PDF(Pubmed)
Abstract：
Pre-conception counselling and management of expectations about chance of success of IVF/ICSI treatments is an integral part of fertility care. Registry data are usually used to inform patients about expected success rates of IVF/ICSI treatment, as these data should best represent real-world populations and clinical practice. In registries, the success rate of IVF/ICSI treatments is conventionally reported per treatment cycle or per embryo transfer and estimated from data for which several treatment attempts per subject have been pooled (e.g. repetitive IVF/ICSI attempts or repetitive attempts of cryotransfer). This, however, may underestimate the true mean chance of success per treatment attempt, because treatment attempts of women with a poor prognosis will usually be over-represented in a pool of treatment cycle data compared to treatment events of women with a good prognosis. Of note, this phenomenon is also a source of potential bias when comparing outcomes between fresh transfers and cryotransfers, since women can undergo a maximum of only one fresh transfer after each IVF/ICSI treatment, but potentially several cryotransfers. Herein, we use a trial dataset from 619 women, who underwent one cycle of ovarian stimulation and ICSI, a Day 5 fresh transfer and/or subsequent cryotransfers (follow-up of all cryotransfers up to 1 year after the start of stimulation), to exemplify the underestimation of the live birth rate, when not accounting for repeated transfers in the same woman. Using mixed-effect logistic regression modelling, we show that the mean live birth rate per transfer per woman in cryocycles is underestimated by the factor 0.69 (e.g. live birth rate per cryotransfer of 36% after adjustment versus 25% unadjusted). We conclude that the average chance of success of treatment cycles of women of a given age, treated in a given centre, etc., when conventionally calculated per cycle or per embryo transfer from a pool of treatment events, do not apply to an individual woman. We suggest that patients are, especially at the outset of treatment, systematically confronted with mean estimates of success per attempt that are too low. Live birth rates per transfer from datasets encompassing multiple transfers from single individuals could be more accurately reported using statistical models accounting for the correlation between cycle outcomes within women.
摘要：
孕前咨询和对IVF/ICSI治疗成功机会的期望管理是生育护理的组成部分。注册数据通常用于告知患者IVF/ICSI治疗的预期成功率。因为这些数据应该最能代表现实世界的人群和临床实践.在登记册中，IVF/ICSI治疗的成功率通常按照每个治疗周期或每个胚胎移植报告,并根据每个受试者的几次治疗尝试汇集的数据(例如重复的IVF/ICSI尝试或重复的冷冻移植尝试)进行估计.这个,然而,可能会低估每次治疗尝试成功的真正平均机会，因为与预后良好的女性的治疗事件相比,预后不良的女性的治疗尝试通常在治疗周期数据集中被过度呈现.值得注意的是，当比较新鲜转移和冷冻转移之间的结果时，这种现象也是潜在偏差的来源，由于妇女在每次IVF/ICSI治疗后最多只能进行一次新鲜转移，但可能有几个冷冻发射器。在这里，我们使用了619名女性的试验数据集，进行了一个周期的卵巢刺激和ICSI，第5天新鲜转移和/或随后的冷冻转移（在刺激开始后1年内对所有冷冻转移进行随访），为了举例说明活产率的低估，当不考虑同一个女人的重复转账时。使用混合效应逻辑回归模型，我们发现,在冷冻周期中,每名妇女每次转移的平均活产率被低估了0.69倍(例如,调整后每次冷冻转移的活产率为36%,未调整后为25%).我们得出的结论是，给定年龄的女性治疗周期的平均成功率，在给定的中心接受治疗，等。,当从治疗事件池中按常规计算每个周期或每个胚胎移植时，不适用于个别女性。我们建议病人是，尤其是在治疗开始时，系统地面对每次尝试成功的平均估计太低。使用统计模型可以更准确地报告来自包含单个个体的多次转移的数据集的每次转移的活产率，该统计模型考虑了女性体内周期结果之间的相关性。
