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Prognostic value of first IVF cycle on success of a subsequent cycle

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Prognostic value of first IVF cycle on success of a subsequent cycle

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To determine whether a live birth or miscarriage in a previous IVF cycle is predictive of success in a subsequent cycle. Retrospective study Private IVF unit 1141 couples having a second IVF cycle. 3 groups; Group I: women who had a live birth in the first cycle, Group II those who had a miscarriage, Group III, women who had a negative pregnancy test in their first cycle. Pregnancy (PR), Live birth (LBR) & miscarriage rates in the second cycle. For women < than 40: PR was 46.4% (368/793), miscarriage rate was 29.9% and the LBR was 32.5% (258/793). Women in groups I & II had a statistically higher PR than those in group III 63.3% v 55.2% v 41.9% respectively. LBR was higher 45% v 37.8 v 29.6% respectively. Miscarriage rate was similar. For women 40 years and older: The PR was 21.0% (73/348), miscarriage rate was 52.1% (38/73) and the LBR was 10.1% (35/348).There was no significant difference in PR among women in groups I, II & III. The LBR and miscarriage rates were similar in all groups. Young women who had a live birth and those who experienced an early miscarriage after IVF have a greater likelihood of achieving a live birth in a second cycle. Outcome of first IVF cycle however does not predict subsequent IVF success in older women.
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ASSISTED REPRODUCTION TECHNOLOGIES
Prognostic value of first IVF cycle on success
of a subsequent cycle
Emmanuel Kalu &Meen-Yau Thum &Hossam Abdalla
Received: 2 November 2010 / Accepted: 27 December 2010 /Published online: 8 January 2011
#Springer Science+Business Media, LLC 2011
Abstract
Objective To determine whether a live birth or miscarriage
in a previous IVF cycle is predictive of success in a
subsequent cycle.
Design Retrospective study
Setting Private IVF unit
Patients 1141 couples having a second IVF cycle.
Intervention 3 groups; Group I: women who had a live
birth in the first cycle, Group II those who had a
miscarriage, Group III, women who had a negative
pregnancy test in their first cycle.
Outcome measures Pregnancy (PR), Live birth (LBR) &
miscarriage rates in the second cycle.
Results For women<than 40: PR was 46.4% (368/793),
miscarriage rate was 29.9% and the LBR was 32.5% (258/
793). Women in groups I & II had a statistically higher PR
than those in group III 63.3% v 55.2% v 41.9%
respectively. LBR was higher 45% v 37.8 v 29.6%
respectively. Miscarriage rate was similar.
For women 40 years and older: The PR was 21.0% (73/
348), miscarriage rate was 52.1% (38/73) and the LBR was
10.1% (35/348).There was no significant difference in PR
among women in groups I, II & III. The LBR and
miscarriage rates were similar in all groups.
Conclusion Young women who had a live birth and those
who experienced an early miscarriage after IVF have a
greater likelihood of achieving a live birth in a second
cycle. Outcome of first IVF cycle however does not predict
subsequent IVF success in older women.
Keywords IVF/ICS outcome .Assisted reproduction .
Miscarriage .Prognosis
Introduction
State funding for IVF in the UK is sparse. In spite of the
recommendations by the National Institute of Health and
Clinical Excellence [1], most health commissioners will
only fund a single IVF cycle per couple [2]. Couples who
wish to have further IVF treatment would usually have to
self-fund. Previous IVF success may motivate a couple to
invest on a further IVF cycle. Although a miscarriage is
devastating, it may also be positively motivating to some
couples who may be inclined to try again with the hope that
the next cycle may be better. As IVF remains physically,
emotionally and economically expensive, couples embark-
ing on further treatment, seek guidance from clinicians to
determine prognosis before investing in another cycle.
Earlier studies suggest that women, who had a live birth
or miscarriage in their first IVF cycle have better prognosis
for success in a subsequent cycle compared to women who
had a negative pregnancy test [3,4]. These previous studies
mainly focused on young women and the result may not be
applicable to older women. In this study we reviewed
treatment outcome to determine whether a live birth or
miscarriage in a previous IVF cycle is predictive of success
in a second cycle, and to determine if this is true for older
women as well as for young women.
Capsule Whilst previous pregnancy (live birth or miscarriage) may be
a positive marker for IVF success in young women, this may not be
the case among women 40 years and over.
