Research Article: Predicting Live Birth, Preterm Delivery, and Low Birth Weight in Infants Born from In Vitro Fertilisation: A Prospective Study of 144,018 Treatment Cycles

Date Published: January 4, 2011

Publisher: Public Library of Science

Author(s): Scott M. Nelson, Debbie A. Lawlor, Nicholas M. Fisk

Abstract: Using the HFEA database of all 144,018 live births in all IVF cycles in the UK between 2003 and 2007, Scott Nelson and Debbie Lawlor show that couple- and treatment-specific factors can be used to help predict successful outcome following IVF.

Partial Text: In-vitro fertilisation (IVF) is now widely used for the treatment of infertility, and validated age-stratified national success rates and outcomes are published annually [1],[2],[3]. To facilitate patient counselling, clinical decision-making, and access to health care provision, prediction models for live birth after IVF have been constructed [4]. However, these studies have been limited by their sample size, development before the introduction of intracytoplasmic sperm injection (ICSI), or lack of validation in external populations [5],[6],[7],[8],[9]. Established multivariable prediction models may therefore not be applicable to contemporary couples seeking treatment. Consequently, clinicians and regulatory bodies have not adopted prediction models and predominantly quote age-related success rates [1],[2],[3].

Figure 1 shows how we established the eligible cohort of IVF treatment cycles (N = 163,425) and the sample used for the main multivariable analyses (i.e. without any missing data N = 144,018; 88% of eligible). Table S1 shows the study characteristics. Amongst the 163,425 eligible cohort, the overall rate of at least one live birth was 23.4 per 100 cycles (95% CI 23.2–23.7). Rates of successful live birth increased linearly over time from 22.7 per 100 cycles in 2003 to 24.9 per 100 cycles in 2007 (p<0.001 for linear trend) (Figure S1). In this study we identify precise estimates of the strength and independence of the factors affecting the odds of IVF success and their association with adverse perinatal outcome. To date, successful prediction of live birth after assisted conception has been limited, with a recent systematic review [4] finding that models were limited by their sample size, incorporating fewer than 3,100 cycles or couples and their lack of external validation. The notable exception was the model of Templeton et al., which analysed 36,961 treatment cycles undertaken in the UK between 1991 and 1994 and was validated in a population of 1,253 couples receiving IVF treatment in The Netherlands between 1991 and 1999 [7],[23]. Since then, ICSI for male factor infertility has been widely adopted, and consequently we demonstrate that this previously validated model, although showing reasonable discrimination, is poorly calibrated and of limited use in contemporary populations. We have developed a new model, which encompasses a series of new measures including use of donor oocytes, ICSI, cycle number, and whether there had been a previous spontaneous or IVF-related live birth or fetal loss. Using this novel model we can statistically significantly improve the overall prediction of live birth as assessed by area under the curve and attain excellent calibration with accurate identification of couples with a poor, moderate, or good prognosis. We also find that maternal characteristics, in particular maternal age, source of the oocyte and cervical causes of infertility are strongly associated with the risk of low birth weight and preterm delivery in singleton live births resulting from IVF. Notably, some of these associations were in the opposite direction to those seen for successful live birth. Thus, in women who successfully have a singleton live birth with IVF, the risk of low birth weight is reduced in older compared with younger women and both low birth weight and preterm are reduced when the woman's own embryo has been used. Source: http://doi.org/10.1371/journal.pmed.1000386

 

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