In this birth cohort, 21.8% of men and 26.0% of women had ever tried to conceive for 12 months or more or sought medical help to conceive by age 38.
Thea van Roode, Ph.D., Nigel Patrick Dickson, M.D., Alida Antoinette Righarts, M.Sc., Wayne Richard Gillett, M.D.
Volume 103, Issue 4, Pages 1053-1058
To estimate the cumulative incidence of infertility for men and women in a population-based sample.
Longitudinal study of a birth cohort.
A population-based birth cohort of 1,037 men and women born in Dunedin, New Zealand, between 1972 and 1973.
Main Outcome Measure(s):
Cumulative incidence of infertility by age 32 and 38, distribution of causes and service use for infertility, live birth subsequent to infertility, and live birth by age 38.
The cumulative incidence of infertility by age 38 ranged from 14.4% to 21.8% for men and from 15.2% to 26.0% for women depending on the infertility definition and data used. Infertility, defined as having tried to conceive for 12 months or more or having sought medical help to conceive, was experienced by 21.8% (95% confidence interval [CI], 17.7–26.2) of men and 26.0% (95% CI, 21.8–30.6) of women by age 38. For those who experienced infertility, 59.8% (95% CI, 48.3–70.4) of men and 71.8% (95% CI, 62.1–80.3) of women eventually had a live birth. Successful resolution of infertility and entry into parenthood by age 38 were much lower for those who first experienced infertility in their mid to late thirties compared with at a younger age.
Comparison of reports from two assessments in this cohort study suggests infertility estimates from a single cross-sectional study may underestimate lifetime infertility. The lower rate of resolution and entry into parenthood for those first experiencing infertility in their mid to late thirties highlights the consequences of postponing parenthood and could result in involuntary childlessness and fewer children than desired.
We describe two luteal phase support protocols after gonadotropin-releasing hormone agonist trigger: the European and the American approaches. Both concepts facilitate fresh embryo transfer with excellent reproductive outcomes in the ovarian hyperstimulation syndrome–risk patient.
Peter Humaidan, M.D., Lawrence Engmann, M.D., Claudio Benadiva, M.D.
Volume 103, Issue 4, Pages 879-885
The challenges in attaining an adequate luteal phase after GnRH agonist (GnRHa) trigger to induce final oocyte maturation have resulted in different approaches focused on rescuing the luteal phase insufficiency so that a fresh transfer can be carried out without jeopardizing IVF outcomes. Over the years, two different concepts have emerged: intensive luteal support with aggressive exogenous administration of E2 and P; and low-dose hCG rescue in the form of a small dose of hCG either on the day of oocyte retrieva or on the day of GnRHa trigger (the so called “dual trigger”). Both approaches have been shown to be effective in achieving pregnancy rates similar to those obtained after conventional hCG trigger and resulting in a very low risk of ovarian hyperstimulation syndrome (OHSS). Although the idea of freezing all embryos after GnRHa trigger and transferring them in a subsequent frozen-thawed cycle has been gaining momentum, a fresh transfer leading to the live birth of a healthy child is currently considered to be the goal of IVF treatment.
Almost half of ART-related multiple births result from transferring two fresh blastocysts to favorable or average-prognosis patients
Dmitry M. Kissin, M.D., M.P.H., Aniket D. Kulkarni, M.B.B.S., M.P.H., Allison Mneimneh, M.P.H., Lee Warner, Ph.D., M.P.H., Sheree L. Boulet, Dr.P.H., M.P.H., Sara Crawford, Ph.D., Denise J. Jamieson, M.D., M.P.H., for the National ART Surveillance System (NASS) group
Volume 103, Issue 4, Pages 954-961
To evaluate assisted reproductive technology (ART) ET practices in the United States and assess the impact of these practices on multiple births, which pose health risks for both mothers and infants.
Retrospective cohort analysis using the National ART Surveillance System data.
US fertility centers reporting to the National ART Surveillance System.
Noncanceled ART cycles conducted in the United States in 2012.
Main Outcome Measure(s):
Multiple birth (birth of two or more infants, at least one of whom was live-born).
Of 134,381 ART transfer cycles performed in 2012, 51,262 resulted in live births, of which 13,563 (26.5%) were multiple births: 13,123 twin and 440 triplet and higher order births. Almost half (46.1%) of these multiple births resulted from the following four cycle types: two fresh blastocyst transfers among favorable or average prognosis patients less than 35 years (1,931 and 1,341 multiple births, respectively), two fresh blastocyst transfers among donor-oocyte recipients (1,532 multiple births), and two frozen/thawed ETs among patients less than 35 years (1,452 multiple births). More than half of triplet or higher order births resulted from the transfer of two embryos (52.5% of births among fresh autologous transfers, 67.2% of births among donor-oocyte recipient transfers, and 42.9% among frozen/thawed autologous transfers).
A substantial reduction of ART-related multiple (both twin and triplet or higher order) births in the United States could be achieved by single blastocyst transfers among favorable and average prognosis patients less than 35 years of age and donor-oocyte recipients.