Editing In vitro fertilisation (section)

====Predictors of success====
The main potential factors that influence pregnancy (and live birth) rates in IVF have been suggested to be [[maternal age]], duration of infertility or subfertility, [[basal FSH|bFSH]] and number of oocytes, all reflecting [[Ovary#Function|ovarian function]].<ref>{{cite journal | vauthors = van Loendersloot LL, van Wely M, Limpens J, Bossuyt PM, Repping S, van der Veen F | title = Predictive factors in in vitro fertilization (IVF): a systematic review and meta-analysis | journal = Human Reproduction Update | volume = 16 | issue = 6 | pages = 577–589 | year = 2010 | pmid = 20581128 | doi = 10.1093/humupd/dmq015 | doi-access = free }}</ref> Optimal age is 23–39 years at time of treatment.<ref name=nice/>

[[File:Triple-line endometrium.jpg|thumb|A [[triple-line endometrium]] is associated with better IVF outcomes.<ref name="ZhaoZhang2012">{{cite journal | vauthors = Zhao J, Zhang Q, Li Y | title = The effect of endometrial thickness and pattern measured by ultrasonography on pregnancy outcomes during IVF-ET cycles | journal = Reproductive Biology and Endocrinology | volume = 10 | issue = 1 | pages = 100 | date = November 2012 | pmid = 23190428 | pmc = 3551825 | doi = 10.1186/1477-7827-10-100 | doi-access = free }}</ref>]]
[[Biomarker (medicine)|Biomarkers]] that affect the pregnancy chances of IVF include:
* [[Antral follicle count]], with higher count giving higher success rates.<ref name=Broer2012>{{cite journal | vauthors = Broer SL, van Disseldorp J, Broeze KA, Dolleman M, Opmeer BC, Bossuyt P, Eijkemans MJ, Mol BW, Broekmans FJ | display-authors = 6 | title = Added value of ovarian reserve testing on patient characteristics in the prediction of ovarian response and ongoing pregnancy: an individual patient data approach | journal = Human Reproduction Update | volume = 19 | issue = 1 | pages = 26–36 | year = 2012 | pmid = 23188168 | doi = 10.1093/humupd/dms041 | doi-access = free }}</ref>
* [[Anti-Müllerian hormone]] levels, with higher levels indicating higher chances of pregnancy,<ref name=Broer2012/> as well as of live birth after IVF, even after adjusting for age.<ref name="IliodromitiKelsey2014">{{cite journal | vauthors = Iliodromiti S, Kelsey TW, Wu O, Anderson RA, Nelson SM | title = The predictive accuracy of anti-Müllerian hormone for live birth after assisted conception: a systematic review and meta-analysis of the literature | journal = Human Reproduction Update | volume = 20 | issue = 4 | pages = 560–570 | year = 2014 | pmid = 24532220 | doi = 10.1093/humupd/dmu003 | doi-access = free }}</ref>
* Level of [[DNA fragmentation]]<ref>{{cite journal | vauthors = Simon L, Brunborg G, Stevenson M, Lutton D, McManus J, Lewis SE | title = Clinical significance of sperm DNA damage in assisted reproduction outcome | journal = Human Reproduction | volume = 25 | issue = 7 | pages = 1594–1608 | date = July 2010 | pmid = 20447937 | doi = 10.1093/humrep/deq103 | doi-access = free }}</ref> as measured, e.g. by [[Comet assay]], [[advanced maternal age]] and [[semen quality]].
* People with ovary-specific [[FMR1]] genotypes including ''het-norm/low'' have significantly decreased pregnancy chances in IVF.<ref name="Gleicher 2010">{{cite journal | vauthors = Gleicher N, Weghofer A, Lee IH, Barad DH | title = FMR1 genotype with autoimmunity-associated polycystic ovary-like phenotype and decreased pregnancy chance | journal = PLOS ONE | volume = 5 | issue = 12 | pages = e15303 | date = December 2010 | pmid = 21179569 | pmc = 3002956 | doi = 10.1371/journal.pone.0015303 | doi-access = free | bibcode = 2010PLoSO...515303G | author-link1 = Norbert Gleicher }}</ref>
*[[Progesterone]] elevation on the day of [[final maturation (IVF)|induction of final maturation]] is associated with lower pregnancy rates in IVF cycles in women undergoing [[Ovulation induction|ovarian stimulation]] using GnRH analogues and gonadotrophins.<ref name=Venetis>{{cite journal | vauthors = Venetis CA, Kolibianakis EM, Bosdou JK, Tarlatzis BC | title = Progesterone elevation and probability of pregnancy after IVF: a systematic review and meta-analysis of over 60 000 cycles | journal = Human Reproduction Update | volume = 19 | issue = 5 | pages = 433–457 | year = 2013 | pmid = 23827986 | doi = 10.1093/humupd/dmt014 | doi-access = free }}</ref> At this time, compared to a progesterone level below 0.8&nbsp;ng/ml, a level between 0.8 and 1.1&nbsp;ng/ml confers an [[odds ratio]] of pregnancy of approximately 0.8, and a level between 1.2 and 3.0&nbsp;ng/ml confers an odds ratio of pregnancy of between 0.6 and 0.7.<ref name=Venetis/> On the other hand, progesterone elevation does not seem to confer a decreased chance of pregnancy in frozen–thawed cycles and cycles with egg donation.<ref name=Venetis/>
* Characteristics of cells from the [[cumulus oophorus]] and the [[membrana granulosa]], which are easily aspirated during [[oocyte retrieval]]. These cells are closely associated with the oocyte and share the same microenvironment, and the rate of expression of certain genes in such cells are associated with higher or lower pregnancy rate.<ref>{{cite journal | vauthors = Fragouli E, Lalioti MD, Wells D | title = The transcriptome of follicular cells: biological insights and clinical implications for the treatment of infertility | journal = Human Reproduction Update | volume = 20 | issue = 1 | pages = 1–11 | year = 2013 | pmid = 24082041 | pmc = 3845680 | doi = 10.1093/humupd/dmt044 }}</ref>
* An endometrial thickness (EMT) of less than 7&nbsp;mm decreases the pregnancy rate by an odds ratio of approximately 0.4 compared to an EMT of over 7&nbsp;mm. However, such low thickness rarely occurs, and any routine use of this parameter is regarded as not justified.<ref name="KasiusSmit2014">{{cite journal | vauthors = Kasius A, Smit JG, Torrance HL, Eijkemans MJ, Mol BW, Opmeer BC, Broekmans FJ | title = Endometrial thickness and pregnancy rates after IVF: a systematic review and meta-analysis | journal = Human Reproduction Update | volume = 20 | issue = 4 | pages = 530–541 | year = 2014 | pmid = 24664156 | doi = 10.1093/humupd/dmu011 | doi-access = free }}</ref>

