title: Predicting the chances of a live birth after one or more complete cycles of in vitro fertilisation: population based study of linked cycle data from 113 873 women.
abstract: OBJECTIVE
  To develop a prediction model to estimate the chances of a live birth over multiple complete cycles of in vitro fertilisation (IVF) based on a couple's specific characteristics and treatment information.
  
  
  METHODS
  Population based cohort study.
  
  
  METHODS
  All licensed IVF clinics in the UK. National data from the Human Fertilisation and Embryology Authority register.
  
  
  METHODS
  All 253 417 women who started IVF (including intracytoplasmic sperm injection) treatment in the UK from 1999 to 2008 using their own eggs and partner's sperm.
  
  
  METHODS
  Two clinical prediction models were developed to estimate the individualised cumulative chance of a first live birth over a maximum of six complete cycles of IVF-one model using information available before starting treatment and the other based on additional information collected during the first IVF attempt. A complete cycle is defined as all fresh and frozen-thawed embryo transfers arising from one episode of ovarian stimulation.
  
  
  RESULTS
  After exclusions, 113 873 women with 184 269 complete cycles were included, of whom 33 154 (29.1%) had a live birth after their first complete cycle and 48 925 (43.0%) after six complete cycles. Key pretreatment predictors of live birth were the woman's age (31 v 37 years; adjusted odds ratio 1.66, 95% confidence interval 1.62 to 1.71) and duration of infertility (3 v 6 years; 1.09, 1.08 to 1.10). Post-treatment predictors included number of eggs collected (13 v 5 eggs; 1.29, 1.27 to 1.32), cryopreservation of embryos (1.91, 1.86 to 1.96), the woman's age (1.53, 1.49 to 1.58), and stage of embryos transferred (eg, double blastocyst v double cleavage; 1.79, 1.67 to 1.91). Pretreatment, a 30 year old woman with two years of unexplained primary infertility has a 46% chance of having a live birth from the first complete cycle of IVF and a 79% chance over three complete cycles. If she then has five eggs collected in her first complete cycle followed by a single cleavage stage embryo transfer (with no embryos left for freezing) her chances change to 28% and 56%, respectively.
  
  
  CONCLUSIONS
  This study provides an individualised estimate of a couple's cumulative chances of having a baby over a complete package of IVF both before treatment and after the first fresh embryo transfer. This novel resource may help couples plan their treatment and prepare emotionally and financially for their IVF journey.
authors.affiliation: Medical Statistics Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK d.mclernon@abdn.ac.uk.
authors.forename: David J
authors.initials: DJ
authors.lastname: McLernon
authors.affiliation: Department of Public Health, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, Netherlands.
authors.forename: Ewout W
authors.initials: EW
authors.lastname: Steyerberg
authors.affiliation: Department of Public Health, Erasmus MC-University Medical Centre Rotterdam, Rotterdam, Netherlands.
authors.forename: Egbert R
authors.initials: ER
authors.lastname: Te Velde
authors.affiliation: Medical Statistics Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK.
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Lee
authors.affiliation: Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.
authors.forename: Siladitya
authors.initials: S
authors.lastname: Bhattacharya
mesh_terms: D000328:Adult; D000367:Age Factors; D001723:Birth Rate; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D050498:Live Birth; D011237:Predictive Value of Tests; D011247:Pregnancy; D018873:Pregnancy Rate; D011336:Probability; D013997:Time Factors; D006113:United Kingdom