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Population trends and live birth rates associated with common ART treatment strategies.
Hum Reprod. 2016 11; 31(11):2632-2641.HR

Abstract

STUDY QUESTION

Have ART live birth rates improved in Australia over the last 12 years?

SUMMARY ANSWER

There were striking improvements in per-cycle live birth rates observed for frozen/thaw embryo transfers, blastocyst transfer and single embryo transfer (SET), while live birth rates following ICSI were lower than IVF for non-male factor infertility in most years.

WHAT IS ALREADY KNOWN

ART and associated techniques have become the predominant treatment of infertility over the past 30 years in most developed countries. However, there are differences in ART laboratory and clinical practices, and success rates worldwide. Australia has one of the highest ART utilization rates and lowest multiple birth rates in the world, thus providing a unique setting to investigate the contribution of common ART strategies in an unrestricted population of patients to ART success rates.

STUDY DESIGN, SIZE, DURATION

A retrospective cohort study of 585 065 ART treatment cycles performed in Australia between 2002 and 2013 using the Australian and New Zealand Assisted Reproduction Database (ANZARD).

PARTICIPANTS MATERIALS, SETTING, METHOD

An unrestricted population of all women who underwent autologous ART treatment between 2002 and 2013. Visual descriptive analysis was used to assess the trends in ART procedures by the calendar years. Adjusted odds ratios (aORs) of a live birth for four common ART techniques were calculated after controlling for important confounders including female age, infertility diagnosis, stage of the embryo (blastocyst versus cleavage stage), type of embryo (fresh versus thawed), fertilization method (IVF versus ICSI) and number of embryos transferred (SET versus multiple embryos).

MAIN RESULTS AND THE ROLE OF CHANCE

The overall live birth rate per embryo transfer increased from 19.2% in 2002 to 23.3% in 2013 (21.9-24.3% for fresh embryo transfers and 14.6-23.3% for frozen/thaw embryo transfers). This occurred concurrently with an increase in SET from 29.7% to 78.9%, and an increase in the average age of women undergoing treatment from 35.0 to 35.9 years. Individuals who had a frozen/thaw embryo transfer cycle in 2002 had 43% (aOR: 0.57, 95% CI: 0.53-0.61) reduced odds of a live birth compared with a fresh embryo transfer cycle. This contrasted with 16% (aOR: 0.84, 95% CI: 0.80-0.98) reduced odds of a live birth from frozen/thaw embryo transfer cycles in 2013. In 2013, the odds of blastocyst transfer resulting in a live birth were more than twice as great as for cleavage stage transfer (aOR 2.01, 95% CI: 1.92-2.11). The adjusted odds of live birth per SET compared with multiple embryo transfer increased significantly over the last 12 years, from a 38% reduced odds of a live birth follow SET in 2002 (aOR: 062, 95% CI: 0.57-0.67) compared to an 8% reduced odds in 2013 (aOR: 0.92, 95% CI: 0.87-0.98). The aOR of a live birth using ICSI compared to IVF in non-male factor patients was lower in most years bringing into question its widespread use.

LIMITATION, REASONS FOR CAUTION

This is a retrospective cohort analysis and cannot confirm causality. High-level evidence on the effectiveness of particular ART techniques, particularly ICSI and blastocyst culture, requires prospective randomized controlled trials or detailed statistical analysis using large-scale data that counts for fertilization failure, embryo loss, prognostic factors and cycle characteristics.

WIDER IMPLICATION OF THE FINDINGS

The most striking improvements in ART success rates in Australia have been observed for frozen/thaw embryo transfers, blastocyst transfer and SET. Further studies of the role of ICSI in non-male factor infertility and blastocyst transfer success rates that take into account embryo loss are needed.

STUDY FUNDING/COMPETING INTERESTS

No funding was received to undertake this study. The authors declare that they do not have competing interests with this study.

TRIAL REGISTRATION NUMBER

NA.

Authors+Show Affiliations

National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health and School of Women's and Children's Health, University of New South Wales, Level 1, AGSM Building, Sydney 2052, Australia g.chambers@unsw.edu.au.The Kirby Institute, University of New South Wales, Sydney 2052, Australia.National Perinatal Epidemiology and Statistics Unit, Centre for Big Data Research in Health and School of Women's and Children's Health, University of New South Wales, Level 1, AGSM Building, Sydney 2052, Australia.IVF Australia, South Sydney, Sydney 2217, Australia.Department of Obstetrics and Gynaecology, University of Auckland, Auckland 1142, New Zealand.Genea Fertility, Sydney 2000, Australia. Department of Obstetrics and Gynaecology, University of Sydney, Sydney 2006, Australia.Queensland Fertility Group, Spring Hill, 4000, Australia.School of Women's and Children's Health, University of New South Wales, Sydney 2052, Australia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27664207

