Top

Journal of Assisted Reproduction and Genetics

Published in:

01-02-2014 | Assisted Reproduction Technologies

Quality of embryos transferred and progesterone levels are the most important predictors of live birth after fresh embryo transfer: a retrospective cohort study

Authors: Qianfang Cai, Fei Wan, Dina Appleby, Linli Hu, Hanwang Zhang

Published in: Journal of Assisted Reproduction and Genetics | Issue 2/2014

Abstract

Purpose

To identify the independent predictors of live birth following IVF, and to assess the role of cohort-specific parameters, including antral follicle count (AFC), the number of oocytes retrieved, the total number of embryos, and the total number of good-quality embryos, in fresh IVF cycles.

Methods

A retrospective cohort study of 2,525 infertile women undergoing IVF between 2002 and 2007. The hypothesis that the number and quality of embryos transferred capture the effects previously attributed to cohort-specific variables was examined using mediation analysis and spline analysis. Independent predictors were identified by a bootstrap algorithm. Multivariable logistic regression was performed and the proportion of explained variation was measured to compare the relative importance of transfer-specific vs. cohort-specific predictors.

Results

The number of good-quality embryos transferred and progesterone level on the day of hCG administration ranked as the two most important predictors of live birth. Prospects of pregnancy started to decrease after progesterone level exceeded 0.6 ng/ml. The achievement of live birth in a fresh IVF cycle is primarily determined by the number and quality of embryos transferred, rather than by embryo cohort-specific variables.

Conclusions

The associations between cohort-specific variables and live birth in a fresh IVF cycle are completely mediated by the quality of embryos transferred. Progesterone level on the day of hCG administration is an independent predictor of pregnancy and merits further investigation.

Van Loendersloot LL, van Wely M, Limpens J, Bossuyt PM, Repping S, van der Veen F. Predictive factors in in vitro fertilization (IVF): a systematic review and meta-analysis. Hum Reprod Update. 2010;16:577–89.PubMedCrossRef

Cai QF, Wan F, Huang R, Zhang HW. Factors predicting the cumulative outcome of IVF/ICSI treatment: a multivariable analysis of 2450 patients. Hum Reprod. 2011;26:2532–40.PubMedCrossRef

Jun SH, Choi B, Shahine L, Westphal LM, Behr B, Reijo Pera RA, et al. Defining human embryo phenotypes by cohort-specific prognostic factors. PLoS One. 2008;3:e2562.PubMedCentralPubMedCrossRef

Strandell A, Bergh C, Lundin K. Selection of patients suitable for one-embryo transfer may reduce the rate of multiple births by half without impairment of overall birth rates. Hum Reprod. 2000;15:2520–5.PubMedCrossRef

Opsahl MS, Blauer KL, Black SH, Lincoln SR, Thorsell L, Sherins RJ. The number of embryos available for transfer predicts successful pregnancy outcome in women over 39 years with normal ovarian hormonal reserve testing. J Assist Reprod Genet. 2001;18:551–6.PubMedCrossRef

Volpes A, Sammartano F, Coffaro F, Mistretta V, Scaglione P, Allegra A. Number of good quality embryos on day 3 is predictive for both pregnancy and implantation rates in in vitro fertilization/intracytoplasmic sperm injection cycles. Fertil Steril. 2004;82:1330–6.PubMedCrossRef

Klinkert ER, Broekmans FJ, Looman CW, Habbema JD, te Velde ER. 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. Fertil Steril. 2005;83:811–4.PubMedCrossRef

Van der Gaast MH, Eijkemans MJ, van der Net JB, de Boer EJ, Burger CW, van Leeuwen FE, et al. Optimum number of oocytes for a successful first IVF treatment cycle. Reprod Biomed Online. 2006;13:476–80.PubMedCrossRef

Sunkara SK, Rittenberg V, Raine-Fenning N, Bhattacharya S, Zamora J, Coomarasamy A. Association between the number of eggs and live birth in IVF treatment: an analysis of 400 135 treatment cycles. Hum Reprod. 2011;26:1768–74.PubMedCrossRef

10.

Thurin A, Hausken J, Hillensjö T, Jablonowska B, Pinborg A, Strandell A, et al. Elective single-embryo transfer versus double-embryo transfer in in vitro fertilization. N Engl J Med. 2004;351:2392–402.PubMedCrossRef

11.

Baruffi RL, Mauri AL, Petersen CG, Nicoletti A, Pontes A, Oliveira JB, et al. Single-embryo transfer reduces clinical pregnancy rates and live births in fresh IVF and Intracytoplasmic Sperm Injection (ICSI) cycles: a meta-analysis. Reprod Biol Endocrinol. 2009;7:36.PubMedCentralPubMedCrossRef

12.

Pandian Z, Templeton A, Serour G, Bhattacharya S. Number of embryos for transfer after IVF and ICSI: a Cochrane review. Hum Reprod. 2005;20:2681–7.PubMedCrossRef

13.

Cai Q, Wan F, Huang K, Zhang H. Does the number of oocytes retrieved influence pregnancy after fresh embryo transfer? PLoS ONE. 2013;8(2):e56189. doi:10.1371/journal.pone.0056189.PubMedCentralPubMedCrossRef

14.

Venetis CA, Kolibianakis EM, Papanikolaou E, Bontis J, Devroey P, Tarlatzis BC. Is progesterone elevation on the day of human chorionic gonadotrophin administration associated with the probability of pregnancy in in vitro fertilization? A systematic review and meta-analysis. Hum Reprod Update. 2007;13:343–55.PubMedCrossRef

15.

Bosch E, Labarta E, Crespo J, Simón C, Remohí J, Jenkins J, et al. Circulating progesterone levels and ongoing pregnancy rates in controlled ovarian stimulation cycles for in vitro fertilization: analysis of over 4000 cycles. Hum Reprod. 2010;25:2092–100.PubMedCrossRef

16.

