Estimation Methods for Infertility Treatment Success: Comparison of Four Methods
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Abstract
Objective: To analyze and compare four methods for estimating the chance of treatment success in infertile couples.
Materials and methods: In a retrospective cohort study, information on demographic and clinical features, including age, body mass index (BMI), duration of infertility, semen analysis, previous history of treatment and clinical examination of infertile couples were analyzed. Treatment success (childbearing) was calculated with four methods as live birth ratio, conditional probability and survival analysis (life table and Kaplan-Meyer method) and results are compared.
Results: The fertility ratio for the first treatment cycle was 29.72% which decreased to 23.13% by total treatment cycles. The success rate was 75.4%. With conditional probability calculation at the end of the five treatment cycles. With the life table method in a five-year period, the probability for live birth was 78% and by Kaplan-Meyer method 73.1% and the median of treatment time was 562 days.
Conclusion: Calculation of infertility treatment success rate by only simple live birth ratio of childbearing couples is associated with underestimation. Using the conditional probability method reduces that underestimation, but it is not considered the censored cases in the treatments. It seems life table (as a proxy of survival analysis) presents the closest estimation to clinical facts with considering the repetition of the treatment cycle and the duration of treatment.
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8. Meldrum DR, Silverberg KM, Bustillo M, Stokes L. Success rate with repeated cycles of in vitro fertilization–embryo transfer. Fertil Steril 1998; 69: 1005-9.
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10. Mascarenhas MN, Flaxman SR, Boerma T, Vanderpoel S, Stevens GA. National Regional and Global Trends in Infertility Prevalence Since 1990: A Systematic Analysis of 277 Health Surveys. PLoS Med 2012; 9: e1001356.
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12. Ombelet W, Vandeput H, Janssen M, Cox A, Vossen C, Pollet H, et al. Treatment of male infertility due to sperm surface antibodies: IUI or IVF? Hum Reprod1997; 12: 1165-70
13. Benyamini Y, Gozlan M, Kokia E. Variability in the difficulties experienced by women undergoing infertility treatments. Fertil Steril 2005; 83: 275-83.
14. Edwards RG, Brody SA. Principles and practice of assisted human reproduction: WB Saunders Co; 1st edition , 1995.
15. Bouckaert A, Psalti I, Loumaye E, De Cooman S, Thomas K. The probability of a successful treatment of infertility by in-vitro fertilization. Hum Reprod 1994; 9: 448-55.
16. Ombelet W, Vandeput H, Van de Putte G, Cox A, Janssen M, Jacobs P, et al. Intrauterine insemination after ovarian stimulation with clomiphene citrate: predictive potential of inseminating motile count and sperm morphology. Hum Reprod 1997; 12:1458–63.
17. Lintsen AM, Eijkemans MJ, Hunault CC, Bouwmans CA, Hakkaart L, Habbema JD, et al. Predicting ongoing pregnancy chances after IVF and ICSI: a national prospective study. Hum Reprod 2007; 22: 2455-62.
18. Van Geloven N, Van der Veen F, Bossuyt PM, Hompes PG, Zwinderman AH, Mol BW. Can we distinguish between infertility and subfertility when predicting natural conception in couples with an unfulfilled child wish? Hum Reprod 2013; 28: 658-65.
19. Veltman-Verhulst SM, Fauser BCJM , Eijkemans MJ. High singleton live birth rate confirmed after ovulation induction in women with anovulatory polycystic ovary syndrome: validation of a prediction model for clinical practice. Fertil Steril 2012; 98 :761-8.e1.
20. Nelson JR, Corson SL, Batzer FR, Gocial B, Huppert L, Go KJ, et al. Predicting success of gamete intrafallopian transfer. Fertil Steril 1993; 60: 116-22.
21. Olsen J, Juul S, Basso O. Measuring time to pregnancy. Methodological issues to consider. Hum Reprod 1998; 13: 1751-3.
22. Uyar A, Bener A, Ciray HN, Bahceci M. Physician experience in performing embryo transfers may affect outcome. Fertil Steril 2011; 95: 1860-2.
23. Porcu G, Lehert P, Colella C, Giorgetti C. Predicting live birth chances for women with multiple consecutive failing IVF cycles: a simple and accurate prediction for routine medical practice. Reprod Biol Endocrinol 2013; 11:1.
24. Erdem A, Erdem M, Atmaca S, Korucuoglu U, Karabaca O. Factors affecting live birth rate in interauterine insemination cycles with recombinant gonadotrophin stimulation. Reprod Biomed Online 2008; 17: 199-206.
25. Gurunath S, Pandian Z, Anderson RA, Bhattacharya S. Defining infertility-a systematic review of prevalence studies. Hum Reprod Update 2011; 17:575.
26. Bouwmeester W, Zuithoff NP, Mallett S, Geerlings MI, Vergouwe Y, Steyerberg EW, et al. Reporting and methods in clinical prediction research: a systematic review. PLoS Med 2012; 9: 1-12.
27. Speirs AL, Lopata A, Gronow MJ, Kellow GN, Johnston WI. Analysis of the benefits and risks of multiple embryo transfer. Fertil Steril 1983; 39: 468-71.
28. van der Steeg JW, Steures P, Eijkemans MJ, Habbema
JD, Hompes PG, Broekmans FJ, et al. Predictive Value and Clinical Impact of Basal Follicle Stimulating Hormone in Subfertile Ovulatory Women. J Clin Endocrinol Metab 2007; 92: 2163-8.
29. Hosseini M, Mohammad K, Rahimzadeh M, Mahmoodi M. Comparison of survival models in studying breastfeeding duration. Hakim Research Journal 2007; 10: 66-71.
30. Bustillo M, Bhattarai S, Munabi AK, Bender S, Dorfman A, Schulman JD, editors. Life table analysis of pregnancy attainment in an IVF program exclusively utilizing ultrasound-guided oocyte retrieval. VI World Congress of In Vitro Fertilization and Alternate Assisted Reproduction, Jerusalem; 1989.
31. McLernon D, Lee AJ, Maheshwari A, van Eekelen R, van Geloven N, Putter H, et al. Predicting the chances of having a baby with or without treatment at different time points in couples with unexplained subfertility. Hum Reprod 2019; 34: 1126-38.
32. Stolwijk AM, Straatman H, Zielhuis GA, Jansen CA, Braat DD, van Dop PA, et al. External validation of prognostic models for ongoing pregnancy after in-vitro fertilization. Hum Reprod 1998; 13:3542-9.
33. Stolwijk AM, Wetzels AM, Braat DD. Cumulative probability of achieving an ongoing pregnancy after in-vitro fertilization and intracytoplasmic sperm injection according to a woman’s age, subfertility diagnosis and primary or secondary subfertility. Hum Reprod 2000; 15: 203-9.
34. Tomassetti C, Geysenbergh B, Meuleman C, Timmerman D, Fieuws S, D'Hooghe T. External validation of the endometriosis fertility index (EFI) staging system for predicting non-ART pregnancy after endometriosis surgery. Hum Reprod 2013; 28: 1280-8.
35. Custers IM, Steures P, van der Steeg JW, van Dessel TJ, Bernardus RE, Bourdrez P, et al. External validation of a prediction model for an ongoing pregnancy IUI. Fertil Steril 2007; 88:425-31.
2. Te Velde ER, Cohlen BJ. The management of infertility. N Engl J Med 1999; 340: 224-6.
3. Leushuis E, van der Steeg JW, Steures P, Bossuyt PM, Eijkemans MJ, van der Veen F, et al. Prediction models in reproductive medicine: A critical appraisal. Hum Reprod Update 2009; 15: 537–52.
4. Bahamondes L, Alma FA, Faundes A, Vera S. Score prognosis for the infertile couple based on historical factors and sperm analysis. Int J Gynaecol Obstet 1994; 46: 311-5.
