Women with a fertility problem in Los Angeles have access to state-of-the-art assisted reproduction technology (ART) at renowned medical centers such as UCLA and Cedars-Sinai. ART is expensive and rigorous; thus, many women are concerned with success rates before they embark on a treatment course. A new study addressed that issue. The authors presented their findings on June 28 in The New England Journal of medicine.
The researchers noted that live-birth rates after treatment with assisted reproductive technology ART have traditionally been reported on a per-cycle basis. They note, however, that for women receiving continued treatment, cumulative success rates are a more important measure. To ascertain pregnancy outcomes after a series of ART cycles, the researchers linked data from cycles of ART in the Society for Assisted Reproductive Technology Clinic Outcome Reporting System database for the period from 2004 through 2009; data on individual women was used in order to estimate cumulative live-birth rates. The authors noted that conservative estimates assumed that women who did not return for treatment would not have achieved a successful pregnancy outcome and that optimal estimates assumed that these women would have live-birth rates similar to those for women continuing treatment.
The study group was comprised of 246,740 women; among them, 471,208 ART cycles were performed and 140,859 live births occurred. Live-birth rates declined with increasing maternal age and increasing cycle number with autologous (from the patient), but not donor, oocytes. By the third cycle, the conservative and optimal estimates of live-birth rates with autologous oocytes (eggs) had declined from 63.3% and 74.6%, respectively for women younger than 31 years of age . For women aged 41 to 42 years, those rates dropped to 18.6% and 27.8%. For women aged 43 or older, the rates dropped to 6.6% and 11.3%. When donor oocytes were used, the rates were higher than 60% and 80%, respectively, for all ages. The rates were higher with blastocyst embryos (day of transfer: 5 or 6) than with cleavage embryos (day of transfer: 2 or 3). At the third cycle, the conservative and optimal estimates of cumulative live-birth rates were, respectively, 42.7% and 65.3% for transfer of cleavage embryos and 52.4% and 80.7% for transfer of blastocyst embryos when fresh autologous oocytes were used.
The authors concluded that their results indicated that live-birth rates following ART are comparable to pregnancy rates in the general population can be achieved by means of assisted reproductive technology when favorable patient and embryo characteristics are present. Live-birth rates among older women are lower than those among younger women when autologous oocytes are used; however, the rates are similar those of young women when donor oocytes are used.
Take home message:
This study reports that women have an excellent chance of achieving a pregnancy with ART. It also reiterates the drop in fertility as a woman ages. However, it gives older women new hope. If they fail to conceive with the use of their own oocytes, they have the option of receiving donor oocytes, which will increase their chances of achieving a pregnancy.