Other [[Risk factor (epidemiology)|determinants]] of outcome of IVF include:
* As maternal age increases, the likelihood of conception decreases<ref>{{cite journal | vauthors = Baker VL, Luke B, Brown MB, Alvero R, Frattarelli JL, Usadi R, Grainger DA, Armstrong AY | display-authors = 6 | title = Multivariate analysis of factors affecting probability of pregnancy and live birth with in vitro fertilization: an analysis of the Society for Assisted Reproductive Technology Clinic Outcomes Reporting System | journal = Fertility and Sterility | volume = 94 | issue = 4 | pages = 1410–1416 | date = September 2010 | pmid = 19740463 | doi = 10.1016/j.fertnstert.2009.07.986 | doi-access = free }}</ref> and the chance of miscarriage increases.<ref name="CDC-2015">{{Cite report|author1 = Centers for Disease Control and Prevention | author2 = American Society for Reproductive Medicine | author3 = Society for Assisted Reproductive Technology|title=2015 Assisted Reproductive Technology National Summary Report | date=2017|publisher=US Dept of Health and Human Services|url=https://www.cdc.gov/art/pdf/2015-report/ART-2015-National-Summary-Report.pdf}}</ref>
*With increasing paternal age, especially 50 years and older, the rate of [[blastocyst]] formation decreases.<ref>{{cite journal | vauthors = Frattarelli JL, Miller KA, Miller BT, Elkind-Hirsch K, Scott RT | title = Male age negatively impacts embryo development and reproductive outcome in donor oocyte assisted reproductive technology cycles | journal = Fertility and Sterility | volume = 90 | issue = 1 | pages = 97–103 | date = July 2008 | pmid = 17765235 | doi = 10.1016/j.fertnstert.2007.06.009 | doi-access = free }}</ref>
* [[Tobacco smoking]] reduces the chances of IVF producing a live birth by 34% and increases the risk of an IVF pregnancy miscarrying by 30%.<ref name=dh2009>{{cite web | url = http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_101070 | title =  Regulated fertility services: a commissioning aid | work = Department of Health UK | date = 18 June 2009 | archive-url = https://web.archive.org/web/20110103051232/http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_101070 | archive-date = 3 January 2011 }}</ref>
* A [[body mass index]] (BMI) over 27 causes a 33% decrease in likelihood to have a live birth after the first cycle of IVF, compared to those with a BMI between 20 and 27.<ref name=dh2009/> Also, pregnant people who are obese have higher rates of [[miscarriage]], [[gestational diabetes]], [[hypertension]], [[thromboembolism]] and problems during [[childbirth|delivery]], as well as leading to an increased risk of fetal [[congenital abnormality]].<ref name=dh2009/> Ideal body mass index is 19–30,<ref name=nice/> and many clinics restrict this BMI range as a criterion for initiation of the IVF process.<ref name="pmid30963351">{{cite journal | vauthors = Kelley AS, Badon SE, Lanham MS, Fisseha S, Moravek MB | title = Body mass index restrictions in fertility treatment: a national survey of OB/GYN subspecialists | journal = J Assist Reprod Genet | volume = 36 | issue = 6 | pages = 1117–1125 | date = June 2019 | pmid = 30963351 | pmc = 6603101 | doi = 10.1007/s10815-019-01448-3 }}</ref>
* [[Salpingectomy]] or [[laparoscopic]] tubal occlusion before IVF treatment increases chances for people with [[hydrosalpinges]].<ref name=nice>{{Cite book|title=Fertility: Assessment and Treatment for People with Fertility Problems |publisher=RCOG Press |location=London |year=2004 |isbn=978-1-900364-97-3 | url = http://www.nice.org.uk/nicemedia/pdf/CG011publicinfoenglish.pdf |archive-url=https://web.archive.org/web/20101115121046/http://www.nice.org.uk/nicemedia/pdf/CG011publicinfoenglish.pdf |archive-date=15 November 2010 }}</ref><ref name=":0">{{cite journal | vauthors = Farquhar C, Marjoribanks J | title = Assisted reproductive technology: an overview of Cochrane Reviews | journal = The Cochrane Database of Systematic Reviews | volume = 2018 | issue = 8 | pages = CD010537 | date = August 2018 | pmid = 30117155 | pmc = 6953328 | doi = 10.1002/14651858.CD010537.pub5 }}</ref>
* Success with previous pregnancy and/or live birth increases chances<ref name=nice/>
* Low alcohol/caffeine intake increases success rate<ref name=nice/>
* The number of embryos transferred in the treatment cycle<ref name=ii2011>{{cite web | url = http://www.ivf-infertility.com/ivf/standard/factors/couples.php | title = Factors affecting IVF success | date = February 2011 | work = IVF-infertility.com }}</ref>
* [[Embryo quality]]
* Some studies also suggest that [[autoimmune disease]] may also play a role in decreasing IVF success rates by interfering with the proper [[Implantation (embryology)|implantation]] of the embryo after transfer.<ref name="Gleicher 2010"/>

