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Developmental Biology - IVF Pregnancy

What are Chances of Second IVF Baby After the First?

Assisted Reproductive Technology (ART) study determines likelyhood of a second baby are between 51% and 88% after six cycles of treatment...

Researchers in Australia calculate that after a woman successfully achieves a live birth using in vitro fertilisation (IVF), also known as Assisted Reproductive Technology (ART), her chances for a second ART baby are between 51% and 88% with six cycles of treatment.

Women have a good chance of having a second child with the help of fertility treatment following the birth of her first child born this way, according to this first ever study to investigate ART. The research was published May 22, 2020 in Human Reproduction, one of the world's leading reproductive medicine journals.

However, the chances of a second ART baby decrease with increasing maternal age. Women younger than 30 years having the best results. For women aged 35-39, chances of a second ART-conceived baby are reduced by 22% when using a frozen embryo from a previous cycle. However, those chances reduce by 50% in treatment begins with a new cycle and a fresh embryo.
Chances also improve when infertility is the result of male partner performance.

Although many parents would like more than one child, there have been no published reports on chances of achieving a second ART-conceived birth after a first ART child until now. Researchers hope this new information will be useful in counselling patients.

Professor Georgina Chambers, Director, the National Perinatal Epidemiology and Statistics Unit at the University of New South Wales in Sydney, Australia, examined live births from 35,290 women receiving ART treatment between 2009 and 2013 in both Australia and New Zealand. The women were then followed for another two years, providing data two to seven years after live births, through to October 2016.

"We calculated two measurements: (1) the woman's chance of achieving a second live birth in a particular cycle of treatment if previous cycles have failed; and (2) what her cumulative chances of achieving a live birth are after a particular number of cycles. For example: What is the overall chance of a woman having a baby after up to three failed cycles?" explained Prof. Chambers.
A cycle includes (1) the stimulation of the ovaries to mature multiple eggs, (2) the collection of eggs for fertilisation in the laboratory to create embryos, and (3) all embryo transfer procedures that use embryos from the egg retrieval procedure. This can include fresh embryo transfers and frozen embryo transfers.

Prof. Chambers and her colleagues calculated Cumulative Live Birth Rates (CLBR) for women who were trying for a second ART baby taking into account both the women who continued treatment, and those who discontinued treatment.

Conservative CLBRs assumed women who drop out had no chance of achieving a second live birth without continuous treatment. The optimal CLBR assumed women would have the same chance of a live birth in a particular cycle as women who had continuous treatment. A range between conservative and optimal estimates gave a more realistic idea of success.
Just over 43% (15,325) of the 35,290 women, with an average (median) age of 36, returned for treatment to conceive a second child by December 2015.

Among these women, 73% used a frozen embryo from the egg retrieval cycle that resulted in their first child. Their CLBR ranged from 61% (conservative estimate) to 88% (optimal estimate) after six cycles.

Among women who had a new stimulation cycle using a fresh embryo, CLBR ranged from 51% to 70%.

"Overall, 43% of women who recommence treatment with one of the frozen embryos from a previous stimulation cycle will have a baby after their first embryo transfer procedure. Between 61% and 88% of these women will have a baby after six cycles," explains Prof Chambers. "Among those who recommence treatment with a new stimulation cycle and a fresh embryo transfer, 31% will have a baby after their first cycle and between 51% and 70% after six cycles."
Although success rates declined with female age, researchers found after three cycles of treatment, conservative and optimal CLBRs in women aged 40 to 44 years were 38% and 55% respectively in those starting with a frozen embryo; 20% and 25% in those recommencing with a new stimulated cycle and fresh embryos.

Another consideration, in Australia and New Zealand, couples are funded to have treatment for infertility without restrictions on the number of cycles or on the mothers' age, numbers of previous children and factors such as body mass index and smoking. Therefore, these findings may not be generalisable to other countries with less supportive funding provision for ART.

Prof Chambers adds: "Couples can be reassured by these figures. Our findings also underline the fact that ART treatment should be considered as a course of treatment, rather than just one single cycle of treatment: if couples don't achieve a pregnancy in the first cycle, it could very well happen in the next. However, it would be best not to wait too long, especially if a new stimulation cycle is needed."

Co-author, Dr Devora Leiberman, a fertility clinician at City Fertility, Sydney, further emphasized:"These results can be used to counsel patients, but it is important to note that these are population estimates and every couple is different. Our analysis does not take account of all individual factors that affect a woman's chance of ART success, including duration of infertility, and body mass index. Whether ART treatment should be commenced or continued should ultimately be a decision for the fertility clinician and patient, taking into account all medical and non-medical factors. But this study provides the range of results that could be expected."
"As the restrictions imposed due to the COVID-19 pandemic on the provision of non-urgent ART services are gradually being lifted in many countries, including Australia and New Zealand, many people are considering expanding their family through ART. This study can provide reassurance that, in most cases, the chance of them having a second baby through ART is quite favourable."

Dr Christos Venetis, a fertility clinician and clinical academic from the research team at the University of New South Wales.

Study Question
What are the success rates for women returning to ART treatment in the hope of having a second ART-conceived child.

Summary Answer
The cumulative live birth rate (LBR) for women returning to ART treatment was between 50.5% and 88.1% after six cycles depending on whether women commenced with a previously frozen embryo or a new ovarian stimulation cycle and the assumptions made regarding the success rates for women who dropped-out of treatment.

What Is Known Already
Previous studies have reported the cumulative LBR for the first ART-conceived child to inform patients about their chances of success. However, most couples plan to have more than one child to complete their family and, for that reason, patients commonly return to ART treatment after the birth of their first ART-conceived child. To our knowledge, there are no published data to facilitate patient counseling and clinical decision-making regarding the success rates for these patients.

Studuy Design, Size, Duration
A population-based cohort study with 35 290 women who commenced autologous (using their own oocytes) ART treatment between January 2009 and December 2013 and achieved their first treatment-dependent live birth from treatment performed during this period. These women were then followed up for a further 2 years of treatment to December 2015, providing a minimum of 2 years and a maximum of 7 years of treatment follow-up.

Repon C. Paul, Oisin Fitzgerald, Devora Lieberman, Christos Venetis and Georgina M. Chambers.

No funding was received to undertake this study.

Conflict of Interest
R. Paul and O. Fitzgerald have nothing to declare. D. Lieberman reports being a fertility specialist and receiving non-financial support from MSD and Merck outside the submitted work. C. Venetis reports being a fertility specialist and receiving personal fees and non-financial support from MSD, personal fees and non-financial support from Merck Serono and Beisins and non-financial support from Ferring outside the submitted work. G.M. Chambers reports being a paid employee of the University of New South Wales, Sydney (UNSW) and Director of the National Perinatal Epidemiology and Statistics Unit (NPESU), UNSW. The Fertility Society of Australia (FSA) contracts UNSW to prepare the Australian and New Zealand Assisted Reproductive Technology Database (ANZARD) annual report series and benchmarking reports.

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