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Natural Cycle IVF Yields Low Success Rate
Title: Natural cycle in-vitro fertilization in couples with unexplained fertility: impact of various factors on outcome
Author: F. Zayed et al.
Address: Sheffield, England
Source: Human Reproduction 12: 2402-2407 (November) 1997
Summary: Although natural cycle in-vitro fertilization (NIVF) results in relatively low pregnancy rates, it provides valuable information on unexplained fertility and the impact of the gamete associated and other factors necessary for a successful pregnancy outcome. This particular retrospective study involves 117 couples who underwent 162 NIVF cycles between the years 1991 and 1993. An oocyte was retrieved in 138 cycles and an embryo transferred in 89 cycles. The implantation rate was 16/89 or 18% and the live birth rate per egg collection was 9/138 or 6.5%. No implantation was recorded for the 67 embryos replaced in the group of women aged 41-44 years. Oocyte quality, sperm quality, embryo quality and the women's age were assessed as impacting factors. The authors concluded that in these cases of unexplained fertility, the outcome following NIVF was affected by sperm and egg quality and by the age of the woman via alterations in fertilization rates. Embryo quality was found to be independent of the these factors but was also found to be a factor for successful implantation. It was recommended that NIVF is not appropriate for couples with a male infertility factor. NIVF naturally is more cost effective than stimulated IVF but offers a low birth rate per cycle.
Comment: This report is similar to several earlier in terms of success rate. Natural cycle IVF while very attractive for many reasons, but the 'take home baby' rate of 6.5% is unacceptable to many patients and IVF centers due to its high cost. This study differs somewhat in study population, but success in conventional IVF would be expected to be much higher in this group. Timing in the natural cycle is difficult and aspiration is technically harder because there is a single follicle available for puncture. Natural cycle IVF probably has a limited, if any role in our present complex system for IVF. Success with clomiphene citrate therapy, cost about $100, is generally about twice as effective as natural cycle IVF and is probably a better choice if considering a
' natural cycle.'
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