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Assisted Reproductive Technology: Cumulative Live-Birth Rates Offer Hope to Infertile Couples

Cumulative live-birth rates can approach those arising from spontaneous conception.

Assisted reproductive technology has helped infertile couples build families for more than 20 years, yielding almost 4 million births worldwide. Just how successful is this approach, and under what conditions is it most apt to result in babies? Registries worldwide commonly refer to "per cycle" pregnancy rates, but what matters to the individual patient is her own likelihood of having a baby. U.S. investigators used the nationwide database of the Society for Assisted Reproductive Technology from 2004 through 2009 to link cycles to individual women, thereby estimating cumulative live-birth rates per cycle. Conservative rates were calculated on the assumption that women who did not return for subsequent treatment would not experience live birth; optimal rates assumed that women who did not return for treatment would experience live-birth rates similar to those who continued treatment.

Data were derived from 246,740 women who underwent 471,208 cycles resulting in 140,859 live births. Live births occurred in 30% of cycles and 57% of women; rates were highest in women younger than 31 and fell with advancing maternal age. After three cycles, conservative and optimal live-birth rates with autologous oocytes in women younger than 31 were 63.3% and 74.6%, respectively. These rates were only 18.6% and 27.8%, respectively, in women aged 41 or 42 and were 6.6% and 11.3% in those 43 or older. When donor oocytes were used, conservative and optimal rates were >60% and >80%, respectively, regardless of recipients' maternal age.

Comment: If only it were this simple! Although live-birth rates with assisted reproductive technology have improved impressively, procedures remain stressful and costly, and discontinuation rates are high (in this study, 25% of women discontinued treatment after unsuccessful first cycles and 33% after subsequent cycles). Still, this study confirms just how much these procedures have advanced; furthermore, the findings make a strong case for encouraging use of donor oocytes in infertile women who are 43 or older.

— Robert W. Rebar, MD

Published in Journal Watch Women's Health June 27, 2012

Citation(s):

Luke B et al. Cumulative birth rates with linked assisted reproductive technology cycles. N Engl J Med 2012 Jun 28; 366:2483.

• Medline abstract (Free)

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