natural ivf/et - treatment success
DESCRIPTION
Natural IVF/ET - treatment success. Neda Smiljan Severinski Marko Gospić. Terminology. Natural IVF/ET cycle : Monitoring of natural cycle - ultrasound No any medication Modified natural cycle Monitoring of natural cycle Only medication is hCG injection for final oocyte maturation. - PowerPoint PPT PresentationTRANSCRIPT
Natural IVF/ET - treatment success
Neda Smiljan Severinski
Marko Gospić
Terminology
• Natural IVF/ET cycleNatural IVF/ET cycle:– Monitoring of natural cycle - ultrasound– No any medication
• Modified natural cycle– Monitoring of natural cycle– Only medication is hCG injection for final
oocyte maturation
SuccessSuccess of assisted reproduction ? of assisted reproduction ?
How to define or calculate IVF/ET How to define or calculate IVF/ET cycle succycle succcess ?ess ?
• CLINICAL PREGNANCY CLINICAL PREGNANCY RATE (CPR):RATE (CPR):
(positive heart beat in intrauterine embryo):
• In relation to started cycle• In relation to number of oocyte
aspirations
• In relation to number of embryo transfers
How to define or calculate IVF/ET How to define or calculate IVF/ET cycle sucess ?cycle sucess ?
• LIVEBIRTH RATE:LIVEBIRTH RATE:• In relation to started cycle• In relation to number of
oocytes aspirations• In relation to number of
embryo transfers
What is failWhat is faileded cycle of assisted cycle of assisted reproduction ?reproduction ?
Cycle cancelation before ovum pick up ? Cycle with bad quality oocytes or without oocytes ? Oocytes fertilisation failure or irregular fertilisation ? Cycle without embryo transfer or bad quality embryos ? Cycle with implantation failure ? Cycle with positive hCG, without clinical pregnancy ? Cycle with vital clinical pregnancy but spontaneus
abortion in first trimester? . . . . .
Absent foliculogenesisAbsent foliculogenesis and oogenesis and oogenesis
• Patients category ?Patients category ?Young reproductive age with diminished ovarian reserve or premature ovarian failureOlder reproductive age (> 35 – 40)Old reproductive age ( > 40 )
•Treatment options:Treatment options:• Natural cycle IVF/ETNatural cycle IVF/ET„Patient friendly IVF/ET”Conventional ovarian stimulationAgressive ovarian stimulation – „fight for every egg”Adjuvant drugs – androgens DHEA
Cycle without Cycle without embryo transferembryo transfer
Bad quality of oocytes, sperm or embryosGrowth retarded embryosDisturbance in endometrium development
Other complication
• Treatment options:Treatment options:DHEA, corticosteroids, LH
Estrogen, progesteron, sildenafil
Interpretation of treatment success?
Institutions with excellent succes of treatment : inclusion - exclusion criterias to starting treatment
Some institution have „cut off” values: age, FSH, AMH or AFC
Results of donation treatment programme:represent the real success of some institutions in
conventional IVF/ET treatment
Who are patients in the center for infertility treatment?
Natural fecundabilityNatural fecundability
10
100
0 2 4 6 8 10 12
Months of unprotected intercourse
Per
cent
fai
led
Nulliparous
Parous
5 months
2.7 months
50
Patients and methodsPatients and methods
• Period 1.1.2010 – 31.12.2011 ( two years )
• 89 patients (couples)
• Age: mean = 34,2 (min. = 24, max. = 45)• 181 modified natural IVF/ET cycles• mean = 2,03 cycle/patient
• only one patient had 8 natural IVF/ET cycles
Legal aspects of treatment
• VII/2009 – VII/2012 “Restrictive” law
• Health ensurance guarantee:– No age limitation for treatment– Number of IVF/ET in natural cycle was
unlimited
Age structureAge structureonly 36% < 33 year
ResultsResults of treatment of treatment
Total
Number of cycles 181
Number of ET/cycles 65 (35,9%)
Pregnancy number: /cycle / ET
15(8,3%)
(23,1%)
Failed cycles 116 (64,1%)
- No oocyte- No fertilisation- No developed embryo- Growth retarded embryo- Polyploidy
Period of treatment = 8 months = 8 modified natural cycle
0102030405060708090
100
1. 2. 3. 4. 5. 6. 7. 8.
cycle pregnancy
Treatment months
n = 89
n = 1
Pregnancy Pregnancy n = 15/89 couples (16,8%)
0
5
10
15
20
25
30
35
1. 2. 3. 4. 5. 6. 7. 8.
ET pregnancy
Treatment months
Max 8
Min 1
Completed cycles (n=65/181 – 35,9%)
0102030405060708090
100
1. 2. 3. 4. 5. 6. 7. 8.
cycle ET
35,5%
37,1%
38,4%29,2% 57,1%
Treatment months
Pregnancy per cycle, overview
0
20
40
60
80
100
1. 2. 3. 4. 5. 6. 7. 8.
pregnancy % cycle
Min4,2%
Max15,4%
Month of treatment
Pregnancy per embryotransfer, overview
83 1 2 2 0 0 00
10
20
30
40
50
1. 2. 3. 4. 5. 6. 7. 8.
pregnancy % ET
Min14,3%
Max40%
Failed cycles
0102030405060708090
100
1. 2. 3. 4. 5. 6. 7. 8.
cycle faild
63%
64,4%70,1% 42,8%
61,5%
Cummulative results
Month of treatment 1 2 3 4 5 6 7 8
Cumulative cycles 89 126 147 159 164 164 165 166
Cumulative pregnacies 8 11 12 14 15 15 15 15
Cumulative pregnancies %
8,98 8,73 8,16 8,88 9,14 9,14 9,09 9,03
Chance for concieving in natural IVF/ET is 8-9% in each month of treatment.After six months of treatment chance to concivewould be 54 % !!!!
Month of treatment 1 2 3 4 5 6 7 8Theoretical number of women ( n )
89 81 78 77 75 74 74 74
Real number of women ( n )
89 45
(-36)
24
(-54)
13
(-63)
7
(-68)
1
(-73)
1
(-73)
1
(-73)
Pregnancy per month ( n )
8 3 1 2 1 0 0 0
Real cummulative pregnancies
8 11 12 14 15 15 15 15
Theoretical cummulative pregnancy ( 9%)
8 15
(+4)
22
(+10)
29
(+15)
36
(+21)
36 36 36
Monthly cummulative success %
8,98 8,73 8,16 8,88 9,14 9,14 9,09 9,03
Theoretical calculation of success: pregnancy rate
Treatment problems
Cycle (n = 89)
0
10
20
30
40
50
60
70
80
90
100
1 2 3 4 5 6
Months of treatment
%
100%
45/89 = 50,6%
24/45 = 53,3%
13/24 = 54,2%7/13 = 53,8%
Conclusion
• Monthly cummulative cuccess (PR/cycle) in modified natural cycles was about 9% in each month
• Significant amount of couples cancel their treatment after only three months. Why?
• Continuation and repeating of monthly treatment in modified natural cycle may have positive influence on PR
Legal aspects of treatment
• VII/2012 – today “Liberal” law
• Health ensurance guarantee:– age limitation for treatment – 42 year– Number of IVF/ET in natural cycle is only two
– Chance to concive in modified natural cycle is 18% for each patient