Online calculator that tries to predict IVF success released

A woman’s age is the most important factor in her chances of having a baby

Abstract

Objective
To develop a prediction model to estimate the chances of a live birth over multiple complete cycles of in vitro fertilisation (IVF) based on a couple’s specific characteristics and treatment information.

Design
Population based cohort study.

Setting
All licensed IVF clinics in the UK. National data from the Human Fertilisation and Embryology Authority register.

Predicting the chances of a live birth after one or more complete cycles of in vitro fertilisation: population based study of linked cycle data from 113 873 women, The BMJ 2016;355:i5735, 16 November 2016.

Participants
All 253 417 women who started IVF (including intracytoplasmic sperm injection) treatment in the UK from 1999 to 2008 using their own eggs and partner’s sperm.

Main outcome measure
Two clinical prediction models were developed to estimate the individualised cumulative chance of a first live birth over a maximum of six complete cycles of IVF—one model using information available before starting treatment and the other based on additional information collected during the first IVF attempt. A complete cycle is defined as all fresh and frozen-thawed embryo transfers arising from one episode of ovarian stimulation.

Results
After exclusions, 113 873 women with 184 269 complete cycles were included, of whom 33 154 (29.1%) had a live birth after their first complete cycle and 48 925 (43.0%) after six complete cycles. Key pretreatment predictors of live birth were the woman’s age (31 v 37 years; adjusted odds ratio 1.66, 95% confidence interval 1.62 to 1.71) and duration of infertility (3 v 6 years; 1.09, 1.08 to 1.10). Post-treatment predictors included number of eggs collected (13 v 5 eggs; 1.29, 1.27 to 1.32), cryopreservation of embryos (1.91, 1.86 to 1.96), the woman’s age (1.53, 1.49 to 1.58), and stage of embryos transferred (eg, double blastocyst v double cleavage; 1.79, 1.67 to 1.91). Pretreatment, a 30 year old woman with two years of unexplained primary infertility has a 46% chance of having a live birth from the first complete cycle of IVF and a 79% chance over three complete cycles. If she then has five eggs collected in her first complete cycle followed by a single cleavage stage embryo transfer (with no embryos left for freezing) her chances change to 28% and 56%, respectively.

Conclusions
This study provides an individualised estimate of a couple’s cumulative chances of having a baby over a complete package of IVF both before treatment and after the first fresh embryo transfer. This novel resource may help couples plan their treatment and prepare emotionally and financially for their IVF journey.

In vitro fertilization success rate for older women is consistently low

The Misleading Promise of I.V.F. for Women Over 40

” Many young women were understandably seduced by the once widely publicized message that if they chose to delay pregnancy and were then unable to conceive, they could still have babies through in vitro fertilization, also known as I.V.F.

Miriam Zoll was one of them. Married at age 35, she thought she had plenty of time to start a family. After all, she said, “My mother had me at 40, and since 1978, the fertility industry has been celebrating its ability to help women have children at older ages.”

When at 39 she and her husband decided to start a family, they discovered that nature refused to cooperate. Four emotionally and physically exhausting I.V.F. cycles (and two attempted donor egg cycles) later, they remained childless. ” …

… continue reading The Misleading Promise of I.V.F. for Women Over 40NY Times, OCT. 17, 2016.

Outdoor air pollution and human infertility

Outdoor air pollution and reproduction, 2016

Abstract

Air pollution is a current research priority because of its adverse effects on human health, including on fertility.

However, the mechanisms through which air pollution impairs fertility remain unclear.

In this article, we perform a systematic review to evaluate currently available evidence on the impact of air pollution on fertility in humans.

Several studies have assessed the impact of air pollutants on the general population, and have found reduced fertility rates and increased risk of miscarriage.

Outdoor air pollution and human infertility: a systematic review, Fertility and Sterility, Volume 106, Issue 4, Pages 897–904, September 15, 2016.

Image: Environmental Research Group, King’s College London, London Air Quality Network.

In subfertile patients, women exposed to higher concentrations of air pollutants while undergoing IVF showed lower live birth rates and higher rates of miscarriage.

After exposure to similar levels of air pollutants, comparable results have been found regardless of the mode of conception (IVF versus spontaneous conception), suggesting that infertile women are not more susceptible to the effects of pollutants than the general population.

In addition, previous studies have not observed impaired embryo quality after exposure to air pollution, although evidence for this question is sparse.

Clomiphene citrate and hormonal cocktails: women as test-sites for fertility drugs

Clomiphene citrate has a chemical structure similar to DES

Synopsis

Clomiphene citrate is a drug that has been given to women for conventional fertility treatment for over 20 years. It is also now being administered—often in connection with other hormone-like drugs to an increasing number of women in IVF programmes (many of whom are fertile), in order to stimulate egg cell growth. Clomiphene citrate is handed out as if it were a “safe drug.”