Aspirin is sometimes prescribed to people for the purpose of increasing the chances of conception by IVF, but {{as of|2016|lc=y}} there was no evidence to show that it is safe and effective.<ref name=CochraneIVF>{{cite journal | vauthors = Siristatidis CS, Basios G, Pergialiotis V, Vogiatzi P | title = Aspirin for in vitro fertilisation | journal = The Cochrane Database of Systematic Reviews | volume = 11 | issue = 11 | pages = CD004832 | date = November 2016 | pmid = 27807847 | pmc = 6463901 | doi = 10.1002/14651858.CD004832.pub4 }}</ref><ref>{{cite journal | vauthors = Groeneveld E, Broeze KA, Lambers MJ, Haapsamo M, Dirckx K, Schoot BC, Salle B, Duvan CI, Schats R, Mol BW, Hompes PG | display-authors = 6 | title = Is aspirin effective in women undergoing in vitro fertilization (IVF)? Results from an individual patient data meta-analysis (IPD MA) | journal = Human Reproduction Update | volume = 17 | issue = 4 | pages = 501–509 | year = 2011 | pmid = 21422062 | doi = 10.1093/humupd/dmr007 | doi-access = free }}</ref>

A 2013 [[systematic review|review]] and [[metaanalysis|meta analysis]] of [[randomised controlled trial]]s of [[acupuncture]] as an [[adjuvant therapy]] in IVF found no overall benefit, and concluded that an apparent benefit detected in a subset of published trials where the control group (those not using acupuncture) experienced a lower than average rate of pregnancy requires further study, due to the possibility of [[publication bias]] and other factors.<ref>{{cite journal | vauthors = Manheimer E, van der Windt D, Cheng K, Stafford K, Liu J, Tierney J, Lao L, Berman BM, Langenberg P, Bouter LM | display-authors = 6 | title = The effects of acupuncture on rates of clinical pregnancy among women undergoing in vitro fertilization: a systematic review and meta-analysis | journal = Human Reproduction Update | volume = 19 | issue = 6 | pages = 696–713 | year = 2013 | pmid = 23814102 | pmc = 3796945 | doi = 10.1093/humupd/dmt026 }}</ref>

A [[Cochrane review]] came to the result that [[Endometrium|endometrial]] injury performed in the month prior to ovarian induction appeared to increase both the live birth rate and clinical pregnancy rate in IVF compared with no endometrial injury. There was no evidence of a difference between the groups in miscarriage, multiple pregnancy or bleeding rates. Evidence suggested that endometrial injury on the day of oocyte retrieval was associated with a lower live birth or ongoing pregnancy rate.<ref name=":0" />

Intake of [[antioxidant]]s (such as [[N-acetyl-cysteine]], [[melatonin]], [[vitamin A]], [[vitamin C]], [[vitamin E]], [[folic acid]], [[myo-inositol]], [[zinc]] or [[selenium]]) has not been associated with a significantly increased [[live birth rate]] or clinical [[pregnancy rate]] in IVF according to [[Cochrane review]]s.<ref name=":0" /> The review found that oral antioxidants given to the sperm donor with male factor or unexplained subfertility may improve live birth rates, but more evidence is needed.<ref name=":0" />

A [[Cochrane review]] in 2015 came to the result that there is no evidence identified regarding the effect of preconception lifestyle advice on the chance of a live birth outcome.<ref name=":0" />