Lee TH, Chen CD, Tsai YY, Chang LJ, Ho HN, Yang YS. Embryo quality is more important for younger women whereas age is more important for older women with regard to in vitro fertilization outcome and multiple pregnancy. Fertil Steril. 2006;86:64–9.PubMedCrossRef

17.

MacKinnon DP. Introduction to Statistical Mediation Analysis. New York: Erlbaum; 2008.

18.

Kenny DA. Mediation. Available at: http://davidakenny.net/cm/mediate.htm#SE. Accessed Mar 23, 2013.

19.

Munné S, Chen S, Colls P, Garrisi J, Zheng X, Cekleniak N, et al. Maternal age, morphology, development and chromosome abnormalities in over 6000 cleavage-stage embryos. Reprod Biomed Online. 2007;14:628–34.PubMedCrossRef

20.

Austin PC, Tu JV. Bootstrap methods for developing predictive models. Am Stat. 2004;58:131–7.CrossRef

21.

Schemper M. The relative importance of predictors in studies of survival. Stat Med. 1993;12:2377–82.PubMedCrossRef

22.

Mittlbock M, Schemper M. Explained variation for logistic regression. Stat Med. 1996;15:1987–97.PubMedCrossRef

23.

Broekmans FJ, Kwee J, Hendriks DJ, Mol BW, Lambalk CB. A systematic review of tests predicting ovarian reserve and IVF outcome. Hum Reprod Update. 2006;12:685–718.PubMedCrossRef

24.

Legro RS, Wong IL, Paulson RJ, Lobo RA, Sauer MV. Recipient’s age does not adversely affect pregnancy outcome after oocyte donation. Am J Obstet Gynecol. 1995;172:96–100.PubMedCrossRef

25.

Stolwijk AM, Zielhuis GA, Sauer MV, Hamilton CJ, Paulson RJ. The impact of the woman’s age on the success of standard and donor in vitro fertilization. Fertil Steril. 1997;67:702–10.PubMedCrossRef

26.

Toner JP, Grainger DA, Frazier LM. Clinical outcomes among recipients of donated eggs: an analysis of the U.S. national experience, 1996–1998. Fertil Steril. 2002;78:1038–45.PubMedCrossRef

27.

Thurin A, Hardarson T, Hausken J, Jablonowska B, Lundin K, Pinborg A, et al. Predictors of ongoing implantation in IVF in a good prognosis group of patients. Hum Reprod. 2005;20:1876–80.PubMedCrossRef

28.

McLernon DJ, Harrild K, Bergh C, Davies MJ, de Neubourg D, Dumoulin JC, et al. Clinical effectiveness of elective single versus double embryo transfer: meta-analysis of individual patient data from randomised trials. BMJ. 2010;341:c6945.PubMedCentralPubMedCrossRef

29.

Fanchin R, Righini C, Olivennes F, Taieb J, de Ziegler D, Frydman R. Computerized assessment of endometrial echogenicity: clues to the endometrial effects of premature progesterone elevation. Fertil Steril. 1999;71:174–81.PubMedCrossRef

30.

Andersen AN, Devroey P, Arce JC. Clinical outcome following stimulation with highly purified hMG or recombinant FSH in patients undergoing IVF: a randomized assessor-blind controlled trial. Hum Reprod. 2006;21:3217–27.PubMedCrossRef

31.

Melo MA, Meseguer M, Garrido N, Bosch E, Pellicer A, Remohi J. The significance of premature luteinization in an oocyte-donation programme. Hum Reprod. 2006;21:1503–7.PubMedCrossRef

32.

Marchini M, Fedele L, Bianchi S, Losa GA, Ghisletta M, Candiani GB. Secretory changes in preovulatory endometrium during controlled ovarian hyperstimulation with buserelin acetate and human gonadotropins. Fertil Steril. 1991;55:717–21.PubMed

33.

Bourgain C, Devroey P. The endometrium in stimulated cycles for IVF. Hum Reprod Update. 2003;9:515–22.PubMedCrossRef

34.

Papanikolaou EG, Kolibianakis EM, Pozzobon C, Tank P, Tournaye H, Bourgain C, et al. Progesterone rise on the day of human chorionic gonadotropin administration impairs pregnancy outcome in day 3 single-embryo transfer, while has no effect on day 5 single blastocyst transfer. Fertil Steril. 2009;91:949–52.PubMedCrossRef

Title: Quality of embryos transferred and progesterone levels are the most important predictors of live birth after fresh embryo transfer: a retrospective cohort study
Authors: Qianfang Cai
Fei Wan
Dina Appleby
Linli Hu
Hanwang Zhang
Publication date: 01-02-2014
Publisher: Springer US
Published in: Journal of Assisted Reproduction and Genetics / Issue 2/2014
Print ISSN: 1058-0468
Electronic ISSN: 1573-7330
DOI: https://doi.org/10.1007/s10815-013-0129-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Quality of embryos transferred and progesterone levels are the most important predictors of live birth after fresh embryo transfer: a retrospective cohort study

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 2/2014

Negative effect of P72 polymorphism on p53 gene in IVF outcome in patients with repeated implantation failure and pregnancy loss

A new treatment to avoid severe ovarian hyperstimulation utilizing insights from in vitro maturation therapy

Searching for genomic answers to recurrent pregnancy loss—barking up the wrong tree?

Apolipoprotein E (Apo E) gene polymorphisms and recurrent pregnancy loss: a meta-analysis

Relationship between HLA-G polymorphism and susceptibility to recurrent miscarriage: A meta-analysis of non-family-based studies

Are zona pellucida genes involved in recurrent oocyte lysis observed during in vitro fertilization?