E. Kalu (*)
Queen Marys Hospital, Kingston Hospital NHS Trust,
Kingston Upon Thames, Surrey, UK KT2 7QB
e-mail: ekalu@doctors.org.uk
M.-Y. Thum :H. Abdalla
Lister Fertility Clinic, Lister Hospital,
Chelsea Bridge Road,
London SW1W 8RH, UK
J Assist Reprod Genet (2011) 28:379382
DOI 10.1007/s10815-010-9534-0
Materials and methods
We prospectively collect and store data of all patients
undergoing IVF/ICSI in our unit in a Medical System for
IVF (MedicalSys, London, UK). We analysed data on 1141
women who had their first and second IVF treatment cycles at
the Lister Fertility clinic from January 2005 to December
2008. Three groups were identified based on the outcome of
the first IVF treatment cycle. Group I consists of women who
had a live birth in the first cycle, (n= 75), Group II; those who
had an early miscarriage in the first cycle (n=223), & Group
III, consists of women who had a negative pregnancy test in
their first cycle (n= 843). Treatment outcomes of the second
cycle were analysed and compared between the groups.
Outcome measures include pregnancy, live birth and miscar-
riage rates. The women were further divided into 2 groups
based on age (<40 and>40 years, and data was analysed to
compare outcome between women in these age groups.
IVF stimulation
In brief, the IVF treatment protocol includes ovarian
stimulation, with either recombinant FSH, human meno-
pausal gonadotrophin or urinary FSH. Patients were down
regulated with either Nafarelin or Buserelin at mid luteal
phase. When follicles reached pre-ovulatory size (18 to
22 mm), 10,000 IU of hCG was administrated. Oocytes
were aspirated using trans-vaginal ultrasound guidance 34
to 36 h after hCG administration. For fertilisation, standard
insemination or ICSI was performed as clinically appropri-
ate. Embryo culture was performed using a sequential
micro-drop system at an atmosphere of 56% CO
2
at 37°C.
SAGE sequential cleavage media (SAGE In-vitro Fertiliza-
tion Inc. Trumbull, Connecticut) was used for embryos on
day 13, and patients who met our criteria for extended
culture continued to the blastocyst stage. 400 mg cyclogest
pessary was administered to all the patients for luteal
support. A pregnancy test was performed 2 weeks follow-
ing embryo transfer and a transvaginal ultrasound scan at
6 weeks to determine the number of gestation.
In this study a pregnancy was defined as a positive serum
or urine HCG test and a sac on ultrasound scan, or an ectopic
pregnancy. Miscarriage was defined as pregnancy loss
following ultrasound confirmation of an intrauterine gestation
sac. A live birth was defined as a pregnancy resulting in a
viable infant. Twins were counted as one live birth. The study
was approved by the local ethics committee.
Data analysis
Data was collected in Medical System for IVF (MedicalSys,
London, UK) and analysed by Statistics Package for Social
Sciences (SPSS, Surrey, UK). Descriptive statistical analysis
was performed initially to examine the normal distribution of
all continuous variances for parametric statistical tests.
Chi-square Cross Tabulation test was used to analyse the
significant difference in pregnancy rates and live birth
rates between the groups. Statistical significant was set at
P<0.05.
Results
1141 women embarked on a second IVF cycle; 441 got
pregnant (Pregnancy rate (PR) = 38.7%). Women in groups I
(live birth in first cycle) & II (miscarriage in first cycle) had
Table 1 Treatment outcome in 2nd IVF cycle in women who failed to achieve a positive pregnancy in 1st IVF cycle compared with those who
miscarried or had a live birth after their 1st IVF cycle
Not pregnancy in 1st cycle
(Group 3)
Miscarriage in 1st Cycle
(Group 2)
Live birth (Group
1)
P-value
Number of patients 843 223 75 NA
Basal FSH levels IU/L±SD 7.26± 6.9 6.11± 5.2 7.13± 2.1 NS 0.17
Mean age± SD 37.9± 4.4 36.9± 4.2 36.6± 3.9 NS 0.46
Average no. of oocytes collected±SD 8.28± 5.9 9.05± 5.4 10.1± 6.1 NS 0.11
Average no of normal fertilized
embryos± SD
6.18± 3.7 6.65± 2.6 7.11± 3.9 NS 0.21
Average no of embryos transferred±SD 1.63± 0..85 1.66± 0.75 1.67 ±).71 NS 0.67
Pregnancy rate (%) 34.5% (291/843) 48.0% (107/223) 57.3% (43/75) 0.001
Miscarriage rate (%) 33.7% (98/291) 33.6% (36/107) 32.6% (14/43) NS 0.907
Live birth rate (%) 22.9% (193/843) 31.8% (71/223) 38.7% (29/75) 0.001
NS= difference not statistically significant (P> 0.05)
NA= not applicable.
