Natural IVF/ET - treatment success

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Natural IVF/ET - treatment success

• Neda Smiljan Severinski
• Marko Gospic

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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

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Success of assisted reproduction ?
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How to define or calculate IVF/ET cycle success ?

• CLINICAL PREGNANCY 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

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How to define or calculate IVF/ET cycle sucess ?

• LIVEBIRTH RATE
• In relation to started cycle
• In relation to number of oocytes aspirations
• In relation to number of embryo transfers

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What is failed cycle of assisted 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?
• . . . . .

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Absent foliculogenesis and oogenesis

• Patients category ?
• Young reproductive age
• with diminished ovarian
• reserve or premature
• ovarian failure
• Older reproductive age
• (gt 35 40)
• Old reproductive age
• ( gt 40 )

• Treatment options
• Natural cycle IVF/ET
• Patient friendly IVF/ET
• Conventional ovarian stimulation
• Agressive ovarian stimulation
• fight for every egg
• Adjuvant drugs androgens
• DHEA

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Cycle without embryo transfer

• Bad quality of oocytes,
• sperm or embryos
• Growth retarded embryos
• Disturbance in
• endometrium development
• Other complication

• Treatment options
• DHEA, corticosteroids, LH
• Estrogen, progesteron,
• sildenafil

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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?

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Natural fecundability
5 months
50
Nulliparous
2.7 months
Parous
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Patients 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

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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

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Age structureonly 36 lt 33 year
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Results 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

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Period of treatment 8 months 8 modified
natural cycle
n 89
n 1
Treatment months
16
Pregnancy n 15/89 couples (16,8)
Max 8
Min 1
Treatment months
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Completed cycles (n65/181 35,9)
Treatment months
18
Pregnancy per cycle, overview
Max 15,4
Min 4,2
Month of treatment
19
Pregnancy per embryotransfer, overview
Max 40
Min 14,3
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Failed cycles
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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 concive would be 54 !!!!
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Theoretical calculation of success pregnancy
rate
Month of treatment 1 2 3 4 5 6 7 8
Theoretical 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
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Treatment problems
100
45/89 50,6
24/45 53,3
13/24 54,2
7/13 53,8
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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

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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