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1.
N Engl J Med ; 366(26): 2483-91, 2012 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-22738098

RESUMO

BACKGROUND: Live-birth rates after treatment with assisted reproductive technology have traditionally been reported on a per-cycle basis. For women receiving continued treatment, cumulative success rates are a more important measure. METHODS: We linked data from cycles of assisted reproductive technology in the Society for Assisted Reproductive Technology Clinic Outcome Reporting System database for the period from 2004 through 2009 to individual women in order to estimate cumulative live-birth rates. Conservative estimates assumed that women who did not return for treatment would not have a live birth; optimal estimates assumed that these women would have live-birth rates similar to those for women continuing treatment. RESULTS: The data were from 246,740 women, with 471,208 cycles and 140,859 live births. Live-birth rates declined with increasing maternal age and increasing cycle number with autologous, but not donor, oocytes. By the third cycle, the conservative and optimal estimates of live-birth rates with autologous oocytes had declined from 63.3% and 74.6%, respectively, for women younger than 31 years of age to 18.6% and 27.8% for those 41 or 42 years of age and to 6.6% and 11.3% for those 43 years of age or older. When donor oocytes were used, the rates were higher than 60% and 80%, respectively, for all ages. Rates were higher with blastocyst embryos (day of transfer, 5 or 6) than with cleavage embryos (day of transfer, 2 or 3). At the third cycle, the conservative and optimal estimates of cumulative live-birth rates were, respectively, 42.7% and 65.3% for transfer of cleavage embryos and 52.4% and 80.7% for transfer of blastocyst embryos when fresh autologous oocytes were used. CONCLUSIONS: Our results indicate that live-birth rates approaching natural fecundity can be achieved by means of assisted reproductive technology when there are favorable patient and embryo characteristics. Live-birth rates among older women are lower than those among younger women when autologous oocytes are used but are similar to the rates among young women when donor oocytes are used. (Funded by the National Institutes of Health and the Society for Assisted Reproductive Technology.).


Assuntos
Coeficiente de Natalidade , Fertilidade , Nascido Vivo , Técnicas de Reprodução Assistida , Adulto , Feminino , Humanos , Idade Materna , Pessoa de Meia-Idade , Doação de Oócitos/estatística & dados numéricos , Gravidez , Transplante Autólogo/estatística & dados numéricos
2.
Fertil Steril ; 95(2): 600-5, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20643404

RESUMO

OBJECTIVE: To determine whether the first cycle of assisted reproductive technology (ART) predicts treatment course and outcome. DESIGN: Retrospective study of linked cycles. SETTING: Society for Assisted Reproductive Technology Clinic Outcome Reporting System database. PATIENT(S): A total of 6,352 ART patients residing or treated in Massachusetts with first treatment cycle in 2004-2005 using fresh, autologous oocytes and no prior ART. Women were categorized by first cycle as follows: Group I, no retrieval; Group II, retrieval, no transfer; Group III, transfer, no embryo cryopreservation; Group IV, transfer plus cryopreservation; and Group V, all embryos cryopreserved. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Cumulative live-birth delivery per woman, use of donor eggs, intracytoplasmic sperm injection (ICSI), or frozen embryo transfers (FET). RESULT(S): Groups differed in age, baseline FSH level, prior gravidity, diagnosis, and failure to return for Cycle 2. Live-birth delivery per woman for groups I through V for women with no delivery in Cycle I were 32.1%, 35.9%, 40.1%, 53.4%, and 51.3%, respectively. Groups I and II were more likely to subsequently use donor eggs (14.5% and 10.9%). Group II had the highest use of ICSI (73.3%); Group III had the lowest use of FET (8.9%). CONCLUSION(S): Course of treatment in the first ART cycle is related to different cumulative live-birth delivery rates and eventual use of donor egg, ICSI, and FET.


Assuntos
Técnicas de Diagnóstico Obstétrico e Ginecológico , Infertilidade/diagnóstico , Infertilidade/terapia , Avaliação de Resultados em Cuidados de Saúde , Técnicas de Reprodução Assistida , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Humanos , Infertilidade/epidemiologia , Masculino , Ciclo Menstrual/fisiologia , Sistemas On-Line , Prognóstico , Técnicas de Reprodução Assistida/estatística & dados numéricos , Estudos Retrospectivos , Sociedades Médicas , Resultado do Tratamento
3.
Fertil Steril ; 94(4): 1334-1340, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19596309

RESUMO

OBJECTIVE: To determine the feasibility of linking assisted reproductive technology (ART) cycles for individual women to compare per-cycle and cumulative live-birth rates. DESIGN: Historical cohort study. SETTING: Clinic-based data. PATIENT(S): A total of 27,906 ART cycles with residency or treatment in Massachusetts during 2004-2006 and reported to the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System (SART CORS) on-line database. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Per-cycle and cumulative live-birth rates. RESULT(S): Linkage of cycles up to and including the first live-birth delivery revealed 14,265 women who averaged 1.9+/-1.2 SD cycles (range 1-11). These cycles yielded 9,452 pregnancies resulting in 7,675 live-birth deliveries. From cycle 1 to cycle 4, the cumulative live-birth rate for all patients increased from 30.4% to 43.3%, 49.1%, and 51.9%, respectively, and plateaued thereafter at about 53%. The cumulative live-birth rate after three cycles using donor oocytes was approximately 60% for women aged<43 years and >50% for women>or=43 years; for autologous oocytes it was 60.1% for ages<35 years and declined steadily to 8.5% for ages>or=43 years. CONCLUSION(S): The results demonstrate the feasibility of linking ART cycles for individual women from SART CORS to characterize cumulative live-birth rates.


Assuntos
Nascido Vivo/epidemiologia , Taxa de Gravidez , Técnicas de Reprodução Assistida , Adulto , Algoritmos , Bases de Dados Factuais , Estudos de Viabilidade , Feminino , Humanos , Recém-Nascido , Armazenamento e Recuperação da Informação , Massachusetts/epidemiologia , Ciclo Menstrual/fisiologia , Modelos Estatísticos , Gravidez , Fatores de Tempo , Resultado do Tratamento
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