This paper analyses some of the medical and scientific literature on the drug including its effect on the women themselves and the children born after such treatment. It also incorporates our research with women who have used the drug.

Women’s Studies International Forum, Feminism and science: In memory of Ruth Bleier, Volume 12, Issue 3, Pages 333-348, 1989.

Full PDF: School of Humanities, Deakin University, Geelong, 3217, Victoria, Australia, citeseerx.ist.psu.edu.

Cocktails image via bustle.

What surfaces is a disturbing array of health hazards ranging from depression, nausea, and weight gain, to burst ovaries, adhesions, and the promotion of cancer leading to death in some women, worrying rates of birth anomalies in the children and severe chromosomal aberrations in egg cell development. Of great concern is the evidence that the drug may stay in a woman’s body for at least six weeks. Since clomiphene citrate has a chemical structure similar to DES there may be as yet unknown long-term adverse effects similar to those from DES. Given the fact that all these “side-effects” have stirred considerable debate in the medical and scientific literature, we are shocked to learn that

  • (a) the women taking the drug are not informed of its possible detrimental effects;
  • (b) and that researchers continue to state, contrary to scientific evidence, that the drug has no side effects.

We posit that the potential risks from the drug are too great to administer it to any women and demand the development of a different science that places values on women’s lives instead of using them as “living test-sites.”

More DES DiEthylStilbestrol Resources

How women are being misled about the success rates of IVF and fertility treatments

Some people are getting IVF who shouldn’t be getting it

The Baby Business – Four Corners, May 31, 2016.

An Australian documentary has claimed that women over 40 are being misled about their chances of conceiving via IVF treatment when using their own eggs.

An investigation by the current affairs documentary Four Corners, on ABC, explained that chances of having a live birth per cycle following IVF treatment using their own fresh eggs were:

  • almost 6% for women aged 41-42 years old,
  • reduced to just under 3% for women aged 43–44 years old,
  • limited to a mere 1% for women over the age of 45.

More Information

IVF Stimulation Drugs to Induce Ovulation: the Risks

Experience: IVF gave me a heart attack

For a long time, I felt angry with the original clinic, but then decided to channel my anger. I now work to raise awareness of the dangers of high-stimulation IVF.

I have also discovered that the UK is well behind other countries in reporting adverse reactions to IVF. This means that if I had died from my heart attack, the real cause would probably never have been found.

I feel so blessed not only to have survived, but to have had two wonderful little girls. I want to do everything I can to protect other women.

Read: IVF gave me a heart attack, the guardian, 6 May 2016.

IVF: BPA causes a linear increase in the death rate of embryos

BPA determined to have adverse effects on couples seeking in vitro fertilization

Endocrine disruptors: Manmade and natural oestrogens: opposite effects on assisted reproduction, Nature Reviews Endocrinology, 18 March 2016.

In a new study, a dramatic decrease in the frequency of implantation, pregnancy and live birth is associated with increased urine levels of Bisphenol-A (BPA) in women undergoing in vitro fertilization (IVF). However, in women who consume soy-containing foods, the interfering effect of BPA on IVF success is negated.

“The findings by Chavarro and colleagues show that the probability of having a surviving embryo goes from more than 50 percent to under 20 percent as levels of BPA increase. … … . As findings continue to mount and confirm that daily exposure to BPA is a reproductive toxicant, it becomes vital to regulate and control this chemical.”

Fred vom Saal, University of Missouri endocrinologist and researcher, BPA determined to have adverse effects on couples seeking in vitro fertilization, MedicalXpress, April 28, 2016.

IVF: the Squishy Squashy Technique to check Embryo Viability

Checking Embryo Viability? Give It a Good Squeeze

Much like a piece of ripe fruit, a human embryo has a certain squishiness that could provide fertility clinic staff with clues about its viability, a new study finds.

Abstract

Human oocyte developmental potential is predicted by mechanical properties within hours after fertilization, NATURE COMMUNICATIONS, Article number: 10809, doi:10.1038/ncomms10809, February 24, 2016.

The causes of embryonic arrest during pre-implantation development are poorly understood.

Attempts to correlate patterns of oocyte gene expression with successful embryo development have been hampered by the lack of reliable and nondestructive predictors of viability at such an early stage.

Here we report that zygote viscoelastic properties can predict blastocyst formation in humans and mice within hours after fertilization, with >90% precision, 95% specificity and 75% sensitivity. We demonstrate that there are significant differences between the transcriptomes of viable and non-viable zygotes, especially in expression of genes important for oocyte maturation. In addition, we show that low-quality oocytes may undergo insufficient cortical granule release and zona-hardening, causing altered mechanics after fertilization.

Checking Embryo Viability? Give It a Good Squeeze, livescience, February 25, 2016.

Our results suggest that embryo potential is largely determined by the quality and maturation of the oocyte before fertilization, and can be predicted through a minimally invasive mechanical measurement at the zygote stage.

