Subsequent Treatment Outcomes Of Multiple Cycles In Women Miscarried In Their First IVF/ICSI Attempt

With the increasing number of infertility patients and the improvement of assisted reproductive technology(ART),more and more people choose assisted reproductive technology treatment to achieve pregnancy.However,the loss of pregnancy during the process of ART is a problem that cannot be ignored by clinicians and patients.Miscarriage accounts for a high proportion of pregnancy loss cases.Previous studies have suggested that patients with a history of miscarriage in previous ART treatments are more likely to have a higher miscarriage than normal women.However,patients with at least one miscarriage history,are more likely to know the chances of obtaining a live birth in subsequent treatments through pre-pregnancy consultation,and then to decide whether to continue the current treatment or not.While studies in this area are limited,and previous studies only evaluated the pro-pregnancy outcomes of a single stimulation cycle after miscarriage.The cumulative live birth rate(CLBR)is a more meaningful tool allowing patients to build realistic expectations and clinicians to provide accurate individual counselling.For patients with a miscarriage history in their first in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI),it is essential to evaluate treatment outcomes in the subsequent multiple cycles.ObjectiveTo analyze the subsequent pregnancy outcomes in women with different treatment outcomes,miscarriage,live birth,without a pregnancy,in their first IVF/ICSI attempt,and to study whether patients with a history of miscarriage have a higher live birth rate and CLBRs or not compared with patients failed to achieve clinical pregnant in prevous treantment,and compare the differences of the CLBRs regarding to age and the number of oocytes retrieved between different groups.Furtherly,this is to provide guidance for clinical works with substantial data support.Materials and methodsThis is a retrospective study of 25490 patients underwent their first IVF/ICSI treatment in the First Affiliated Hospital of Zhengzhou University from June 1,2009 to August 31,2016.A complete cycle is defined as,a fresh stimulated cycle and all the associated thaw cycles after oocyte retrieval.Informations associated with continuous pregnancy cycles and relevant pregnancy outcomes were recorded.Patients in this study were followed until August 31,2018.Results1.A total of 25490 patients underwent the first cycle,of which miscarriage accounted for 13.2%.A total of 4,168 patients entered the second cycle,accounting for 5.6% of the live birth group,20.1% of the miscarriage group,and 74.4% of the non-pregnancy group.The demographic and clinical characteristics of the non-pregnancy group,the miscarriage group,and the live birth group were compared.There was no significant difference between the three groups in patients' age,body mass index(BMI),and antral follicle number(all p > 0.05).The number of oocytes retrieved in the live birth group and the miscarriage group was significantly higher than that in the non-pregnancy group(p < 0.001).2.The miscarriage rate in the second cycle was significantly different between the three groups(p = 0.028).The miscarriage group was significantly higher than the non-pregnant group(15.4% vs.11.4%,p = 0.001,aOR = 1.520,95% CI = 1.185-1.949).There was no significant difference between the miscarriage group and the live birth group(15.4% vs.13.8%,p = 0.505,aOR = 1.171,95% CI = 0.736-1.862).The live birth rate of the second cycle was statistically different between the three groups(p < 0.001).The miscarriage group and the live birth group were significantly higher than non-pregnant group(48.0% vs.37.5%,p < 0.001,aOR = 1.384,95% CI = 1.178-1.626;55.2% vs.37.5 %,p < 0.001,aOR = 1.719,95% CI = 1.291-2.288).The probability of non-pregnancy of the second cycle was statistically different between the three groups(p < 0.001).the miscarriage group and the live birth group were significantly lower than the non-pregnant group(34.3% vs.49.8%,p < 0.001,aOR = 0.585,95% CI = 0.495-0.692;30.2% vs.49.8 %,p < 0.001,aOR = 0.537,95% CI = 0.393-0.735).3.The live birth rate of the non-pregnancy group and the miscarriage group decreased with the increasing of the number of cycles.The live birth rate of the non-pregnancy group and the miscarriage group decreased from 37.5%,48.0% of the second cycle to 15.4%,20% of the ? 5 cycle,respectively,and a significant difference were detected between different cycles(p < 0.001).while the conservative and optimistic CLBR increased with the increasing of the number of cycles.The conservative CLBR gradually increased slowly after the third cycle.The live birth rate,conservative and optimistic CLBR were higher in the miscarriage group than that in the non-pregnancy group,and the CLBR optimistic estimates were significantly different between the two groups(p < 0.001).4.Overall,the CLBR of each cycle of the miscarriage group was higher than that of the non-pregnancy group.Regardless of the non-pregnancy group or the miscarriage group,the CLBR in patients < 35 years were higher than that in the patients ? 35 years The CLBR of the non-pregnancy group and the miscarriage group increased with the number of oocytes retrieved.When the number of oocytes retrieved in the non-pregnancy group was less than 5,the CLBR was between 20% and 30%;when the number of oocytes retrieved ranged from 6 to10,the CLBR was between 40 to 50%;when the number of oocytes obtained was over 11,the CLBR was between 50% and 60%.When the number of oocytes retrieved in the miscarriage group was less than 5,the CLBR was between 20% and 40%;and when the number of oocytes was over 6,the CLBR was between 40% and 60%.The number of oocytes retrieved in each group increased gradually with the increasing of the cycle number,but when entering the third cycle,the growth trend slowed down significantly.Conclusions1.After their first IVF/ICSI attempt treatment,the single-cycle live birth rate and CLBRs in the miscarriage group were much higher than those in the non-pregnant group.2.The subsequent single-cycle miscarriage rate in the miscarriage group was higher than that in the non-pregnant group.There was no significant difference between live birth group and miscarriage group.3.The CLBRs of the non-pregnant group and the miscarriage group decreased with age,but increased with the increasing of the number of oocytes retrieved.