IVF prognosis after recurrent implantation failure: Experience of German centers

Purpose: The birth rates achieved after three or more unsuccessful IVF cycles are difficult to establish in single centers. Alternatively, follow-up data from a supraregional institution were evaluated. Materials and Methods: Between 1999 and 2002, 1700 couples were referred for adjuvant lymphocyte immunotherapy (LIT) after 3 - 21 retrievals in 47 German centers. Interviews were carried out two years later. The outcomes of pregnancy were registered until 2005. Further interventions in addition to LIT were noted. Results: Of 1700 couples, 183 (10.8%) had abandoned IVF therapy, 78 (4.6%) had frozen embryo transfers only, and 265 couples (15.6%) gave no feedback. Overall, 1174 couples continued with conventional IVF or ICSI in Germany. The female age at LIT was 34.2 +/- 2.9 years (21 - 43); birth rates per fresh transfer no. 4 - 8 were 17.4% (701 couples), 18.3% (306 couples), 15% (92 couples), 12.9% (42 couples), and 12.9% (17 couples); the decline was not significant. Birth rates were 27% in women under 30 years, and 10% after the age of 39 years (p < 0.002). They were higher when cryotransfers had been carried out in the first cycles, compared to couples without cryotransfers: 20.4 vs. 16.1% per fresh transfer (p < 0.05), 22.9 vs. 16.9% per retrieval (p < 0.005). Additional interventions were offered preferentially to couples with a favorable prognosis. Conclusion: For the first time, the birth rates achieved in Germany after recurrent implantation failure are presented. In addition to age, the ovarian response plays a significant role: additional cryotransfers in past cycles indicate a favorable outcome. Cycle rank is a less important prognostic feature. This should be taken into account in randomized trials of additional interventions.