title: How effective is in vitro fertilization, and how can it be improved?
abstract: OBJECTIVE
  To measure IVF effectiveness, which is defined as the cumulative incidence of live delivery over real time in women after commencing IVF treatment.
  
  
  METHODS
  Population-based retrospective cohort study.
  
  
  METHODS
  IVF clinics in Western Australia (WA).
  
  
  METHODS
  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).
  
  
  METHODS
  Data on IVF cycles were extracted from hospital records and a statutory reproductive technology register and linked to records of births.
  
  
  METHODS
  Cumulative incidence of an IVF-attributed live delivery and cumulative incidence of an IVF-attributed or IVF treatment-independent live delivery.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  IVF effectiveness could be improved if women, particularly those over 35, underwent more cycles.
authors.affiliation: School of Population Health, The University of Western Australia, Crawley, Western Australia, Australia. louise.stewart@uwa.edu.au
authors.forename: Louise M
authors.initials: LM
authors.lastname: Stewart
authors.forename: C D'Arcy J
authors.initials: CD
authors.lastname: Holman
authors.forename: Roger
authors.initials: R
authors.lastname: Hart
authors.forename: Judith
authors.initials: J
authors.lastname: Finn
authors.forename: Qun
authors.initials: Q
authors.lastname: Mai
authors.forename: David B
authors.initials: DB
authors.lastname: Preen
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D007246:Infertility / Q000453:epidemiology / Q000628:therapy*; D011153:Population; D011247:Pregnancy; D018873:Pregnancy Rate; D058996:Quality Improvement / Q000706:statistics & numerical data / Q000639:trends; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult