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Paper Information

Journal:   INTERNATIONAL JOURNAL OF REPRODUCTIVE BIOMEDICINE (IRANIAN JOURNAL OF REPRODUCTIVE MEDICINE)   SPRING 2011 , Volume 9 , Number SUPPL 2; Page(s) 12 To 12.
 
Paper: 

PROGNOSTIC MODELLING IN IVF, INCLUDING EGG FREEZING

 
 
Author(s):  VAN DER VEEN F.*
 
* CENTER FOR REPRODUCTIVE MEDICINE, DEPARTMENT OF OBSTETRICS AND GYNAECOLOGY, ACADEMIC MEDICAL CENTER, AMSTERDAM, THE NETHERLANDS
 
Abstract: 
IVF is nowadays also initiated in couples with subfertility based upon other factors than tubal occlusion, the indication for which it was primarily developed. In contrast to women with bilateral tubal occlusion, these women still have a chance of natural conception. To prevent overtreatment, several cohort studies have identified possible predictive factors for success. A recent meta-analysis of these studies identified female age, duration of subfertility, bFSH and number of oocytes as predictors. Data on embryo quality were not available in the literature. Although in itself of value, it is equally important to know when to stop offering new IVF cycles due to futility. We developed a prediction model to predict pregnancy chances after failed previous cycles and identified female age, duration of subfertility, bFSH, total fertilisation failure, number of failed cycles and mean morphological scores day 3 embryos as independent prognosticators. As far as changes in management are concerned the independent factors were initial FSH dose and number of embryos transferred. The model calibrated extremely well, but still needs external validation. Since female age is the most important variable and women still postpone bearing their first child to higher age, IVF success rates in women of advanced age are very low. In this respect oocyte freezing could help these women to expand their natural reproductive lifespan. In view of criticisms on this approach, we performed a cost effectiveness analysis. The analysis showed that oocyte freezing is more cost effective compared to delayed natural conception and IVF at age 40, if at least 60% of the women would return to collect their oocytes and if one is willing to pay over 26.4000 Euros per additional live birth.
 
Keyword(s): PROGNOSTIC MODELLING, IVF, EGG FREEZING
 
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