|
| date=14 January 2007}}</ref> Dengan [[donasi sel telur]] dan IVF, wanita yang melewati masa reproduktifnya atau telah mengalami [[menopause]] masih dapat hamil. [[Adriana Iliescu]] sempat memegang rekor sebagai wanita tertua yang melahirkan dengan menggunakan IVF dan sel telur dari donasi, ketika ia melahirkan pada tahun 2004 di usianya yang ke-66 tahun, sebelum rekornya terlampaui pada tahun 2006. Setelah menggunakan IVF, dikatakan bahwa banyak pasangan dapat hamil tanpa perawatan kesuburan.<ref>{{en}} {{Cite news|title = After IVF, some couples get pregnant without help|url = http://www.reuters.com/article/2012/05/03/us-after-ivf-pregnant-idUSBRE84212L20120503|newspaper = Reuters|date = 2012-05-03|access-date = 2015-11-05}}</ref> Pada tahun 2012, diperkirakan bahwa lima juta anak telah lahir di seluruh dunia menggunakan IVF dan teknik reproduksi berbantu lainnya.<ref>{{en}} {{Cite journal|last=Adamson|first=G.D.|last2=Tabangin|first2=M.|last3=Macaluso|first3=M.|last4=Mouzon|first4=J. de|title=The number of babies born globally after treatment with the assisted reproductive technologies (ART)|url=http://linkinghub.elsevier.com/retrieve/pii/S0015028213025867|journal=Fertility and Sterility|volume=100|issue=3|doi=10.1016/j.fertnstert.2013.07.1807}}</ref>
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== Penggunaan medis ==
Penggunaan IVF dimungkinkan untuk menangani [[infertilitas wanita]], yang disebabkan karena masalah pada [[tuba fallopi]] sehingga mengalami kesulitan dalam [[inseminasi|fertilisasi ''in vivo'']]. IVF juga dimungkinkan untuk menangani [[Kemandulan pada pria|infertilitas pria]], yang dalam situasi ini dapat digunakan [[injeksi sperma intrasitoplasmik]] (ICSI) dengan cara menginjeksi suatu sel sperma secara langsung ke dalam sel telur. Metode tersebut digunakan ketika sperma memiliki kesulitan untuk melakukan penetrasi pada sel telur, dan dalam kasus ini dapat digunakan sperma dari pasangan ataupun donor. ICSI juga digunakan ketika jumlah sel sperma sangat sedikit. Ketika terindikasi, ICSI digunakan untuk meningkatkan tingkat keberhasilan IVF.
IVF may be used to overcome [[female infertility]] where it is due to problems with the [[fallopian tube]]s, making [[in vivo fertilisation|fertilisation ''in vivo'']] difficult. It can also assist in [[male infertility]], in those cases where there is a defect in [[sperm quality]]; in such situations [[intracytoplasmic sperm injection]] (ICSI) may be used, where a sperm cell is injected directly into the egg cell. This is used when sperm has difficulty penetrating the egg, and in these cases the partner's or a donor's sperm may be used. ICSI is also used when sperm numbers are very low. When indicated, the use of ICSI has been found to increase the success rates of IVF.
AccordingMenurut to the Britishpedoman [[NICENational guidelinesInstitute for Health and Care Excellence|NICE]] Britania, penggunaan IVF treatmentadalah istepat appropriatedalam in cases ofkasus [[unexplainedinfertilitas infertilityyang tak dapat dijelaskan]] forbagi womenwanita thatyang havebelum nothamil conceived aftersetelah 2 yearstahun ofhubungan regularseksual unprotectedreguler sexualtanpa intercoursekontrasepsi.<ref>{{en}} [http://guidance.nice.org.uk/CG156 Fertility: assessment and treatment for people with fertility problems]. [[NICE guidelines|NICE clinical guideline]] ;– Issued: February 2013</ref> ThisAturan ruleini doestidak notberlaku applydi tosemua all countriesnegara. (Seelih. [[infertilityinfertilitas]].)
IVF juga dianggap cocok dalam kasus salah satu perluasannya menjadi kepentingan, yaitu, suatu prosedur yang biasanya tidak diperlukan dalam prosedur IVF itu sendiri, tetapi dianggap hampir tidak mungkin atau secara teknis sulit melaksanakannya tanpa secara serentak melaksanakan metode IVF. Perluasan tersebut misalnya [[diagnosis genetik praimplantasi]] (PGD) untuk menyingkirkan kemungkinan adanya [[kelainan genetik]], serta [[donasi sel telur]] dan [[surogasi]] di mana wanita yang menyediakan sel telur tidak sama dengan wanita yang akan menjalani kehamilan dalam jangka waktu normal.
