Predicting live birth, preterm delivery, and low birth weight in infants born from in vitro fertilisation: a prospective study of 144,018 treatment cycles.
BACKGROUND
The extent to which baseline couple characteristics affect the probability of live birth and adverse perinatal outcomes after assisted conception is unknown.


RESULTS
We utilised the Human Fertilisation and Embryology Authority database to examine the predictors of live birth in all in vitro fertilisation (IVF) cycles undertaken in the UK between 2003 and 2007 (n = 144,018). We examined the potential clinical utility of a validated model that pre-dated the introduction of intracytoplasmic sperm injection (ICSI) as compared to a novel model. For those treatment cycles that resulted in a live singleton birth (n = 24,226), we determined the associates of potential risk factors with preterm birth, low birth weight, and macrosomia. The overall rate of at least one live birth was 23.4 per 100 cycles (95% confidence interval [CI] 23.2-23.7). In multivariable models the odds of at least one live birth decreased with increasing maternal age, increasing duration of infertility, a greater number of previously unsuccessful IVF treatments, use of own oocytes, necessity for a second or third treatment cycle, or if it was not unexplained infertility. The association of own versus donor oocyte with reduced odds of live birth strengthened with increasing age of the mother. A previous IVF live birth increased the odds of future success (OR 1.58, 95% CI 1.46-1.71) more than that of a previous spontaneous live birth (OR 1.19, 95% CI 0.99-1.24); p-value for difference in estimate <0.001. Use of ICSI increased the odds of live birth, and male causes of infertility were associated with reduced odds of live birth only in couples who had not received ICSI. Prediction of live birth was feasible with moderate discrimination and excellent calibration; calibration was markedly improved in the novel compared to the established model. Preterm birth and low birth weight were increased if oocyte donation was required and ICSI was not used. Risk of macrosomia increased with advancing maternal age and a history of previous live births. Infertility due to cervical problems was associated with increased odds of all three outcomes-preterm birth, low birth weight, and macrosomia.


CONCLUSIONS
Pending external validation, our results show that couple- and treatment-specific factors can be used to provide infertile couples with an accurate assessment of whether they have low or high risk of a successful outcome following IVF.
Centre for Population and Health Sciences, University of Glasgow, Glasgow, Scotland, United Kingdom. scott.nelson@glasgow.ac.uk
Scott M
SM
Nelson
Debbie A
DA
Lawlor
D000293:Adolescent; D000328:Adult; D003625:Data Collection; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007247:Infertility, Female / Q000628:therapy; D007248:Infertility, Male / Q000628:therapy; D050498:Live Birth / Q000453:epidemiology; D019520:Living Donors; D008297:Male; D008962:Models, Theoretical; D018587:Oocyte Donation / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D047928:Premature Birth / Q000453:epidemiology*; D011336:Probability; D011446:Prospective Studies; D012307:Risk Factors; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
Hum Reprod. 2004 Jan;19(1):3-7
14688149
Placenta. 2003 Apr;24 Suppl A:S21-7
12842410
Obstet Gynecol. 2004 Mar;103(3):551-63
14990421
Br J Obstet Gynaecol. 1995 Feb;102(2):101-6
7756199
Hum Reprod. 2008 Apr;23(4):756-71
18281243
Hum Reprod. 2000 May;15(5):1065-8
10783353
N Engl J Med. 1987 Apr 30;316(18):1105-10
3574358
JAMA. 2002 Nov 13;288(18):2320-3
12425710
Biometrics. 1988 Sep;44(3):837-45
3203132
Hum Reprod. 2006 Mar;21(3):829-32
16311294
JAMA. 2010 Feb 10;303(6):527-34
20145229
Lancet. 2006 Sep 30;368(9542):1164-70
17011943
Lancet. 1996 Nov 23;348(9039):1402-6
8937279
BMJ. 2005 Sep 24;331(7518):662
16115831
Fertil Steril. 2007 Jun;87(6):1314-21
17307175
Lancet. 2002 Jul 13;360(9327):151-9
12126838
Lancet. 1999 May 22;353(9166):1746-9
10347987
Hum Reprod. 2009 Jun;24(6):1267-87
19225009
BMJ. 2007 Apr 21;334(7598):836
17355993
Stat Med. 2008 Jan 30;27(2):157-72; discussion 207-12
17569110
Fertil Steril. 2002 Apr;77(4):725-32
11937124
Hum Reprod Update. 2009 Sep-Oct;15(5):537-52
19435779
Lancet. 2007 Oct 20;370(9596):1453-7
18064739
JAMA. 2003 Oct 22;290(16):2127-8
14570947
Acta Obstet Gynecol Scand. 2007;86(7):774-82
17611820
Lancet. 1996 Mar 16;347(9003):714-8
8602000
Lancet. 2008 Aug 30;372(9640):737-43
18674812
Hum Reprod. 1998 Dec;13(12):3542-9
9886547
N Engl J Med. 1998 Dec 17;339(25):1817-22
9854117
Hum Reprod. 2003 Nov;18(11):2478-84
14585905
J Obstet Gynaecol Can. 2006 Mar;28(3):220-233
16650361
Lancet. 1992 Jul 4;340(8810):17-8
1351601
Hum Reprod. 1996 Oct;11(10):2298-303
8943544
Lancet. 1997 Jan 25;349(9047):284
9014934
Cochrane Database Syst Rev. 2010 Jan 20;(1):CD002125
20091531