Search

Purpose To dynamically assess the evolution of live birth predictive factors’ impact throughout the in vitro fertilization (IVF) process, for each fresh and subsequent frozen embryo transfers. Methods In this multicentric study, data from 13,574 fresh IVF cycles and 6,770 subsequent frozen embryo transfers were retrospectively analyzed. Fifty-seven descriptive parameters were included and split into four categories: (1) demographic (couple’s baseline characteristics), (2) ovarian stimulation, (3) laboratory data, and (4) embryo transfer (fresh and frozen). All these parameters were used to develop four successive predictive models with the outcome being a live birth event. Results Eight parameters were predictive of live birth in the first step after the first consultation, 9 in the second step after the stimulation, 11 in the third step with laboratory data, and 13 in the 4th step at the transfer stage. The predictive performance of the models increased at each step. Certain parameters remained predictive in all 4 models while others were predictive only in the first models and no longer in the subsequent ones when including new parameters. Moreover, some parameters were predictive in fresh transfers but not in frozen transfers. Conclusion This work evaluates the chances of live birth for each embryo transfer individually and not the cumulative outcome after multiple IVF attempts. The different predictive models allow to determine which parameters should be taken into account or not at each step of an IVF cycle, and especially at the time of each embryo transfer, fresh or frozen.

L’examen du sperme tel qu’il a ete defini par l’Organisation Mondiale de la Sante (OMS) constitue une des etapes clefs dans l’exploration du couple infertile. La morphologie du spermatozoide a ete reconnue comme le meilleur facteur predictif de la fertilite naturelle, de l’issue en insemination intra-uterine ou en fecondationin vitro classique. Les anomalies ultrastructurales des spermatozoides qui sembleraient etre les seules anomalies capables d’influencer le devenir de l’ICSI(Intracytoplasmic Sperm Injection) ne sont pas detectables aux grossissements x100 ou X200—400 utilises au cours de la procedure d’ICSI. Bartoov et al. (2002) ont mis au point un systeme capable d’etudier la morphologie fine des spermatozoides mobiles en temps reel au grossissement x6600 appele MSOME pourMagnification Motile Sperm Morphology Examination. Les anomalies detectees a ce grossissement, en dehors des anomalies morphologiques habituelles, sont des vacuoles situees sur les tetes spermatiques dont la localisation, le nombre et la taille sont variables. L’analyse en MSOME pourrait etre utilisee comme facteur predictif du pouvoir fecondant des spermatozoides et etre realisee dans l’exploration des atteintes spermatiques severes avant ICSI. L’ICSI serait classique ou precedee d’une selection fine des spermatozoides avant injection si les spermatozoides presentent un nombre eleve de vacuoles.