IVF is also considered suitable in cases where any of its expansions is of interest, that is, a procedure that is usually not necessary for the IVF procedure itself, but would be virtually impossible or technically difficult to perform without concomitantly performing methods of IVF. Such expansions include [[preimplantation genetic diagnosis]] (PGD) to rule out presence of [[genetic disorder]]s, as well as [[egg donation]] or [[surrogacy]] where the woman providing the egg isn't the same who will carry the pregnancy to term. Further details in the [[#Expansions|Expansions]]-section below.
=== Tingkat keberhasilan ===
Tingkat keberhasilan IVF adalah persentase dari semua prosedur IVF yang memberikan hasil sesuai keinginan. Tergantung pada jenis kalkulasi yang digunakan, hasil tersebut mungkin merepresentasikan jumlah kehamilan yang terkonfirmasi, disebut [[tingkat kehamilan]], atau jumlah kelahiran hidup, disebut [[tingkat kelahiran hidup]]. Tingkat keberhasilannya bergantung pada berbagai faktor variabel seperti usia maternal, penyebab infertilitas, status embrio, riwayat reproduksi, dan faktor-faktor gaya hidup.
IVF success rates are the percentage of all IVF procedures which result in a favourable outcome. Depending on the type of calculation used, this outcome may represent the number of confirmed pregnancies, called the [[pregnancy rate]], or the number of live births, called the [[live birth rate]]. The success rate depends on variable factors such as maternal age, cause of infertility, embryo status, reproductive history and lifestyle factors.
MaternalUsia age:maternal Younger(''maternal candidatesage''): ofkandidat IVF areyang morelebih likelymuda tolebih getmemungkinkan pregnantuntuk hamil. WomenWanita olderyang thanusianya lebih dari 41 aretahun morelebih likelymungkin tohamil getdengan pregnantsuatu withsel atelur donor egg.<ref name="mayoclinic.org">{{en}} {{Cite web|title = In vitro fertilization (IVF) Results - Mayo Clinic|url = http://www.mayoclinic.org/tests-procedures/in-vitro-fertilization/basics/results/prc-20018905|website = www.mayoclinic.org|accessdate = 2015-11-05}}</ref>
ReproductiveRiwayat historyreproduksi: Womenwanita whoyang havesebelumnya beenpernah previouslyhamil pregnantdalam arebanyak inkasus manylebih casesmungkin moreberhasil successful withmenggunakan IVF treatments then thosedaripada whowanita haveyang neverbelum beenpernah pregnanthamil.<ref name="mayoclinic.org"/>
====Live birthTingkat kelahiran hidup rate====
TheTingkat liveatau birthangka ratekelahiran ishidup theadalah percentagepersentase ofsemua allsiklus IVF cyclesyang thatmenyebabkan leadkelahiran to a live birthhidup. This rateTingkat doesini nottidak includetermasuk [[miscarriagekeguguran]] oratau [[stillbirthlahir mati|kelahiran mati]], anddan multiple-orderkelahiran birthskembar suchdihitung assebagai twinssatu andkehamilan. tripletsSebuah are counted as one pregnancy.ringkasan Atahun 2012 summarydisusun compiled by theoleh Society for Reproductive Medicine whichyang reportsmelaporkan therata-rata tingkat averagekeberhasilan IVF successdi ratesAmerika inSerikat theuntuk Unitedmasing-masing kelompok Statesumur peryang agemenggunakan groupsel usingtelur non-donor eggs compiled the following data:<ref name="2012 Clinic Summary Report">{{en}} {{cite web|title=2012 Clinic Summary Report|url=https://www.sartcorsonline.com/rptCSR_PublicMultYear.aspx?ClinicPKID=0|work=Society for Reproductive Medicine|accessdate=2014-11-06}}</ref>
{| class="wikitable"
! !! <35 !! 35-37 !! 38-40 !! 41-42 !! >45
|-
| PregnancyTingkat kehamilan rate|| 46.,7 || 37.,8 || 29.,7 || 19.,8 || 8.,6
|-
| LiveTingkat birthkelahiran ratehidup || 40.,7 || 31.,3 || 22.,2 || 11.,8 || 3.,9
|}
