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Hum. Reprod. Advance Access originally published online on March 24, 2005
Human Reproduction 2005 20(5):1135-1143; doi:10.1093/humrep/deh889
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© The Author 2005. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions{at}oupjournals.org

New Debate

Life table (survival) analysis to generate cumulative pregnancy rates in assisted reproduction: are we overestimating our success rates?

Salim Daya

Departments of Obstetrics and Gynaecology, and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada

Corresponding address: Department of Obstetrics and Gynaecology, McMaster University, 1200 Main Street West, Hamilton, Ontario, Canada L8N 3Z5. Email: dayas{at}mcmaster.ca

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.

Key words: cumulative pregnancy rate/informative censoring/life table method of analysis/survival analysis/treatment efficacy


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