Increased IVF Treatment Cycles Could Boost Success Rates

Six IVF cycles produce the highest live birth rates for infertile women up to the age of 42, according to a new study.

Researchers at the University of Bristol (United Kingdom) and the University of Glasgow (United Kingdom) conducted a prospective study of 156,947 women who received a total 257,398 IVF ovarian stimulation cycles between 2003 and 2010 to determine the live-birth rate per IVF cycle; a cycle was defined as an episode of ovarian stimulation, including all subsequent separate fresh and frozen embryo transfers. The main outcomes were live-birth rate per IVF cycle and cumulative live-birth rates across all cycles as stratified by age and treatment type.

The results showed that the women in the study were a median age of 35 at the start of treatment, and underwent median infertility duration for all cycles of four years. Overall, the live birth rate for the first IVF cycle was 29.5%, and there was a live birth rate of at least 20% for each cycle up to the fourth cycle. The cumulative, prognosis-adjusted live birth rate over all cycles of IVF continued to rise right up until the ninth cycle, with a live birth rate of 65.3% identified for the sixth cycle.

Among women under the age of 40 who underwent IVF with their own oocytes, the live birth rate was 32% for the first cycle, rising by at least 20% up to the fourth cycle. For the sixth cycle, however, a live birth rate of around 68% was achieved. Women aged 40–42 years had a 12% live birth rate for the first cycle of IVF, while a live birth rate of 31.5% was achieved with six cycles. For women over the age of 42, however, live birth rates for each cycle were lower than 4%, and among women who used donor eggs for IVF, success rates did not differ by age. The study was published on December 22, 2015, in JAMA.

“The majority of women opt to stop IVF after experiencing around three or four unsuccessful cycles,” said lead author Debbie Lawlor, PhD, of the University of Bristol. “Some couples may find prolonged IVF treatment emotionally stressful and financially costly. Several IVF cycles may be unsustainable for them, health services, and insurers.”

“These findings suggest that for some couples, especially those in whom the female partner is younger than 40 years, male-factor infertility is treated with ICSI, or oocyte or semen donation is used, the incremental increase in cumulative pregnancy probability after three or four cycles may be worthwhile, especially if financial resources are available,” said Evan Myers, MD, of Duke University (Durham, NC, USA), in accompanying editorial. “It is important doctors share the study data with couples so they can make a truly informed decision.”

Intracytoplasmic sperm injection (ICSI) is an IVF procedure in which a single sperm is injected directly into an egg. During the past decade, ICSI has been applied increasingly to alleviate problems of severe male infertility in human patients who either could not be assisted by conventional IVF procedures or could not be accepted for IVF because too few motile and morphologically normal sperm were present in the ejaculate of the male partner.

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University of Bristol
University of Glasgow