380 J Assist Reprod Genet (2011) 28:379382
a higher PR than those in Group III (negative pregnancy
test in first cycle). 57.3% (43/75), vs 48.0% (107/223), vs
34.5% (291/843) respectively; (p = 0.00). There was also a
statistically significant difference in the live birth rate
(LBR) between the 3 groups. Women in Groups I & II
had a higher LBR in their second cycle compared to those
in III; 38.7%(29/75) vs 31.8% (71/23) vs 22.9% (193/843)
respectively (p=0.01). The rate of miscarriage in the second
cycle was not significantly different in the 3 groups (32.6%
v 33.6% v 33.7% respectively). (Table 1)
When only women age less than 40 were considered Of
1141 women in the study, 793 were age<40 years. In this
cohort, the PR was 46.4% (368/793), miscarriage rate was
29.9% and the LBR was 32.5% (258/793). Women in
groups I & II had a statistically higher PR than those in
group III (63.3% v 55.2% v 41.9% respectively (p=0.00).
Similarly the LBR was higher (45% v 37.8 v 29.6%
respectively, p= 0.015). There was however no difference in
the miscarriage rate in the 3 groups. (28.9% v 31.6% v
29.4% respectively). (Table 2).
When only women age 40 years or older were analysed Of
1141 women, 348 were age >=40 years. The PR in this
older cohort was 21.0% (73/348), miscarriage rate was
52.1% (38/73) and the LBR was 10.1% (35/348).
There was no significant difference in PR among women
in groups I, II & III (33.3 v 23.5 v 19.9% p=0.44). The
LBR was similar in the three groups (13.3 v 11.8 v 9.6%
respectively). There was no difference in the miscarriage
rates in the three groups (Table 3).
Discussion
IVF treatment is stressful and costly. The emotional stress
may even be greater in women who achieve pregnancy but
Table 2 Treatment outcome in 2nd IVF cycle in women aged <40 years, who failed to achieve a positive pregnancy in their 1st IVF cycle
compared with those who miscarried or had a live birth after their 1st IVF cycle
Not pregnancy in 1st cycle Miscarriage in 1st Cycle Live birth P-value
Number of patients 561 172 60 NA
Basal FSH levels IU/L±SD 6.10± 5.4 4.97± 4.6 5.92± 2.5 NS
Mean age± SD 35.2± 3.4 34.8± 3.5 33.4±3.8 NS
Average no. of oocytes collected±SD 9.16± 6.1 9.34± 5.5 11.7± 6.0 NS
Average no of fertilized embryos± SD 7.21±2.8 6.95±1.5 8.01±3.1 NS
Average no of embryos transferred±SD 1.43± 0.79 1.76± 0.48 1.78 ± 0.41 NS
Pregnancy rate (%) 41.9% (235/561) 55.2% (95/172) 63.3% (38/60) <0.001
Miscarriage rate (%) 29.4% (69/235) 31.6% (30/95) 28.9% (11/38) NS
Live birth rate (%) 29.6% (166/561) 37.8% (65/172) 45.0% (27/60) 0.015
NS difference not statistically significant (P>0.05)
NA not applicable
Table 3 Treatment outcome in 2nd IVF cycle in women aged >=40, who failed to achieve a positive pregnancy in 1st IVF cycle compared with
those who miscarried or had a live birth after their 1st IVF cycle
Not pregnancy in 1st cycle Miscarriage in 1st Cycle Live birth P-value
Number of patients 282 51 15 NA
Basal FSH levels IU/L±SD 9.02± 6.9 6.10± 4.2 11.97±2.6 NS
Mean age± SD 42.07± 2.4 41.58± 1.3 40.4±1.2 NS
Average no. of oocytes collected±SD 6.53± 5.0 7.96± 4.9 7.80± 5.6 NS
Average no of fertilized embryos± SD 4.13±2.2 5.63±2.2 4.31±3.1 NS
Average no of embryos transferred±SD 1.77± 1.02 1.95± 0.75 1.93±0.45 NS
Pregnancy rate (%) 19.9% (56/282) 23.5% (12/51) 33.3% (5/15) NS
Miscarriage rate (%) 51.8% ((29/56) 50.0% (6/12) 60.0% (3/5) NS
Live birth rate (%) 9.6% (27/282) 11.8% (6/51) 13.3% (2/15) NS
NS difference not statistically significant (P>0.05)
NA not applicable
J Assist Reprod Genet (2011) 28:379382 381
unfortunately suffer miscarriage. There is a tendency for
such couple to pull resources together to try a further IVF
with the hope that outcome will be better. This expectation
is not unfounded as studies have shown that women who
achieve a pregnancy (whether this is a live birth or a
miscarriage) in a previous IVF cycle have a better chance of
conceiving in subsequent cycles [3,4]. Our data supports
this assertion and is consistent with these previous studies.