Citation

Chambers, Georgina M., et al. "Population Trends and Live Birth Rates Associated With Common ART Treatment Strategies." Human Reproduction (Oxford, England), vol. 31, no. 11, 2016, pp. 2632-2641.
Chambers GM, Wand H, Macaldowie A, et al. Population trends and live birth rates associated with common ART treatment strategies. Hum Reprod. 2016;31(11):2632-2641.
Chambers, G. M., Wand, H., Macaldowie, A., Chapman, M. G., Farquhar, C. M., Bowman, M., Molloy, D., & Ledger, W. (2016). Population trends and live birth rates associated with common ART treatment strategies. Human Reproduction (Oxford, England), 31(11), 2632-2641.
Chambers GM, et al. Population Trends and Live Birth Rates Associated With Common ART Treatment Strategies. Hum Reprod. 2016;31(11):2632-2641. PubMed PMID: 27664207.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Population trends and live birth rates associated with common ART treatment strategies. AU - Chambers,Georgina M, AU - Wand,Handan, AU - Macaldowie,Alan, AU - Chapman,Michael G, AU - Farquhar,Cynthia M, AU - Bowman,Mark, AU - Molloy,David, AU - Ledger,William, Y1 - 2016/09/22/ PY - 2016/05/08/received PY - 2016/07/26/revised PY - 2016/08/22/accepted PY - 2016/9/25/pubmed PY - 2018/1/13/medline PY - 2016/9/25/entrez KW - ICSI KW - IVF/ICSI outcome KW - assisted reproduction KW - embryo transfer KW - epidemiology SP - 2632 EP - 2641 JF - Human reproduction (Oxford, England) JO - Hum. Reprod. VL - 31 IS - 11 N2 - STUDY QUESTION: Have ART live birth rates improved in Australia over the last 12 years? SUMMARY ANSWER: There were striking improvements in per-cycle live birth rates observed for frozen/thaw embryo transfers, blastocyst transfer and single embryo transfer (SET), while live birth rates following ICSI were lower than IVF for non-male factor infertility in most years. WHAT IS ALREADY KNOWN: ART and associated techniques have become the predominant treatment of infertility over the past 30 years in most developed countries. However, there are differences in ART laboratory and clinical practices, and success rates worldwide. Australia has one of the highest ART utilization rates and lowest multiple birth rates in the world, thus providing a unique setting to investigate the contribution of common ART strategies in an unrestricted population of patients to ART success rates. STUDY DESIGN, SIZE, DURATION: A retrospective cohort study of 585 065 ART treatment cycles performed in Australia between 2002 and 2013 using the Australian and New Zealand Assisted Reproduction Database (ANZARD). PARTICIPANTS MATERIALS, SETTING, METHOD: An unrestricted population of all women who underwent autologous ART treatment between 2002 and 2013. Visual descriptive analysis was used to assess the trends in ART procedures by the calendar years. Adjusted odds ratios (aORs) of a live birth for four common ART techniques were calculated after controlling for important confounders including female age, infertility diagnosis, stage of the embryo (blastocyst versus cleavage stage), type of embryo (fresh versus thawed), fertilization method (IVF versus ICSI) and number of embryos transferred (SET versus multiple embryos). MAIN RESULTS AND THE ROLE OF CHANCE: The overall live birth rate per embryo transfer increased from 19.2% in 2002 to 23.3% in 2013 (21.9-24.3% for fresh embryo transfers and 14.6-23.3% for frozen/thaw embryo transfers). This occurred concurrently with an increase in SET from 29.7% to 78.9%, and an increase in the average age of women undergoing treatment from 35.0 to 35.9 years. Individuals who had a frozen/thaw embryo transfer cycle in 2002 had 43% (aOR: 0.57, 95% CI: 0.53-0.61) reduced odds of a live birth compared with a fresh embryo transfer cycle. This contrasted with 16% (aOR: 0.84, 95% CI: 0.80-0.98) reduced odds of a live birth from frozen/thaw embryo transfer cycles in 2013. In 2013, the odds of blastocyst transfer resulting in a live birth were more than twice as great as for cleavage stage transfer (aOR 2.01, 95% CI: 1.92-2.11). The adjusted odds of live birth per SET compared with multiple embryo transfer increased significantly over the last 12 years, from a 38% reduced odds of a live birth follow SET in 2002 (aOR: 062, 95% CI: 0.57-0.67) compared to an 8% reduced odds in 2013 (aOR: 0.92, 95% CI: 0.87-0.98). The aOR of a live birth using ICSI compared to IVF in non-male factor patients was lower in most years bringing into question its widespread use. LIMITATION, REASONS FOR CAUTION: This is a retrospective cohort analysis and cannot confirm causality. High-level evidence on the effectiveness of particular ART techniques, particularly ICSI and blastocyst culture, requires prospective randomized controlled trials or detailed statistical analysis using large-scale data that counts for fertilization failure, embryo loss, prognostic factors and cycle characteristics. WIDER IMPLICATION OF THE FINDINGS: The most striking improvements in ART success rates in Australia have been observed for frozen/thaw embryo transfers, blastocyst transfer and SET. Further studies of the role of ICSI in non-male factor infertility and blastocyst transfer success rates that take into account embryo loss are needed. STUDY FUNDING/COMPETING INTERESTS: No funding was received to undertake this study. The authors declare that they do not have competing interests with this study. TRIAL REGISTRATION NUMBER: NA. SN - 1460-2350 UR - https://www.unboundmedicine.com/medline/citation/27664207/Population_trends_and_live_birth_rates_associated_with_common_ART_treatment_strategies_ L2 - https://academic.oup.com/humrep/article-lookup/doi/10.1093/humrep/dew232 DB - PRIME DP - Unbound Medicine ER -