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Prognosefaktoren der assistierten Reproduktion

Analysen auf der Grundlage der Ergebnisse des Deutschen IVF-Registers (D·I·R)

Prognostic factors of assisted reproduction

Analyses based on results from the German IVF Registry

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Der Gynäkologe Aims and scope

Zusammenfassung

Die reproduktive Anamnese sollte bei der Beratung über die Erfolgsaussichten einer Therapie unter Zuhilfenahme von Techniken der assistierten Reproduktion (ART) mit einbezogen werden. Aufgrund der umfangreichen Angaben zu vorausgehenden Schwangerschaften bei geplanten Behandlungen wurde eine Untersuchung aus Daten des Deutschen IVF-Registers durchgeführt. Das Alter der Frau, die Art einer vorausgehenden Konzeption und der Schwangerschaftsausgang zeigten dabei einen signifikanten Einfluss auf die Erfolgsaussicht einer reproduktionsmedizinischen Therapie. Eine vorausgehende Schwangerschaft war positiv korreliert zur ART-Erfolgsrate. Mehr als eine vorausgehende Schwangerschaft war negativ korreliert. Diese negative Korrelation verschwand, wenn das Alter auf maximal 35 Jahre limitiert wurde. Eine vorausgehende Lebendgeburt oder ein Abort, der aus einer ART-Behandlung hervorging, hatte den größten positiven Einfluss auf eine folgende ART-Behandlung. Jeder vorausgehende Abort erhöhte die Wahrscheinlichkeit, auch durch eine ART-Behandlung einen Abort zu erleiden. Ein vorausgehender Abort, der aus einer ART-Behandlung resultierte, hatte einen größeren Einfluss als ein Abort als Folge einer spontanen Konzeption. Eine signifikant steigende Abortrate war ab einem Alter der Frau von 35 Jahren festzustellen.

Abstract

Previous conceptions are one predictor for the outcome of assisted reproductive technology (ART) procedures. This study analyzes German IVF Registry data to examine the impact of former pregnancies on the outcome of ART procedures. The dataset consists of a total of 174,909 ART procedures performed between January 1998 and December 2000. Multiple logistic regression was used to assess the correlation between spouse/partner change, women’s age, and infertility diagnosis. More than one former pregnancy was negatively associated with ART regarding the woman’s age and duration of infertility. ART success was significantly more likely when a former pregnancy had been achieved through ART than when it was achieved by spontaneous conception. It was also demonstrated that any former miscarriage would increase the treatment-dependant miscarriage rate in ART procedures. A significantly higher impact was shown for one former miscarriage achieved by ART procedures compared to spontaneous conception. Partner change was shown to have no specific impact on the treatment-dependant pregnancy rate. A statistically significant increase of miscarriages in all ART procedures was found among women older than 34 years of age. The highest rate of treatment-dependant miscarriages was seen in ART procedures with cryopreserved embryo transfer. Successful ART procedures ending in a live birth or even a miscarriage predicted the success of subsequent ART procedures. More than one former pregnancy, age factors, and duration of infertility were inversely associated with ART success.

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Danksagung

Die vorliegende Untersuchung konnte nur durch die aktive Mithilfe des Vorstandes und des Kuratoriums des Deutschen IVF-Registers sowie der Mitarbeiterinnen und Mitarbeiter der Ärztekammer Schleswig-Holstein durchgeführt werden. Ohne die mühevolle und zeitaufwändige Datensammlung an den über 100 IVF-Zentren in Deutschland kann ein lebendiges Register mit standardisierten Jahresauswertungen und wissenschaftlich orientierten Analysen nicht existieren. Den vielen Beteiligten in ganz Deutschland sei an dieser Stelle herzlich gedankt.

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Authors and Affiliations

  1. Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Ludwig-Maximilians Universität München-Innenstadt

    M. S. Kupka & K. Friese

  2. Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck

    R. E. Felberbaum

  3. Abteilung für Gynäkologische Endokrinologie und Reproduktionsmedizin, Klinik und Poliklinik für Geburtshilfe und Frauenheilkunde, Klinikum der Rheinischen Friedrich-Wilhelms-Universität, Bonn

    H. H. van der Ven

  4. Zentrum für Reproduktionsmedizin und Gynäkologische Endokrinologie, Langenhagen

    K. Bühler

  5. Ärztekammer Schleswig-Holstein, Bad Segeberg

    W. Dahncke

  6. Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Klinikum der Ludwig-Maximilians Universität München-Innenstadt, Maistraße 11, 80337 , München

    M. S. Kupka

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  1. M. S. Kupka
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  2. R. E. Felberbaum
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  3. H. H. van der Ven
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  4. K. Bühler
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  6. K. Friese
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Correspondence to M. S. Kupka.

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Kupka, M.S., Felberbaum, R.E., van der Ven, H.H. et al. Prognosefaktoren der assistierten Reproduktion. Gynäkologe 37, 686–695 (2004). https://doi.org/10.1007/s00129-004-1562-3

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  • DOI: https://doi.org/10.1007/s00129-004-1562-3

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