From our data, women who had a live birth or suffered a
miscarriage following their first IVF cycle had a live birth
rate of 38.7% and 31.8% respectively, significantly higher
than 22.9% for women who had a negative pregnancy test
following their fist IVF. However this assertion seems to
apply only to young women. Among our young women age
below 40, those who had a live birth or suffered a
miscarriage following their first IVF had a significantly
higher chance (45% and 37.8% respectively) of having a
live birth in a subsequent IVF cycle compared to 29.6%
among women who had a negative pregnancy test in the
first cycle. Interestingly our results suggests that among
older women (>=40 years), the situation is different. A
miscarriage or even a live birth in a first IVF cycle does not
confer a better prognosis in the second cycle. In this older
cohort, we did not find any significant difference in
pregnancy or live birth rates in women in all three groups.
This finding is consistent with results from one previous
study [5]. Although the authors from this also included data
from thaw transfer cycles, as well as data from gamete
intrafallopian transfer, their results were similar to ours and
showed that an early pregnancy loss is not predictive of a
successful delivery in subsequent IVF cycles for women
older than 40 years. This observation is important when
counseling women prior to subsequent IVF cycles.
Sneeringer et al. [5], suggested that the differences in the
findings for younger and older women may be due to the
different aetiologies for infertility between these two
groups. They suggest that whilst an early pregnancy loss
may represent a proven ability to become pregnant in
younger women with varied aetiologies of infertility, for
older women where the aetiology is usually diminished
ovarian reserve, early pregnancy loss does not select for a
group with a more favourable prognosis in this older
cohort.
We did not find any significant difference in the rate of
miscarriage among women in the three groups. Women
who had a miscarriage in their first IVF are not at increased
risk of suffering a further miscarriage in a subsequent cycle
compared to women who had a live birth.
In conclusion, whilst previous pregnancy (miscarriage or
live birth) may be a positive marker for success in a
subsequent cycle in young women, this may not be the case
among women over 40 years of age. In this older cohort, a
live birth or previous pregnancy loss is not predictive of a
successful delivery in a subsequent IVF cycle. This
information should enable clinicians to effectively counsel
couples and guide them as they make informed decisions
prior to committing more resources towards further IVF
cycles.
Conflict of interest All the authors declare no conflict of interest.
References
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3. Bates Jr GW, Ginsburg ES. Early pregnancy loss in in vitro
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the results of a first in vitro fertilization cycle on the outcome of
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382 J Assist Reprod Genet (2011) 28:379382
... Little is known about the prognostic significance of prior early pregnancy loss on future IVF cycles. The literature contains conflicting data concerning the prognostic value of an early pregnancy on IVF cycles, some reported higher success rates after first trimester miscarriage during the next IVF attempt [4] [5]. Younger maternal age, premature rupture of membranes, intra-uterine growth restriction, hypertensive disorders, and preeclampsia are all independently associated with an initial miscarriage [6]. ...
... IVF patients therefore need a good understanding of their own chance that IVF might result in a birth before they finalize any treatment decision [1] , although current efforts to provide this information early in the evaluation are typically based on cumulative clinic-specific data from IVF patients of similar age who previously attempted IVF at that institution . However, especially for older women, the outcome of the first IVF cycle is not predictive of subsequent IVF success [2], irrespective of where the treatment is offered later [3]. It is important for IVF providers to explain statistics on treatment outcomes and associated risks in an understandable way, so that patient expectations are not set unreal- istically [4]. ...
