Fertility and Sterility
Volume 95, Issue 5 , Pages 1677-1683, April 2011

How effective is in vitro fertilization, and how can it be improved?

  • Louise M. Stewart, B.Sc.(Hons), Grad.Dip.P.H.

      Affiliations

    • School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia
    • Corresponding Author InformationReprint requests: Louise M. Stewart, B.Sc.(Hons), Grad.Dip.P.H., School of Population Health, University of Western Australia, M431, 35 Stirling Highway, Crawley, Western Australia 6009, Australia.
    • ,
  • C. D’Arcy J. Holman, M.P.H., Ph.D., F.A.F.P.H.M.

      Affiliations

    • School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia
    • ,
  • Roger Hart, M.D., C.R.E.I.

      Affiliations

    • School of Women’s and Infants Health, The University of Western Australia and Fertility Specialists of Western Australia, Crawley, Western Australia, Australia
    • ,
  • Judith Finn, Ph.D., R.N.

      Affiliations

    • Discipline of Emergency Medicine, The University of Western Australia, Crawley, Western Australia, Australia
    • ,
  • Qun Mai, M.B.B.S., M.P.H.

      Affiliations

    • School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia
    • ,
  • David B. Preen, Ph.D.

      Affiliations

    • School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia

Received 18 October 2010; received in revised form 31 December 2010; accepted 15 January 2011. published online 14 February 2011.

Objective

To measure IVF effectiveness, which is defined as the cumulative incidence of live delivery over real time in women after commencing IVF treatment.

Design

Population-based retrospective cohort study.

Setting

IVF clinics in Western Australia (WA).

Patient(s)

All women ages 20–44 years inclusive at start of treatment, commencing IVF in 1982–1992 and 1993–2002 at clinics in WA (n = 8,275).

Intervention(s)

Data on IVF cycles were extracted from hospital records and a statutory reproductive technology register and linked to records of births.

Main Outcome Measure(s)

Cumulative incidence of an IVF-attributed live delivery and cumulative incidence of an IVF-attributed or IVF treatment-independent live delivery.

Result(s)

IVF effectiveness in the 1993–2002 cohort was 47% overall. It was highest in women ages 20–29 years at the start of treatment, measuring 58%; and 79% with the inclusion of IVF treatment-independent deliveries, and declined to 22% and 33%, respectively, in women ages 40–44 years. Couples underwent, on average, only three cycles, even though the cumulative probability of a live delivery increased with each successive cycle for at least the first five cycles.

Conclusion(s)

IVF effectiveness could be improved if women, particularly those over 35, underwent more cycles.

Key Words: Cohort studies, fertilization in vitro, life tables, live birth, maternal age, probability

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 L.M.S. has nothing to disclose. C.D.J.H. has nothing to disclose. R.H. is Medical Director of Fertility Specialists of Western Australia and Medical Director of Fertility Specialists South. He is a consultant to the Fertility Advisory Board Merck Serono Australia and Fertility Advisory Board Schering-Plough Australia and received industry sponsorship to attend the annual meeting of the European Society of Human Reproduction and Embryology in 2009. J.F. has nothing to disclose. Q.M. has nothing to disclose. D.B.P. has nothing to disclose.

 This study was supported by OSPREY, a capacity building grant from the National Health and Medical Research Council, Australia; project no. 573122. L.M.S. holds an Australian Postgraduate Award from the Australian Government Department of Innovation, Industry, Science and Research.

PII: S0015-0282(11)00164-6

doi:10.1016/j.fertnstert.2011.01.130

Fertility and Sterility
Volume 95, Issue 5 , Pages 1677-1683, April 2011

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