5. Luke B, Brown MB, Wantman E, Lederman A, Gibbons W, Schattman GL, et al. Cumulative birth rates with linked assisted reproductive technology cycles. N Engl J Med 2012; 366: 2483-91.
6. Meijerink AM, Cissen M, Mochtar MH, Fleischer K, Thoonen I, de Melker AA, et al. Prediction model for live birth in ICSI using testicular extracted sperm. Hum Reprod 2016; 31: 1942-51.
7. Huang JY, Rosenwaks Z. In vitro fertilisation treatment and factors affecting success. Best Pract Res Clin Obstet Gynaecol 2012; 26: 777-88.
8. Meldrum DR, Silverberg KM, Bustillo M, Stokes L. Success rate with repeated cycles of in vitro fertilization–embryo transfer. Fertil Steril 1998; 69: 1005-9.
9. Chambers GM, Sullivan EA, Ishihara O, Chapman MG, Adamson GD. The economic impact of assisted reproductive technology: a review of selected developed countries. Fertil Steril 2009; 91: 2281-94.
10. Mascarenhas MN, Flaxman SR, Boerma T, Vanderpoel S, Stevens GA. National Regional and Global Trends in Infertility Prevalence Since 1990: A Systematic Analysis of 277 Health Surveys. PLoS Med 2012; 9: e1001356.
11. La Marca A, Capuzzo M, Donno V, Mignini Renzini M, Giovane CD, D’Amico R, et al. The predicted probability of live birth in In Vitro Fertilization varies during important stages throughout the treatment: analysis of 114,882 first cycles. J Gynecol Obstet Hum Reprod 2021; 50: 101878.
12. Ombelet W, Vandeput H, Janssen M, Cox A, Vossen C, Pollet H, et al. Treatment of male infertility due to sperm surface antibodies: IUI or IVF? Hum Reprod1997; 12: 1165-70
13. Benyamini Y, Gozlan M, Kokia E. Variability in the difficulties experienced by women undergoing infertility treatments. Fertil Steril 2005; 83: 275-83.
14. Edwards RG, Brody SA. Principles and practice of assisted human reproduction: WB Saunders Co; 1st edition , 1995.
15. Bouckaert A, Psalti I, Loumaye E, De Cooman S, Thomas K. The probability of a successful treatment of infertility by in-vitro fertilization. Hum Reprod 1994; 9: 448-55.
16. Ombelet W, Vandeput H, Van de Putte G, Cox A, Janssen M, Jacobs P, et al. Intrauterine insemination after ovarian stimulation with clomiphene citrate: predictive potential of inseminating motile count and sperm morphology. Hum Reprod 1997; 12:1458–63.
17. Lintsen AM, Eijkemans MJ, Hunault CC, Bouwmans CA, Hakkaart L, Habbema JD, et al. Predicting ongoing pregnancy chances after IVF and ICSI: a national prospective study. Hum Reprod 2007; 22: 2455-62.
18. Van Geloven N, Van der Veen F, Bossuyt PM, Hompes PG, Zwinderman AH, Mol BW. Can we distinguish between infertility and subfertility when predicting natural conception in couples with an unfulfilled child wish? Hum Reprod 2013; 28: 658-65.
19. Veltman-Verhulst SM, Fauser BCJM , Eijkemans MJ. High singleton live birth rate confirmed after ovulation induction in women with anovulatory polycystic ovary syndrome: validation of a prediction model for clinical practice. Fertil Steril 2012; 98 :761-8.e1.
20. Nelson JR, Corson SL, Batzer FR, Gocial B, Huppert L, Go KJ, et al. Predicting success of gamete intrafallopian transfer. Fertil Steril 1993; 60: 116-22.
21. Olsen J, Juul S, Basso O. Measuring time to pregnancy. Methodological issues to consider. Hum Reprod 1998; 13: 1751-3.