Specific genetic pattern in womb might predict whether or not IVF treatment is likely to be successful

Fertility experts identify genetic pattern in womb linked to IVF failure

image of genetic-pattern
Fertility experts in Southampton and the Netherlands have identified a specific genetic pattern in the womb that could predict whether or not IVF treatment is likely to be successful.

Abstract

The discovery should help clinicians understand why IVF fails repeatedly in some women.

The primary limiting factor for effective IVF treatment is successful embryo implantation. Recurrent implantation failure (RIF) is a condition whereby couples fail to achieve pregnancy despite consecutive embryo transfers. Here we describe the collection of gene expression profiles from mid-luteal phase endometrial biopsies (n = 115) from women experiencing RIF and healthy controls. Using a signature discovery set (n = 81) we identify a signature containing 303 genes predictive of RIF. Independent validation in 34 samples shows that the gene signature predicts RIF with 100% positive predictive value (PPV). The strength of the RIF associated expression signature also stratifies RIF patients into distinct groups with different subsequent implantation success rates. Exploration of the expression changes suggests that RIF is primarily associated with reduced cellular proliferation. The gene signature will be of value in counselling and guiding further treatment of women who fail to conceive upon IVF and suggests new avenues for developing intervention.

Sources and more information
  • An endometrial gene expression signature accurately predicts recurrent implantation failure after IVF, nature, 22 January 2016.
  • Fertility experts identify genetic pattern in womb linked to IVF failure, University of Southampton, 22 January 2016.

2/3 of IVF couples conceive by 6th cycle of treatment

Scientists say patients should not view process as a ‘single shot’ as chances of success increase with number of treatments

in-vitro-fertilisation
Recent findings support the efficacy of extending the number of IVF cycles beyond 3 or 4, as 65% of women acheived a live birth by the sixth cycle. Wellcome Images.

2015 Study Abstract

It will take two-thirds of couples undergoing IVF treatment up to six attempts to have a successful pregnancy, according to new research.

Importance
The likelihood of achieving a live birth with repeat in vitro fertilization (IVF) is unclear, yet treatment is commonly limited to 3 or 4 embryo transfers.

Objective
To determine the live-birth rate per initiated ovarian stimulation IVF cycle and with repeated cycles.

Design, Setting, and Participants
Prospective study of 156 947 UK women who received 257 398 IVF ovarian stimulation cycles between 2003 and 2010 and were followed up until June 2012.

Exposures
In vitro fertilization, with a cycle defined as an episode of ovarian stimulation and all subsequent separate fresh and frozen embryo transfers.

Main Outcomes and Measures
Live-birth rate per IVF cycle and the cumulative live-birth rates across all cycles in all women and by age and treatment type. Optimal, prognosis-adjusted, and conservative cumulative live-birth rates were estimated, reflecting 0%, 30%, and 100%, respectively, of women who discontinued due to poor prognosis and having a live-birth rate of 0 had they continued.

Results
Among the 156 947 women, the median age at start of treatment was 35 years (interquartile range, 32-38; range, 18-55), and the median duration of infertility for all 257 398 cycles was 4 years (interquartile range, 2-6; range, <1-29). In all women, the live-birth rate for the first cycle was 29.5% (95% CI, 29.3%-29.7%). This remained above 20% up to and including the fourth cycle. The cumulative prognosis-adjusted live-birth rate across all cycles continued to increase up to the ninth cycle, with 65.3% (95% CI, 64.8%-65.8%) of women achieving a live birth by the sixth cycle. In women younger than 40 years using their own oocytes, the live-birth rate for the first cycle was 32.3% (95% CI, 32.0%-32.5%) and remained above 20% up to and including the fourth cycle. Six cycles achieved a cumulative prognosis-adjusted live-birth rate of 68.4% (95% CI, 67.8%-68.9%). For women aged 40 to 42 years, the live-birth rate for the first cycle was 12.3% (95% CI, 11.8%-12.8%), with 6 cycles achieving a cumulative prognosis-adjusted live-birth rate of 31.5% (95% CI, 29.7%-33.3%). For women older than 42 years, all rates within each cycle were less than 4%. No age differential was observed among women using donor oocytes. Rates were lower for women with untreated male partner–related infertility compared with those with any other cause, but treatment with either intracytoplasmic sperm injection or sperm donation removed this difference.

Conclusions and Relevance
Among women in the United Kingdom undergoing IVF, the cumulative prognosis-adjusted live-birth rate after 6 cycles was 65.3%, with variations by age and treatment type. These findings support the efficacy of extending the number of IVF cycles beyond 3 or 4.

Sources and more information
  • Live-Birth Rate Associated With Repeat In Vitro Fertilization Treatment Cycles, The Journal of American Medical Association, doi:10.1001/jama.2015.17296, December 22/29, 2015.
  • IVF: Two-thirds of couples conceive by sixth cycle of treatment, study says, independent, 22 December 2015.
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