Journal of Assisted Reproduction and Genetics

, Volume 12, Issue 2, pp 88–92 | Cite as

Confounding variables affectingin vitro fertilization success: A decade of experience

  • Mansour Alsalili
  • A. Albert Yuzpe
  • Ian S. Tummon
  • Janice Parker
  • James S. B. Martin
  • Jeffrey A. Nisker
  • Susan A. J. Daniel
Clinical Assisted Reproduction

Abstract

Purpose

To evaluate etiology of infertility, female age, ovarian response and stimulation protocol in affecting in vitro fertilization (IVF) success.

Methods

Retrospective analysis was used. Computer records of all 5209 cycles initiated in 2391 couples from February 1, 1984 to December 31, 1993 were analyzed.

Results

There were 644 intrauterine, 24 solely ectopic and 7 heterotopic pregnancies. Pregnancy rates increased with number of embryos transferred with a significant increase still found between transfer of three or four embryos. Multiple gestations also increased in association with an increasing number of embryos transferred. Pregnancy rates per cycle did not decline with repeated cycles. Reduced pregnancy rates were associated with a primary diagnosis of male infertility. Covariates associated with a better pregnancy rate were younger age of the female partner or higher peak preovulatory serum estradiol. Routine administration of GnRH-agonist was associated with a reduced cycle cancellation rate, an increase in oocytes retrieved and an improved pregnancy rate.

Conclusions

Couples with male infertility and increased female age should be counselled regarding the reduced prognosis for success.