22. Uyar A, Bener A, Ciray HN, Bahceci M. Physician experience in performing embryo transfers may affect outcome. Fertil Steril 2011; 95: 1860-2.
23. Porcu G, Lehert P, Colella C, Giorgetti C. Predicting live birth chances for women with multiple consecutive failing IVF cycles: a simple and accurate prediction for routine medical practice. Reprod Biol Endocrinol 2013; 11:1.
24. Erdem A, Erdem M, Atmaca S, Korucuoglu U, Karabaca O. Factors affecting live birth rate in interauterine insemination cycles with recombinant gonadotrophin stimulation. Reprod Biomed Online 2008; 17: 199-206.
25. Gurunath S, Pandian Z, Anderson RA, Bhattacharya S. Defining infertility-a systematic review of prevalence studies. Hum Reprod Update 2011; 17:575.
26. Bouwmeester W, Zuithoff NP, Mallett S, Geerlings MI, Vergouwe Y, Steyerberg EW, et al. Reporting and methods in clinical prediction research: a systematic review. PLoS Med 2012; 9: 1-12.
27. Speirs AL, Lopata A, Gronow MJ, Kellow GN, Johnston WI. Analysis of the benefits and risks of multiple embryo transfer. Fertil Steril 1983; 39: 468-71.
28. van der Steeg JW, Steures P, Eijkemans MJ, Habbema
JD, Hompes PG, Broekmans FJ, et al. Predictive Value and Clinical Impact of Basal Follicle Stimulating Hormone in Subfertile Ovulatory Women. J Clin Endocrinol Metab 2007; 92: 2163-8.
29. Hosseini M, Mohammad K, Rahimzadeh M, Mahmoodi M. Comparison of survival models in studying breastfeeding duration. Hakim Research Journal 2007; 10: 66-71.
30. Bustillo M, Bhattarai S, Munabi AK, Bender S, Dorfman A, Schulman JD, editors. Life table analysis of pregnancy attainment in an IVF program exclusively utilizing ultrasound-guided oocyte retrieval. VI World Congress of In Vitro Fertilization and Alternate Assisted Reproduction, Jerusalem; 1989.
31. McLernon D, Lee AJ, Maheshwari A, van Eekelen R, van Geloven N, Putter H, et al. Predicting the chances of having a baby with or without treatment at different time points in couples with unexplained subfertility. Hum Reprod 2019; 34: 1126-38.
32. Stolwijk AM, Straatman H, Zielhuis GA, Jansen CA, Braat DD, van Dop PA, et al. External validation of prognostic models for ongoing pregnancy after in-vitro fertilization. Hum Reprod 1998; 13:3542-9.
33. Stolwijk AM, Wetzels AM, Braat DD. Cumulative probability of achieving an ongoing pregnancy after in-vitro fertilization and intracytoplasmic sperm injection according to a woman’s age, subfertility diagnosis and primary or secondary subfertility. Hum Reprod 2000; 15: 203-9.
34. Tomassetti C, Geysenbergh B, Meuleman C, Timmerman D, Fieuws S, D'Hooghe T. External validation of the endometriosis fertility index (EFI) staging system for predicting non-ART pregnancy after endometriosis surgery. Hum Reprod 2013; 28: 1280-8.
35. Custers IM, Steures P, van der Steeg JW, van Dessel TJ, Bernardus RE, Bourdrez P, et al. External validation of a prediction model for an ongoing pregnancy IUI. Fertil Steril 2007; 88:425-31.
| Files | ||
| Issue | Vol 15, No 3 (September 2021) | |
| Section | Original Articles | |
| DOI | https://doi.org/10.18502/jfrh.v15i3.7136 | |
| Keywords | ||
| Fertility Infertility Pregnancy Rate | ||
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How to Cite
1.
Zarinara A, Kamali K, Akhondi MM. Estimation Methods for Infertility Treatment Success: Comparison of Four Methods. J Family Reprod Health. 2021;15(3):179-185.
