Cumulative probabilities of live birth across multiple complete IVF/ICSI cycles: a call for attention.

Purpose: To call attention to the fact that cumulative live birth (LB) proportions exhibit an inverted pattern to that displayed by each individual oocyte retrieval cycle (ORC-specific LB proportions) as well as when grouping together all the ORCs undergone by a woman (TNORC-specific LB proportions).

Methods: A retrospective study of 1433 infertile women that had a LB using autologous fresh or frozen embryos and/or dropped out of IVF/ICSI treatment after completing a maximum number of three treatment cycles. Generalized Estimating Equations (GEE) and standard and landmark Kaplan-Meier survival analyses were applied.

Results: A standard Kaplan-Meier analysis indicated that cumulative LB proportions rose as number of ORCs increased (0.320, 0.484, and 0.550 at ORC 1, 2, and 3, respectively). In contrast, landmark ORC-specific LB proportions showed an inverted pattern (0.320, 0.242, and 0.127 at ORC 1, 2, and 3, respectively). GEE models revealed that women's clinical outcomes decreased as TNORCs increased. In particular, compared to women that experienced just one ORC, women that underwent two and three ORCs displayed higher incidences of cycle cancellations before either oocyte retrieval or embryo transfer, and clinical pregnancy losses, and lower odds of LB.

Conclusion: Infertile women should be informed that cumulative LB probabilities exhibit an inverted pattern to that displayed by each individual ORC as well as when grouping together all the ORCs undergone by a woman.