... IVF patients therefore need a good understanding of their own chance that IVF might result in a birth before they finalize any treatment decision [1] , although current efforts to provide this information early in the evaluation are typically based on cumulative clinic-specific data from IVF patients of similar age who previously attempted IVF at that institution . However, especially for older women, the outcome of the first IVF cycle is not predictive of subsequent IVF success [2], irrespective of where the treatment is offered later [3]. It is important for IVF providers to explain statistics on treatment outcomes and associated risks in an understandable way, so that patient expectations are not set unreal- istically [4]. ...
Article
Full-text available
In vitro fertilization (IVF) has become a standard treatment for subfertility after it was demonstrated to be of value to humans in 1978. However, the introduction of IVF into mainstream clinical practice has been accompanied by concerns regarding the number of multiple gestations that it can produce, as multiple births present significant medical consequences to mothers and offspring. When considering IVF as a treatment modality, a balance must be set between the chance of having a live birth and the risk of having a multiple birth. As IVF is often a costly decision for patients-financially, medically, and emotionally-there is benefit from estimating a patient's specific chance that IVF could result in a birth as fertility treatment options are contemplated. Historically, a patient's "chance of success" with IVF has been approximated from institution-based statistics, rather than on the basis of any particular clinical parameter (except age). Furthermore, the likelihood of IVF resulting in a twin or triplet outcome must be acknowledged for each patient, given the known increased complications of multiple gestation and consequent increased risk of poor birth outcomes. In this research, we describe a multivariate risk assessment model that incorporates metrics adapted from a national 7.5-year sampling of the Human Fertilisation & Embryology Authority (HFEA) dataset (1991-1998) to predict reproductive outcome (including estimation of multiple birth) after IVF. To our knowledge, http://www.formyodds.com is the first Software-as-a-Service (SaaS) application to predict IVF outcome. The approach also includes a confirmation functionality, where clinicians can agree or disagree with the computer-generated outcome predictions. It is anticipated that the emergence of predictive tools will augment the reproductive endocrinology consultation, improve the medical informed consent process by tailoring the outcome assessment to each patient, and reduce the potential for adverse outcomes with IVF.
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To identify whether biochemical pregnancy (BP) and spontaneous abortion (SA) cases have the same clinical characteristics in assisted reproductive therapy (ART), and to assess its predictive value for the subsequent cycles. Retrospectively reviewed 12,174 cycles in the first in vitro fertilization and embryo transfer (IVF-ET) cycle from January 2009 to December 2012 of Peking University Third Hospital Reproductive Medical Center. Besides those patients who reached ongoing pregnancy stage, 7,598 cases were divided into three groups: group 1, lack of pregnancy (n = 6,651); group 2, BP (n = 520); and group 3, SA (n = 427). We compared the basic status of patients of the three groups, including ages, body mass index, basic hormone levels, controlled ovarian hyperstimulation protocols, amount of gonadotropin use, and endometrium thickness. The reproductive outcome of the next embryo transfer cycles of the three groups was analyzed. 520 patients ended as BP, and 427 patients ended as SA. The age, primary infertility proportion, body mass index, basic FSH level and basic E2 level were similar among groups. Endometrial thickness, controlled ovarian hyperstimulation protocol, Gn dosage, average oocyte retrieval and ET numbers were also similar. Multivariate analysis showed that only the age (P = 0.037, OR 1.060, 95 % CI 1.001-1.120) and endometrium thickness on hCG administration day (P = 0.029, OR 1.136, 95 % CI 1.013-1.275) may result in the differences between BP and SA groups. In the subsequent ET cycles, the total BP rate was 4.37 %, clinical pregnancy rate was 37.28 %, and miscarriage rate was 8.18 %. The clinical pregnancy rates were similar among groups. However, BP group still had the highest BP rate (P < 0.05, 7.97 vs. 4.01 % and 5.28 %), BP and SA group had higher miscarriage rate (P < 0.05, 11.76 % and 14.75 vs. 7.41 %). BP and SA in first IVF cycles had negative predictive value for subsequent ART outcomes.
