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

Funding: This work was supported by a Chief Scientist Office postdoctoral training fellowship in health services research and health of the public research (ref PDF/12/06). The views expressed here are those of the authors and not necessarily those of the Chief Scientist Office. The funder did not have any role in the study design; the collection, analysis, and interpretation of data; the writing of the report; nor the decision to submit the paper for publication. DJM had full access to all the data in the study and had final responsibility for the decision to submit for publication.Peer reviewedPublisher PD

An improvement in the method used to assess discriminatory ability when predicting the chances of a live birth after one or more complete cycles of in vitro fertilisation

Peer reviewedPostprin

Південноукраїнські історики та російська академічна еліта: етапи та напрямки співпраці у другій половині ХІХ – на початку XX ст.

У статті на широкій джерельній базі досліджено інфраструктурні та особисті зв’язки між південноукраїнськими істориками та академіками Санкт-Петербурзької (Російської) Академії наук впродовж другої половини ХІХ ст. – 1920-х років.The article, based on a great number of sources, researches the infrastructural and personal contacts between the historians of South Ukraine and academicians of the St.-Petersburg Academy of Sciences throughout the second half of the ХІХ century – 1920-ies

Introduction

With late fertility as the main trigger and focal point, this book discusses the future of motherhood in western societies: to what extent and under what conditions are motherhood and emancipation (still) compatible? Is it possible to define an optimal time path or optimal conditions? Earlier discussions in the Netherlands on late motherhood/parenthood and the dilemma of health issues versus personal and socio-economic motives revealed that adressing this general question, immediately brings up a series of related questions in which many scientific dimensions are involved.That is why we brought together an international team of scolars and scientists from various disciplines to present and discuss their view on the relation between motherhood and emancipation and the dilemmas around late parenthood. This book consists of several chapters resulting from these consultations

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. STUDY DESIGN, SIZE, DURATION An established computer simulation model of fertility, updated with recent IVF success rates, was used to simulate a cohort of 10 000 couples in order to assess the chances of realizing a one-, two- or three-child family, for different female ages at which the couple starts trying to conceive. PARTICIPANTS/MATERIALS, SETTING, METHODS The model uses treatment-independent pregnancy chances and pregnancy chances after IVF/ICSI. In order to focus the discussion, we single out three levels of importance that couples could attach to realizing a desired family size: (i) Very important (equated with aiming for at least a 90% success chance). (ii) Important but not at all costs (equated with a 75% success chance) (iii) Good to have children, but a life without children is also fine (equated with a 50% success chance). MAIN RESULTS AND THE ROLE OF CHANCE In order to have a chance of at least 90% to realize a one-child family, couples should start trying to conceive when the female partner is 35 years of age or younger, in case IVF is an acceptable option. For two children, the latest starting age is 31 years, and for three children 28 years. Without IVF, couples should start no later than age 32 years for a one-child family, at 27 years for a two-child family, and at 23 years for three children. When couples accept 75% or lower chances of family completion, they can start 4–11 years later. The results appeared to be robust for plausible changes in model assumptions. LIMITATIONS, REASONS FOR CAUTION Our conclusions would have been more persuasive if derived directly from large-scale prospective studies. An evidence-based simulation study (as we did) is the next best option. We recommend that the simulations should be updated every 5–10 years with new evidence because, owing to improvements in IVF technology, the assumptions on IVF success chances in particular run the risk of becoming outdated. WIDER IMPLICATIONS OF THE FINDINGS Information on the chance of family completion at different starting ages is important for prospective parents in planning their family, for preconception counselling, for inclusion in educational courses in human biology, and for increasing public awareness on human reproductive possibilities and limitations

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. PATIENT(S): Patients undergoing IVF. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Poor ovarian response, nonpregnancy. RESULT(S): A total of 10 studies were detected reporting on ovarian volume and 17 studies on AFC. Because of heterogeneity among studies, calculation of one summary point estimate for sensitivity and specificity was not meaningful. However, for both tests, summary receiver operating characteristic curves for the outcome measures poor response and nonpregnancy could be estimated and compared. The AFC performed statistically significantly better than ovarian volume in the prediction of poor response. The overall accuracy for predicting nonpregnancy was poor for both tests. The clinical value in poor response prediction was only evident for the AFC as a considerable number of cases can be identified who will have a high chance of producing a poor response to stimulation. The clinical value for nonpregnancy was virtually absent for both tests. CONCLUSION(S): In conclusion, the predictive performance of ovarian volume toward poor response is clearly inferior compared with that of AFC. Therefore, the AFC may be considered the test of first choice when estimating quantitative ovarian reserve before IVF. For the prediction of cases with a very low chance for pregnancy, ovarian reserve testing with the use of ultrasound appears inadequat