Women’s morbid conditions are associated with decreased odds of live birth in the first IVF/ICSI treatment: a retrospective single-center study

Abstract

Purpose The present study aims to ascertain whether there is a causal relationship between women's disease conditions present at the starting time of the first intended oocyte retrieval cycle and IVF/ICSI outcomes, primarily odds of live birth in the first IVF/ ICSI treatment. Methods This is a retrospective study of infertile healthy and diseased women that had a live birth and/or exhibited a complete first oocyte retrieval cycle. Generalized Estimating Equations (GEE) models were applied to adjust standard errors for the potential correlation among women exhibiting the same infertility etiology. Confounders to be controlled for in these GEE models were previously selected following a strict stepwise methodology. Results Compared to healthy women, diseased women exhibited lower odds of live birth (OR (95% CI) 0.704 (0.576-0.860)). Further screening analyses indicated that subclinical iodine-deficiency hypothyroidism together with autoimmune thyroiditis contributed significantly to decrease odds of live birth (OR (95% CI) 0.720 (0.608-0.853)). Another important contribution arose from practically all the remaining morbid conditions analyzed. These diseases were individually associated with lower odds of live birth, although differences were non-significant. Notwithstanding, differences became significant after merging these diseases in a single group (OR (95% CI) 0.605 (0.394-0.930)). Conclusion There is a significant causal association between most diseases present at the starting time of the first intended oocyte retrieval cycle and lower odds of live birth in the first IVF/ICSI treatment.

Cumulative probabilities of live birth across multiple complete IVF/ICSI cycles: a call for attention

“…GEE models allow for analysis of repeated measurements or other correlated observations such as clustered data, especially when they are binary or in the form of counts [13]. In a previous study [14], we found that the goodness-of-fit of GEE models improved on most occasions after adjusting standard errors for the potential correlation among women exhibiting the same infertility etiology. Therefore, variables were arranged in a hierarchical two-level structure with women starting ovarian stimulation clustered within female infertility etiology.…”

“…Only ICD-10 chapters with sample sizes ≥ 10 women/men were included in the study as distinct groups. ICD-10 chapters with sample sizes < 10 women/men were combined in a single "catch-all" group called "other diseases" [14] g ICD-10 chapters: "Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism" (n = 23), "Endocrine, nutritional and metabolic diseases" (n = 187), "Mental and behavioral disorders" (n = 17), "Diseases of the nervous system" (n = 22), "Diseases of the circulatory system" (n = 18), "Diseases of the respiratory system" (n = 23), "Diseases of the digestive system" (n = 20), "Diseases of the musculoskeletal system and connective tissue" (n = 17), and "other diseases" (n = 30) h ICD-10 chapters: "Endocrine, nutritional and metabolic diseases" (n = 33), "Diseases of the circulatory system" (n = 40), "Diseases of the respiratory system" (n = 27), "Diseases of the digestive system" (n = 23), "Diseases of the genitourinary system" (n = 15), and "other diseases" (n = 68)…”

A predictive model for women’s assisted fecundity before starting the first IVF/ICSI treatment cycle

“…Values are means and SDs in parenthesis b Number of cigarettes smoked per day for the 3 months before starting the first intended oocyte retrieval cycle c Values are percentages d Medical conditions were assessed following the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10 Version 2016)[14] …”

The Efficacy of Assisted Reproduction in Women with a Wide Spectrum of Chronic Diseases – A Review

“…A paper from 2019 examined very broad categories of women with chronic diseases and found lower odds of a live birth, compared to healthy women. 9 The study included 1291 women receiving ART and the underlying diseases for these women were distributed across all ICD10 categories. The studies included in this review points towards a more varied and complex picture.…”

“…Seven papers were excluded as they did not include an external reference group, and one paper was excluded because the analyses were based on overall chapters from the International Classification of Disease (and not the specific diseases of interest). 9 The overview is given in Figure 2 (PRISMA flow chart). A total of 13 papers were thus eligible for the review criteria.…”