Key words

confounding variables in vitro fertilization pregnancy 

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References

  1. 1.
    Ebrahim A, Rienhardt G, Morris S, Kruger TF, Lombard CJ, Van der Merwe JP: Follicle stimulating hormone levels on cycle day 3 predict ovulation stimulation response. J Assist Reprod Genet 1993;10:130–136PubMedGoogle Scholar
  2. 2.
    Lyles R, Gibbons WE, Dodson MG, Poindexter AN, Young RL, Rossavic IK, Findley WE: Characterization and response of women undergoing repeat cycles of ovulation induction in an in vitro fertilization and embryo transfer program. Fertil Steril 1985;44:832–836PubMedGoogle Scholar
  3. 3.
    Hughes EG, King C, Wood EC: A prospective study of prognostic factors in in vitro fertilization and embryo transfer. Fertil Steril 1989;51:838–844PubMedGoogle Scholar
  4. 4.
    Dicker D, Goldman JA, Ashkenazi J, Feldberg D, Shelef M, Levy T: Age and pregnancy rates in in vitro fertilization. J in Vitro Fertil Embryo Transfer 1991;8:141–144Google Scholar
  5. 5.
    Meldrum DR: Female reproductive aging—ovarian and uterine factors. Fertil Steril 1993;59:1–5PubMedGoogle Scholar
  6. 6.
    Benshushan A, Schenker JG: Age limitation in human reproduction: Is it justified? J Assist Reprod Genet 1993;10:321–331PubMedGoogle Scholar
  7. 7.
    Sauer MV, Paulson RJ, Ary BA, Lobo RA: Three hundred cycles of oocyte donation at the University of Southern California: assessing the effect of age and infertility diagnosis on pregnancy and implantation rates. J Assist Reprod Genet 1994;11:92–96PubMedGoogle Scholar
  8. 8.
    Hughes EG, Fedorkow DM, Daya S, Sagle MA, Van de Koppel P, Collins JA: The routine use of gonadotropinreleasing hormone agonist prior to in vitro fertilization and gamete intrafallopian transfer: A meta-analysis of randomized, controlled trials. Fertil Steril 1992;58:888–896PubMedGoogle Scholar
  9. 9.
    Yuzpe AA, Brown SE, Casper RF, Nisker JA, Graves G: Rates and outcome of pregnancies achieved in the first 4 years of an in vitro fertilization program. Can Med Assoc J 1989;140:167–172Google Scholar
  10. 10.
    Yuzpe AA, Brown SE, Casper RF, Nisker JA, Graves G, Shatford L: Transvaginal ultrasound-guided oocyte retrieval for in vitro fertilization. J Reprod Med 1989;34:937–942PubMedGoogle Scholar
  11. 11.
    Tummon IS, Yuzpe AA, Daniel SAJ, Deutsch A: Total acrosin activity correlates with fertility potential after fertilization in vitro. Fertil Steril 1991;56:933–938PubMedGoogle Scholar
  12. 12.
    Alsalili M, Yuzpe A, Tummon I, Parker J, Martin J, Daniel S, Rebel M, Nisker J: Cumulative pregnancy rates and pregnancy outcome after in vitro fertilization: Five thousand cycles at one centre. Hum Reprod (in press)Google Scholar
  13. 13.
    Gratton RJ, Nisker JA, Daniel S, Toth S, Gunter J, Kaplan BR, Tummon IS, Yuzpe AA: An aggressive philosophy in controlled ovarian stimulation cycles increases pregnancy rates. Hum Reprod 1993;8:528–531PubMedGoogle Scholar
  14. 14.
    Muasher SJ, Oehninger S, Simonetti S, Matta J, Ellis LM, Liu HC, Jones GS, Rosenwaks Z: The value of basal and/or stimulated serum gonadotropin levels in prediction of stimulation response and in vitro fertilization outcome. Fertil Steril 1988;50:298–307PubMedGoogle Scholar
  15. 15.
    Gore-Langton RE, Daniel SAJ, Nisker JA, Yuzpe AA: Superiority of HTF medium versus T6 medium in an IVF-ET controlled trial. Presented at the 49th Annual Clinical Meeting of The Society of Obstetricians and Gynaecologists of Canada, Ottawa, Ontario, Canada, June 22–26, 1993Google Scholar
  16. 16.
    Tan SL, Royston P, Campbell S, Jacobs HS, Betts J, Mason B, Edwards RG: Cumulative conception and live birth rates after in vitro fertilization. Lancet 1992;339:1390–1394PubMedGoogle Scholar
  17. 17.
    FIVNAT: French National IVF Registry: Analysis of 1986 to 1990 data. Fertil Steril 1993;59:587–595Google Scholar
  18. 18.
    Edwards RG, Van Steirteghen AC: Intracytoplasmic sperm injections (ICSI) and human fertilization: Does calcium hold the key to success? Hum Reprod 1993;8:988–989PubMedGoogle Scholar
  19. 19.
    Yaron Y, Botchan A, Amit A, Kogosowski A, Yovel I, Lessing JB: Endometrial receptivity: The age-related decline in pregnancy rates and the effect of ovarian function. Fertil Steril 1993;60:314–318PubMedGoogle Scholar
  20. 20.
    Navot D, Bergh PA, Williams AM, Garrisi JG, Guzman I, Sandler B, Grufeld L: Poor oocyte quality rather than implantation failure as a cause of age-related decline in female fertility. Lancet 1991;337:1375–1377PubMedGoogle Scholar
  21. 21.
    Abdalla HI, Burton G, Kirkland A, Johnson MR, Leonard T, Brooks AA, Studd JWW: Age, pregnancy and miscarriage: Uterine versus ovarian factors. Hum Reprod 1993;8:1512–1517PubMedGoogle Scholar
  22. 22.
    Toner JP, Philput CB, Jones GS, Muasher SJ; Basal folliclestimulating hormone level is a better predictor of in vitro fertilization performance than age. Fertil Steril 1991;55:784–791PubMedGoogle Scholar
  23. 23.
    Ahmed Ebbiary NA, Lenton EA, Salt C, Ward AM, Cooke ID: The significance of elevated basal follicle stimulating hormone in regularly menstruating infertile women. Hum Reprod 1994;9:245–252PubMedGoogle Scholar
  24. 24.
    Chenette PE, Sauer MV, Paulson RJ: Very high serum estradiol levels are not detrimental to clinical outcome of in vitro fertilization. Fertil Steril 1990;54:858–863PubMedGoogle Scholar
  25. 25.
    Forman R, Belaisch-Allart J, Fries N, Hazout A, Testart J, Frydman R: Evidence of an adverse effect of elevated serum estradiol concentration on embryo implantation. Fertil Steril 1988;49:118–122PubMedGoogle Scholar
  26. 26.
    Abdalla HI, Ahuja KK, Leonard T, Morris NN, Honour JW, Jacobs HS: Comparative trial of luteinizing hormonereleasing analog/human menopausal gonadotropin and clomiphene citrate/human menopausal gonadotropin in an assisted conception program. Fertil Steril 1990;53:473–478PubMedGoogle Scholar
  27. 27.
    Tummon IS, Daniel SAJ, Kaplan BR, Nisker JA, Yuzpe AA: Randomized prospective comparison of luteal leuprolide acetate and gonadotropins versus clomiphene citrate and gonadotropins in 408 first cycles in vitro fertilization. 1992;58:563–568Google Scholar
  28. 28.
    Sharma V, Riddle A, Mason BA, Pampiglione J, Campbell S: An analysis of factors influencing the establishment of a clinical pregnancy in an ultrasound-based ambulatory in vitro fertilization program. Fertil Steril 1988;49:468–478PubMedGoogle Scholar

Copyright information

© Plenum Publishing Corporation 1995

Authors and Affiliations

  • Mansour Alsalili
    • 1
  • A. Albert Yuzpe
    • 1
  • Ian S. Tummon
    • 1
  • Janice Parker
    • 1
  • James S. B. Martin
    • 1
  • Jeffrey A. Nisker
    • 1
  • Susan A. J. Daniel
    • 1
  1. 1.Department of Gynaecology and Reproductive MedicineUniversity HospitalLondonCanada

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