Helping patients achieve their expected live birth rate: an ART paradigm shift

Since its early days, assisted reproductive technology (ART) has undergone tremendous developments and is now largely used to treat a wide range of causes of infertility and to prevent the transmission of genetic disorders. Nevertheless, success rates per cycle remain relatively low (especially in poor-prognosis patients), while the high costs associated with treatment frequently limit the completion of an adequate number of cycles, thus increasing drop-out rates. In this context, the availability of reliable data and provision of comprehensive information by reproductive medicine specialists are essential. However, current metrics and indicators are not up to date with recent innovations in clinical and laboratory practice. This paper supports an approach based on identifying, before starting a treatment, the realistic number of embryo transfers required by a specific couple to achieve the expected chance of a live birth, defined as expected live birth rate, based on a thorough diagnostic assessment. Furthermore, once a treatment strategy is agreed upon by clinicians and patients, postponing embryo transfer until the necessary number of embryos has been cryopreserved may reduce the risk of treatment discontinuation before all the embryos are used. This approach may also improve clinical outcomes and enhance the cost-effectiveness of ART treatments.