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.

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.

Design:  Population based cohort study.

Setting:  All licensed IVF clinics in the UK.

Realizing a desired family size: when should couples start?

Study Question: Until what age can couples wait to start a family without compromising their chances of realizing the desired number of children?

Summary Answer: The latest female age at which a couple should start trying to become pregnant strongly depends on the importance attached to achieving a desired family size and on whether or not IVF is an acceptable option in case no natural pregnancy occurs.

What Is Known Already: It is well established that the treatment-independent and treatment-dependent chances of pregnancy decline with female age. However, research on the effect of age has focused on the chance of a first pregnancy and not on realizing more than one child.

Too old to have children? Lessons from natural fertility populations.

Study Question: Is it possible to construct an age curve denoting the ages above which women are biologically too old to reproduce?

Summary Answer: We constructed a curve based on the distribution of female age at last birth in natural fertility populations reflecting the ages above which women have become biologically too old to have children.

What Is Known Already: The median age at last birth (ALB) for females is ∼40-41 years of age across a range of natural fertility populations. This suggests that there is a fairly universal pattern of age-related fertility decline.

Advanced maternal age, short interpregnancy interval, and perinatal outcome.

Objective: The purpose of this study was to evaluate whether the association between short interpregnancy intervals and perinatal outcome varies with maternal age.

Study Design: We performed a retrospective cohort study among 263,142 Dutch women with second deliveries that occurred between 2000 and 2007. Outcome variables were preterm delivery (<37 weeks of gestation), low birthweight in term deliveries (<2500 g) and small-for-gestational age (<10th percentile for gestational age on the basis of sex- and parity-specific Dutch standards).

The effect of in vitro fertilization on birth rates in western countries.

Background: We will assess to what extent in vitro fertilization (IVF) is effective in increasing the number of births overall and whether earlier application of IVF will increase this number.

Methods: We simulate 100 000 women trying for their first and second child. Natural and IVF pregnancy rates and infertility rates are age-dependent and based on published data.

Expected poor ovarian response in predicting cumulative pregnancy rates: a powerful tool.

Poor ovarian response in IVF cycles is associated with poor pregnancy rates. Expected poor responders may represent the worst prognostic group. Data were used from 222 patients starting the first of three IVF treatment cycles.

A mild treatment strategy for in-vitro fertilisation: a randomised non-inferiority trial.

Background: Mild in-vitro fertilisation (IVF) treatment might lessen both patients' discomfort and multiple births, with their associated risks. We aimed to test the hypothesis that mild IVF treatment can achieve the same chance of a pregnancy resulting in term livebirth within 1 year compared with standard treatment, and can also reduce patients' discomfort, multiple pregnancies, and costs.

Methods: We did a randomised, non-inferiority effectiveness trial.

A case study of the applicability of a prediction model for the selection of patients undergoing in vitro fertilization for single embryo transfer in another center.

Objective: To evaluate the application in a different fertility clinic of a prediction model for selecting IVF patients for elective single embryo transfer.

Design: Retrospective analysis of a large database obtained from a tertiary infertility center.

Setting: University medical center.

Female reproductive ageing: current knowledge and future trends.

Over the past few decades, postponement of childbearing has led to a decrease in family size and increased rates of age-related female subfertility. Age-related decrease in ovarian follicle numbers and a decay in oocyte quality dictate the occurrence of natural loss of fecundity and, ultimately, menopause. The rate of this ovarian ageing process is highly variable among women.

Ultrasonography as a tool for the prediction of outcome in IVF patients: a comparative meta-analysis of ovarian volume and antral follicle count.

Objective: To investigate by meta-analysis the predictive capacity of ovarian volume as an ovarian reserve test in comparison to the antral follicle count (AFC).

Design: Meta-analysis.

Setting: Tertiary fertility center.

FSH receptor genotype is associated with pregnancy but not with ovarian response in IVF.

Two very common single nucleotide polymorphisms at positions 307 and 680 in exon 10 of the FSH receptor gene have been associated with ovarian response in IVF. This observational study evaluated the role of the FSH receptor genotype in the prediction of poor response and clinical pregnancy in IVF in comparison with other markers, such as age, basal FSH, anti-Müllerian hormone and antral follicle count. In addition, the in-vitro cAMP response towards recombinant FSH in cultured granulosa cells of patients with different FSH receptor genotypes was determined.

The clomiphene citrate challenge test for the prediction of poor ovarian response and nonpregnancy in patients undergoing in vitro fertilization: a systematic review.

Objective: To systematically review the value of the clomiphene citrate challenge test (CCCT) in the prediction of poor ovarian response and pregnancy in IVF.

Design: Systematic review.

Setting: All studies that evaluated the CCCT in the prediction of poor ovarian response or pregnancy after IVF.

A high number of oocytes obtained after ovarian hyperstimulation for in vitro fertilization or intracytoplasmic sperm injection is not associated with decreased pregnancy outcome.

Objective: To investigate the possible negative effects of a strong ovarian response on oocyte quality.

Design: Retrospective study.

Setting: Tertiary academic center.

Use of ovarian reserve tests for the prediction of ongoing pregnancy in couples with unexplained or mild male infertility.

The chance of infertile patients conceiving is related to factors like female age and duration of infertility. This prospective observational study evaluated whether the results of ovarian reserve tests, including the novel marker serum anti-Mullerian hormone (AMH), were of additional value in predicting ongoing pregnancy. Two hundred and twenty-two patients diagnosed with unexplained infertility or mild male factor (total motile count>10x10(6)) on the basis of the infertility work-up were prospectively included.

Serum antimullerian hormone levels best reflect the reproductive decline with age in normal women with proven fertility: a longitudinal study.

Objective: The aim of this study was to assess which of the basal ovarian reserve markers provides the best reflection of the changes occurring in ovarian function over time (i.e., reproductive aging).

Prospective validation of two models predicting pregnancy leading to live birth among untreated subfertile couples.

Background: Models predicting clinical outcome need external validation before they can be applied safely in daily practice. This study aimed to validate two models for the prediction of the chance of treatment-independent pregnancy leading to live birth among subfertile couples.

Methods: The first model uses the woman's age, duration and type of subfertility, percentage of progressive sperm motility and referral status.

The antral follicle count is a better marker than basal follicle-stimulating hormone for the selection of older patients with acceptable pregnancy prospects after in vitro fertilization.

This observational study shows that the antral follicle count is a better predictor of ongoing pregnancy in IVF patients aged >38 years of age than is basal FSH. Patients aged <44 years with a normal antral follicle count still have acceptable pregnancy rates after IVF and therefore deserve treatment.

Antral follicle count in the prediction of poor ovarian response and pregnancy after in vitro fertilization: a meta-analysis and comparison with basal follicle-stimulating hormone level.

Objective: To assess the predictive performance of the antral follicle count (AFC) as a test for ovarian reserve in IVF patients and to compare this performance with that of basal FSH level.

Design: Meta-analysis.

Setting: Tertiary fertility center.

Antral follicle counts are related to age at natural fertility loss and age at menopause.

Objective: The variability in ultrasound-based antral follicle counts sized 2-10 mm after allowing for age-related decline is considerable. This may represent differences in actual reproductive age among women. This hypothesis was tested by cohort comparison for distribution of age at occurrence of reproductive events.