Life table (survival) analysis to generate cumulative pregnancy rates in assisted reproduction: are we overestimating our success rates?
Author: Daya, Salim
Source: Human Reproduction, Volume 20, Number 5, May 2005 , pp. 1135-1143(9)
Publisher: Oxford University Press
Abstract:The variability in the numbers of treatment cycles couples may undertake with assisted reproductive technology (ART) and the length of time they may have to wait between successive cycles of treatment make the evaluation of treatment efficacy and prognosis complicated. The cumulative pregnancy rate using the life table method of analysis is being used more frequently to estimate the effectiveness of treatment. Although this approach is valid in some areas of infertility research, its use in ART is not appropriate, because the factors necessary for the analysis (particularly the scale for measuring the passage of time and lack of informative censoring) are not satisfied. Consequently, an overestimation of the effect of treatment is produced that may lead to biased decision making. Although there is no easy solution to this problem, several options for summarizing the outcome data are offered: pregnancy rate per cycle, time-limited analysis using proportions, conservative cycle-based cumulative pregnancy rate and real-time-based cumulative pregnancy rate. In this manner, more realistic information can be generated to counsel patients, evaluate the efficacy of treatments, compare rates among centres and guide the formulation of policies for infertility management and resource allocation.
Document Type: Research Article
Publication date: 2005-05-01
- Human Reproduction features full-length, peer-reviewed papers reporting original research, clinical case histories, as well as opinions and debates on topical issues. Papers published cover the scientific and medical aspects of reproductive physiology and pathology, endocrinology, andrology, gonad function, gametogenesis, fertilization, embryo development, implantation, pregnancy, genetics, genetic diagnosis, oncology, infectious disease, surgery, contraception, infertility treatment, psychology, ethics and social issues. The highest scientific and editorial standard is maintained throughout the journal along with a rapid rate of publication.