 IVF 和卵胞浆内单精子注射 (ICSI) 周期的累积活产率 (CLBR)、累积多胎活产率 (CMLBR) 和辍学率如何随时间变化？

设计

前瞻性纵向队列（n  = 16,073 名患者；48,946 个周期）在 2014 年 1 月 1 日至 2016 年 12 月 31 日期间开始第一个新鲜辅助生殖技术周期，随访至 2017 年 12 月 31 日。2014-2017 年和 2009-20 年期间的结果为比较的。

结果

6 个完整周期后 CLBR 的保守估计值在每个周期后 35 岁以下的女性中显着更高：1 到 3 个，调整后的P-value [p adj] < 0.0001; 四、p=0.01；五、p adj = 0.03；六，p adj = 0.04）和2014-2017年与2009-2012年35-37岁女性的第一个周期后（p adj = 0.04）。对于最佳估计，35 岁以下女性的前三个周期后（所有 p adj < 0.0001）和 35-37 岁女性的第一个周期后（p adj = 0.04）的 CLBR 显着更高。在整个队列的六个完整周期后，CMLBR 率从保守估计的 5.1% ± 0.19 (SE) 降至 4.1% ± 0.16，并从最佳估计的 8.6% ±0.37 (SE) 降至 6.7% ± 0.30。在第一个到第五个周期后，完整周期的辍学率分别为 26.5%、29.4%、33.4%、38.9% 和 47.3%。与2009-2012年相比，本期辍学率明显偏高（P< 0.0001) 和第二个 ( P  = 0.0124) 周期。

结论

与 2009-2012 年相比，2014-2017 年超过 6 个完整的 IVF/ICSI 周期，CLBR 和辍学率增加，多胎活产率下降。