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Early pregnancy loss is common among women treated with assisted reproduction treatment, but whether it is a prognostic factor for success in subsequent IVF cycles is not well established. The aim of this study was to determine whether a biochemical pregnancy (BP) or spontaneous abortion (SA) affects the pregnancy rates in the following cycle. A retrospective study of 2687 women undergoing 6678 cycles between January 1998 and March 2010 was performed. Ongoing pregnancy rate (PR) per cycle was compared between patients with a pregnancy loss versus a negative beta-HCG in their previous cycles. Multivariate analysis of factors affecting ongoing pregnancy rate was performed. BP and/or SA in the first three cycles did not significantly alter the chances to conceive (16.9% patients with BP and/or SA in the previous cycle versus 16.5% patients with no previous pregnancy). From cycle 4 onwards, the presence of a previous abortion (either BP or SA) was associated with better ongoing PR (23.0% versus 11.2%, P < 0.001). In conclusion, BP and/or SA in a previous cycle appears to be a positive marker for success in subsequent cycles in patients with repeated IVF failures. These results should be further investigated in this challenging group of patients. RBM Online (c) 2012, Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.
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This study examines the relationship between the first cycle of in-vitro fertilization (IVF) and subsequent cycles. The results of all IVF cycles conducted at The Hammersmith Hospital or The Royal Masonic Hospital between 1988 and 1995 were studied including those cycles where egg recovery was abandoned due to poor ovarian response. All patients underwent a standardized treatment protocol. Of those women who achieved a clinical pregnancy during their first IVF attempt, 33% achieved a pregnancy during their second cycle, statistically significantly different from the 24% of patients conceiving during a second cycle who had failed to conceive during their first. 36% of those who achieved a biochemical pregnancy in their first cycle became pregnant in their second. Age was an important factor in the success of IVF treatment, with pregnancy rates of 48% in the 20-25 year age group falling to 8% in those aged > or =41 years. Cumulative pregnancy rates were 26% after one cycle, increasing to 43% after two cycles and reached 80% after seven cycles. A previous pregnancy significantly improved a couple's probability of conception in a later IVF cycle. Overall pregnancy rates per cycle were constant for the first three attempts. Cumulative pregnancy rates continued to rise to 72% after six cycles. Thus the more cycles a couple undergo (up to six) the greater their chance of a pregnancy.
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The provision of infertility services has always provoked controversy. On the one hand, patients' groups and clinicians involved with infertile couples have long campaigned against the 'postcode lottery'. On the other hand, commissioners have been reluctant to commit resources to what they see as a low priority in health care. The issue has been brought back into the news with the government's decision to ask the National Institute of Clinical Excellence to review the inequalities in provision of fertility services. This article sets out the evidence for viewing infertility as an illness that deserves public funding, and argues that assisted conception should be viewed in the same light as other chronic non-life-threatening conditions that are currently funded by the NHS.
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To determine the significance of biochemical pregnancy losses and clinical spontaneous abortion (SAB) on outcomes of future IVF cycles. Retrospective cohort study. Academic IVF program. Women with a history of unsuccessful IVF attempts undergoing IVF. None. Clinical pregnancy rate. Patients with an early pregnancy loss had a greater ongoing clinical pregnancy rate in the immediate next cycle when compared with those women who had a negative pregnancy test (37.3% vs. 27.3%). Patients with a history of a biochemical pregnancy or a clinical spontaneous abortion had an ongoing clinical pregnancy rate in the next cycle of 38.4% and 42.3%, respectively, compared with 27.3% in women who had a history of a negative pregnancy test. The cumulative pregnancy rate after the first IVF attempt was 54.1% in patients with a previous biochemical pregnancy loss, 61.4% in those with a previous clinical SAB, and 46.5% in women with a previous negative pregnancy test. Women who experience an early pregnancy loss after IVF have a greater likelihood of success in subsequent IVF cycles when compared with patients who fail to conceive.
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To determine if there is an association between first IVF cycle outcome and subsequent delivery rate for women over 40 years. Retrospective data analysis. Large, private academically affiliated IVF center. Patients over 40 years of age undergoing IVF. Delivery rate compared between patients with a pregnancy loss versus a negative beta-hCG in their first cycle. Additional factors including subsequent pregnancy losses, total number of IVF cycles, and delivery rates per cycle were also analyzed. Among women who underwent their first IVF cycle over age 40, 8% of women had a pregnancy loss and 82% had a negative beta-hCG in their initial IVF cycle. In the pregnancy loss and negative beta-hCG groups, 17.9% and 21.9%, respectively, had a successful delivery in a future cycle. There were no further pregnancies leading to delivery after the fourth treatment cycle for the pregnancy loss group and the sixth treatment cycle for the negative beta-hCG group. The average number of cycles and the number of subsequent pregnancy losses were similar in both groups. Outcome of initial IVF cycle is not prognostic of future delivery for women over the age of 40 years.