A prediction model for live birth and multiple births within the first three cycles of assisted reproductive technology

Abstract

Objective To develop a model predictive of live-birth rates (LBR) and multiple birth rates (MBR) for an individual considering assisted reproduction technology (ART) using linked cycles from Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) for 2004–2011. Design Longitudinal cohort. Setting Clinic-based data. Patient(s) 288,161 women with an initial autologous cycle, of whom 89,855 did not become pregnant and had a second autologous cycle and 39,334 did not become pregnant in the first and second cycles and had a third autologous cycle, with an additional 33,598 women who had a cycle using donor oocytes (first donor cycle). Intervention(s) None. Main Outcome Measure(s) LBRs and MBRs modeled by woman’s age, body mass index, gravidity, prior full-term births, infertility diagnoses by oocyte source, fresh embryos transferred, and cycle, using backward-stepping logistic regression with results presented as adjusted odds ratios (AORs) and 95% confidence intervals. Result(s) The LBRs increased in all models with prior full-term births, number of embryos transferred; in autologous cycles also with gravidity, diagnoses of male factor, and ovulation disorders; and in donor cycles also with the diagnosis of diminished ovarian reserve. The MBR increased in all models with number of embryos transferred and in donor cycles also with prior full-term births. For both autologous and donor cycles, transferring two versus one embryo greatly increased the probability of a multiple birth (AOR 27.25 and 38.90, respectively). Conclusion(s) This validated predictive model will be implemented on the Society for Assisted Reproductive Technology Web site (www.sart.org) so that patients considering initiating a course of ART can input their data on the Web site to generate their expected outcomes.

Application of a validated prediction model for in vitro fertilization: comparison of live birth rates and multiple birth rates with 1 embryo transferred over 2 cycles vs 2 embryos in 1 cycle

“…Development and validation of the original model has been described previously [40]. This analysis was based on de-identified data, and was therefore deemed exempt by IRB review at Michigan State University (as defined in 45 CFR 46.l02(f).…”

“…We developed validated prediction models for LBR and MBR using the SART CORS data from 2004-2011 [40]. We have subsequently revised the model to include data from 2006-2012; this revised model is implemented on the Society for Assisted Reproductive Technology website (www.sart.org) [40].…”

“…We have subsequently revised the model to include data from 2006-2012; this revised model is implemented on the Society for Assisted Reproductive Technology website (www.sart.org) [40]. The goal of this analysis is to compare the estimates of LBR and MBR when two embryos are transferred, either (1) both in one cycle (double embryo transfer, DET), or (2) in two successive cycles, each with a single embryo (i.e., SET).…”

Factors predicting double embryo implantation following double embryo transfer in assisted reproductive technology: implications for elective single embryo transfer

“…This is especially important because many women in the average prognosis category may otherwise be counseled towards DET, while pregnancy would be safer with eSET. A prediction model of success in ART by Luke and colleagues show an adjusted odds ratio of 27.25 for a multiple birth pregnancy following DET compared to SET [25]. Data are restricted to fresh, non-donor embryos.…”

Antimüllerian hormone levels and antral follicle count as prognostic indicators in a personalized prediction model of live birth

“…Using population-level registry data, several groups including our own have developed and validated live-birth prediction models (1,9). These models were inevitably lacking in detail regarding clinical phenotype owing to the nature of the data source.…”