Veronique Viardot-Foucault1, Bee Choo Tai2, Zhao Jin Chen3, Gek Hsiang Lim4, Seong Feei Loh5, Heng Hao Tan6, Sadhana Nadarajah6, Jerry Kok Yen Chan7. 1. Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore 229899, Singapore. Electronic address: veraxel3@yahoo.fr. 2. Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117597, Singapore; Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 119228, Singapore; Investigational Medicine Unit, National University Health System, Singapore 119074, Singapore. Electronic address: bee_choo_tai@nuhs.edu.sg. 3. Investigational Medicine Unit, National University Health System, Singapore 119074, Singapore. 4. Health Promotion Board, National Registry of Diseases Office, Singapore 168937, Singapore. 5. Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore 229899, Singapore; Thomson Fertility Centre, Novena Specialist Center, Singapore 307470, Singapore. 6. Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore 229899, Singapore. 7. Department of Reproductive Medicine, KK Women's and Children's Hospital, Singapore 229899, Singapore; Cancer and Stem Cell Biology Program, Duke-NUS Graduate Medical School, National University of Singapore, Singapore 169857, Singapore; Experimental Fetal Medicine Group, Department of Obstetrics and Gynecology, National University of Singapore, Singapore 119228, Singapore.
Abstract
OBJECTIVE(S): To explore the use of competing risk (CR) as compared to the commonly used Kaplan-Meier (KM) methodology in estimating the cumulative live-birth rate (CLBR) after IVF Treatment in a context of high dropout rates and informative censoring. STUDY DESIGN: We compare the KM and CR methodologies for estimating 2-year CLBR in a retrospective cohort of 2779 patients undergoing 5002 embryo transfers over a period of 9 years, from 2000 to 2008, at KKIVF Centre. RESULTS: We observed a total of 1105 LB (39.8%), and a dropout rate of 44.2% (1228 patients). The overall CLBR is lower with CR compared with KM method (39% vs 52%) after up to nine embryo-transfer cycles over a period of two years. The highest CLBR was achieved for ovulation disorders (57% vs 49%, KM vs CR) followed by male factors (54% vs 43%, KM vs CR), with poorer outcomes from patients with decreased ovarian reserve (37% vs 16%, KM vs CR) and endometriosis (36% vs 25%, KM vs CR). As dropouts in our cohort are generally older and more likely to have poorer ovarian reserves, the CR method, which accounted for these dropouts, is likely to give more meaningful estimation of IVF success rates. CONCLUSION(S): The CR method should be considered as a useful alternative in deriving CLBR for IVF treatment where dropout rates are high and when informative censoring is involved.
OBJECTIVE(S): To explore the use of competing risk (CR) as compared to the commonly used Kaplan-Meier (KM) methodology in estimating the cumulative live-birth rate (CLBR) after IVF Treatment in a context of high dropout rates and informative censoring. STUDY DESIGN: We compare the KM and CR methodologies for estimating 2-year CLBR in a retrospective cohort of 2779 patients undergoing 5002 embryo transfers over a period of 9 years, from 2000 to 2008, at KKIVF Centre. RESULTS: We observed a total of 1105 LB (39.8%), and a dropout rate of 44.2% (1228 patients). The overall CLBR is lower with CR compared with KM method (39% vs 52%) after up to nine embryo-transfer cycles over a period of two years. The highest CLBR was achieved for ovulation disorders (57% vs 49%, KM vs CR) followed by male factors (54% vs 43%, KM vs CR), with poorer outcomes from patients with decreased ovarian reserve (37% vs 16%, KM vs CR) and endometriosis (36% vs 25%, KM vs CR). As dropouts in our cohort are generally older and more likely to have poorer ovarian reserves, the CR method, which accounted for these dropouts, is likely to give more meaningful estimation of IVF success rates. CONCLUSION(S): The CR method should be considered as a useful alternative in deriving CLBR for IVF treatment where dropout rates are high and when informative censoring is involved.
Authors: Loukia Vassilopoulou; Michail Matalliotakis; Maria I Zervou; Charoula Matalliotaki; Demetrios A Spandidos; Ioannis Matalliotakis; George N Goulielmos Journal: Exp Ther Med Date: 2018-06-13 Impact factor: 2.447