Objective

To develop in vitro fertilization (IVF) prediction models to estimate the individualized chance of cumulative live birth at two time points: pretreatment (i.e., before starting the first complete cycle of IVF) and posttreatment (i.e., before starting the second complete cycle of IVF in those couples whose first complete cycle was unsuccessful).

Design

Population-based cohort study.

Setting

National data from the Society for Assisted Reproductive Technology (SART) Clinic Outcome Reporting System.

Patient(s)

Based on 88,614 women who commenced IVF treatment using their own eggs and partner’s sperm in SART member clinics.

Intervention(s)

Not applicable.

Main Outcome Measure(s)

The pretreatment model estimated the cumulative chance of a live birth over a maximum of three complete cycles of IVF, whereas the posttreatment model did so over the second and third complete cycles. One complete cycle included all fresh and frozen embryo transfers resulting from one episode of ovarian stimulation. We considered the first live birth episode, including singletons and multiple births.

Result(s)

Pretreatment predictors included woman’s age (35 years vs. 25 years, adjusted odds ratio 0.69, 95% confidence interval 0.66–0.73) and body mass index (35 kg/m² vs. 25 kg/m², adjusted odds ratio 0.75, 95% confidence interval 0.72–0.78). The posttreatment model additionally included the number of eggs from the first complete cycle (15 vs. 9 eggs, adjusted odds ratio 1.10, 95% confidence interval 1.03–1.18). According to the pretreatment model, a nulliparous woman aged 34 years with a body mass index of 23.3 kg/m², male partner infertility, and an antimüllerian hormone level of 3 ng/mL has a 61.7% chance of having a live birth over her first complete cycle of IVF (and a cumulative chance over three complete cycles of 88.8%). If a live birth is not achieved, according to the posttreatment model, her chance of having a live birth over the second complete cycle 1 year later (age 35 years, number of eggs 7) is 42.9%. The C-statistic for all models was between 0.71 and 0.73.

Conclusion(s)

The focus of previous IVF prediction models based on US data has been cumulative live birth excluding cycles involving frozen embryos. These novel prediction models provide clinically relevant estimates that could help clinicians and couples plan IVF treatment at different points in time.

中文翻译：

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预测体外受精后的个性化累积活产

客观的

开发体外受精 (IVF) 预测模型，以估计在两个时间点累积活产的个体化机会：治疗前（即在 IVF 的第一个完整周期开始之前）和治疗后（即在 IVF 的第二个完整周期开始之前）在那些第一个完整周期不成功的夫妇中）。

设计

基于人群的队列研究。

环境

来自辅助生殖技术协会 (SART) 临床结果报告系统的国家数据。

耐心）

基于在 SART 成员诊所使用自己的卵子和伴侣的精子开始 IVF 治疗的 88,614 名女性。

干预措施

不适用。

主要观察指标）

预处理模型估计了在最多三个完整的体外受精周期内活产的累积机会，而后处理模型在第二个和第三个完整周期内估计了活产的累积机会。一个完整的周期包括由一次卵巢刺激引起的所有新鲜和冷冻胚胎移植。我们考虑了第一个活产事件，包括单胎和多胎。

结果）

治疗前预测因素包括女性年龄（35 岁 vs. 25 岁，调整优势比 0.69，95% 置信区间 0.66-0.73）和体重指数（35 kg/m ² vs. 25 kg/m ²，调整优势比 0.75, 95 % 置信区间 0.72–0.78)。后处理模型还包括第一个完整周期的卵子数量（15 对 9 个卵子，调整优势比 1.10，95% 置信区间 1.03-1.18）。根据预处理模型，一名 34 岁的未生育女性，体重指数为 23.3 kg/m ², 男性伴侣不孕症和 3 ng/mL 的抗苗勒管激素水平在她的第一个完整的 IVF 周期中有 61.7% 的机会活产（三个完整周期的累积机会为 88.8%）。如果没有实现活产，根据治疗后模型，她在 1 年后的第二个完整周期（年龄 35 岁，卵子数 7）内活产的几率为 42.9%。所有模型的 C 统计量在 0.71 和 0.73 之间。

结论

以前基于美国数据的 IVF 预测模型的重点是累积活产，不包括涉及冷冻胚胎的周期。这些新颖的预测模型提供了临床相关的估计，可以帮助临床医生和夫妇在不同的时间点计划 IVF 治疗。