Achieving Two Live Births from One Ovarian Stimulation Cycle: The One-and-Done Approach Revisited.

IF 7 1区 医学 Q1 OBSTETRICS & GYNECOLOGY
Alexandra Huttler, Daniel Duvall, Denny Sakkas, Quetrell Heyward, Riwa Sabbagh, Michael Alper, Denis Vaughan
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引用次数: 0

Abstract

Objective: To identify the proportion of patients who would achieve ≥2 live births following a single in vitro fertilization (IVF) stimulation/embryo creation cycle.

Design: Retrospective cohort study at a university-affiliated infertility practice SUBJECTS: Patients undergoing their first IVF cycle between January 1, 2014 and December 31, 2023 EXPOSURE: Index oocyte retrieval cycle and subsequent autologous embryo transfer cycles MAIN OUTCOME MEASURES: Live births following autologous embryo transfer cycles from the index oocyte retrieval were analyzed, with additional live birth potential estimates extrapolated using age and oocyte number for those that had remaining frozen high-quality embryos. Univariable and multivariable logistic regression models were used to evaluate the association of known fertility factors with the outcome.

Results: 16,474 patients were included who underwent 20,710 total transfers during the study period. 8,223 patients (49.9%) achieved ≥ 1 live birth and 1,857 patients (11.3%) achieved ≥ 2 live births. Of note, 6,662 patients (40.4%) had a total of 24,067 remaining frozen high-quality embryos. Including estimates of additional live births resulting from use of remaining frozen embryos, 9,599 (58.3%, 95% confidence interval [CI] 57.6%-59.1%) patients would achieve ≥ 1 live birth and 4,511 (27.3%, 95% CI 26.8%-28.0%) patients would achieve ≥ 2 live births. The proportion of patients achieving ≥2 live births progressively increased across groups of increasing oocyte yield and decreased with advancing age. Predictors of the odds of achieving ≥ 2 live births included age and number of oocytes retrieved. 5,105 (31.0%) patients utilized pre-implantation genetic testing for aneuploidy (PGT-A). Those that utilized PGT-A had a lower odds of achieving ≥ 2 live births (p<0.001).

Conclusion: With current IVF practices, over 1/4 of patients could complete their families by achieving ≥2 live births from a single IVF stimulation cycle. Increasing number of oocytes retrieved and age <35 years increased the odds of achieving this result. Providers can utilize these values as a counseling tool to guide shared decision-making to avoid additional stimulation cycles.

从一个卵巢刺激周期实现两个活产:一次完成的方法重新审视。
目的:确定单次体外受精(IVF)刺激/胚胎创造周期后实现≥2例活产的患者比例。设计:一所大学附属不孕症诊所的回顾性队列研究对象:2014年1月1日至2023年12月31日进行第一次IVF周期的患者暴露:指数卵母细胞回收周期和随后的自体胚胎移植周期从索引卵母细胞检索中分析了自体胚胎移植周期后的活产,并根据年龄和卵母细胞数量推断了剩余冷冻高质量胚胎的活产潜力。使用单变量和多变量logistic回归模型来评估已知生育因素与结果的关联。结果:16,474例患者在研究期间共进行了20,710次转移。8223例(49.9%)患者活产≥1例,1857例(11.3%)患者活产≥2例。值得注意的是,6662名患者(40.4%)总共保留了24067个高质量的冷冻胚胎。包括使用剩余冷冻胚胎导致的额外活产估计,9599例(58.3%,95%置信区间[CI] 57.6%-59.1%)患者将实现≥1例活产,4511例(27.3%,95% CI 26.8%-28.0%)患者将实现≥2例活产。活产≥2胎的患者比例随着卵母细胞数量的增加而逐渐增加,随着年龄的增长而下降。实现≥2个活产的几率的预测因子包括年龄和获得的卵母细胞数量。5105例(31.0%)患者进行了非整倍体植入前基因检测(PGT-A)。使用PGT-A的患者获得≥2个活产的几率较低(结论:在目前的试管婴儿实践中,超过1/4的患者可以通过单个试管婴儿刺激周期获得≥2个活产来完成他们的家庭。卵母细胞数量和年龄的增加
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来源期刊
Fertility and sterility
Fertility and sterility 医学-妇产科学
CiteScore
11.30
自引率
6.00%
发文量
1446
审稿时长
31 days
期刊介绍: Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.
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