A clinical counseling tool predicting supernumerary embryos after a fresh IVF cycle
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ASSISTED REPRODUCTION TECHNOLOGIES
A clinical counseling tool predicting supernumerary embryos after a fresh IVF cycle Yetunde Ibrahim 1 & Greg Stoddard 2 & Erica Johnstone 1 Received: 19 November 2019 / Accepted: 28 February 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose To identify factors predictive of having supernumerary embryos in a fresh IVF cycle and create a prediction model for clinical counseling. Methods We utilized a multivariable Poisson regression to identify predictive factors and then entered these into a logistic regression model, calculating a risk index for each significant variable. The final model was tested using a receiver operating characteristic curve. Results A total of 60,616 fresh transfer cycles were reported to the Society for Assisted Reproductive Technology in 2014. Of these, 47.17% produced supernumerary embryos. A multivariate Poisson regression identified factors predictive of having supernumerary embryos, with age and AMH being the most predictive. Clinical prediction models were developed with acceptable and excellent discrimination. 23.5% of our cohort did not achieve a live birth following their fresh transfer and had excess embryos cryopreserved for future attempts. Conclusion Our study suggests that in a minority of fresh IVF cycles in the USA, the fresh transfer is not successful, and there are excess embryos cryopreserved for future use. The likelihood of excess embryos beyond those that would be transferred can be predicted with satisfactory precision prior to initiation of the cycle and with improved precision after fresh embryo transfer. Providing patients with a realistic estimate of their chances of having excess embryos at an initial IVF consult especially those with suspected poor prognosis can be beneficial in determining whether to proceed with multiple embryo banking cycles as opposed to proceeding with a fresh transfer, and whether to opt for an enhanced embryo selection technique such as preimplantation genetic testing for aneuploidy (PGT-A). Keywords Prediction model . Counseling tool . Embryo selection . Fresh IVF cycle . Preimplantation genetic testing
Introduction In vitro fertilization (IVF) is a challenging process for patients to undertake, physically, psychologically, and financially [1]. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10815-020-01731-8) contains supplementary material, which is available to authorized users. * Yetunde Ibrahim [email protected] 1
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Utah, School of Medicine, 675 Arapeen Drive, Suite 205, Salt Lake City, UT 84108, USA
2
Division of Epidemiology, Study Design and Biostatistics Center, University of Utah Health Center for Clinical and Translational Science, 295 Chipeta Way, Salt Lake City, UT 84122, USA
The ASRM Ethics Committee has noted the propensity of patients to overestimate their chance of success with
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