InPada tahun 2006, Canadianklinik-klinik clinicsdi reportedKanada amelaporkan livetingkat birthkelahiran rate ofhidup 27%.<ref name=canadians/> BirthTingkat rateskelahiran inpada youngerpasien patientsyang werelebih slightlymuda higher,sedikit withlebih atinggi, successdengan ratetingkat ofkeberhasilan 35.,3% forbagi thoseyang berumur 21 andtahun youngerdan yang lebih muda, thekelompok youngestumur grouptermuda evaluatedyang dievaluasi. SuccessTingkat rateskeberhasilan forpasien olderyang patientslebih weretua alsojuga lowerlebih andrendah decreasedan withmenurun ageseiring dengan usia, withdengan 37-year-oldstingkat atkeberhasilan 27.,4% andbagi noyang liveberumur births37 fortahun thosedan oldertidak thanada kelahiran hidup bagi yang usianya lebih dari 48 tahun, thekelompok oldestumur grouptertua evaluatedyang dievaluasi.<ref name=r1>{{en}} {{cite web|url=http://www.cdc.gov/art/ART2006/section1.htm|archiveurl=https://web.archive.org/web/20090331150713/http://www.cdc.gov/art/ART2006/section1.htm|archivedate=2009-03-31|publisher=[[Centers for Disease Control and Prevention]]|title=2006 Assisted Reproductive Technology (ART) Report: Section 2|accessdate=25 March 2009}}</ref> SomeBeberapa clinicsklinik exceededdikatakan thesemelebihi ratesangka-angka tersebut, buttetapi tidak itmungkin ismemastikan impossibleapakah tohal determineitu ifdisebabkan thatoleh isteknik dueyang tolebih superiorunggul techniqueatau orpemilihan patientpasien selectiontertentu, becausekarena itmungkin issaja possiblemeningkatkan totingkat artificiallykeberhasilan increasedengan successcara ratesmenolak byuntuk refusingmenerima topasien accepttersulit theatau mostdengan difficultmengarahkan patientsmereka orke bysiklus steeringdonasi them into oocyte donation cyclesoosit (whichyang aredikompilasi compiledsecara separatelyterpisah). FurtherSelain itu, pregnancytingkat rateskehamilan candapat besaja increasedditingkatkan bydengan thecara placementmenempatkan ofbeberapa severalembrio embryosdengan atrisiko themeningkatkan riskkemungkinan ofterjadinya increasing the chance forkelahiran multipleskembar.
TheTingkat livekelahiran birthhidup ratesmenggunakan usingsel-sel telur donor eggsjuga arediberikan also given by theoleh SART anddan includemencakup allsemua agekelompok groupsumur usingyang eithermenggunakan freshsel ortelur thawedsegar eggsataupun dicairkan.<ref name="2009 Clinic Summary Report">{{en}} {{cite web|title=2009 Clinic Summary Report|url=https://www.sartcorsonline.com/rptCSR_PublicMultYear.aspx?ClinicPKID=0|work=Society for Reproductive Medicine|accessdate=14 July 2011}}</ref>
{| class="wikitable"
|-
! !! FreshEmbrio dari sel telur donor eggyang embryossegar !! ThawedEmbrio dari sel telur donor eggyang embryosdicairkan
|-
| LiveTingkat birthkelahiran ratehidup || 55.,1 || 33.,8
|}
BecauseKarena nottidak eachsemua siklus IVF cycleyang thatdimulai isakan startedmengarah willpada leadpengambilan tooosit oocyteatau retrievaltransfer or embryo transferembrio, reportslaporan oftingkat livekelahiran birthhidup ratesperlu need to specify themenyebutkan denominator, namelyyaitu IVFsiklus cyclesmulai startedIVF, IVFpemulihan retrievalsIVF, oratau embryotransfer transfersembrio. The Society for Assisted Reproductive Technology (SART) summarisedmerangkum 2008-9tingkat successkeberhasilan ratestahun for2008-2009 USpada clinicsklinik-klinik fordi freshAmerika embryoSerikat cyclesbagi thatsiklus didembrio notsegar involveyang donortidak eggsmencakup andsel-sel gavetelur livedonor birthdan ratesmenyajikan bytingkat thekelahiran agehidup ofberdasarkan theusia prospectivecalon motheribu, withdengan aangka peak attertinggi 41.,3% per cyclesiklus startedmulai anddan 47.,3% per embryo transfer forembrio patientsuntuk underpasien 35di yearsbawah ofusia 35 agetahun.
Upaya-upaya IVF attemptsdalam inbeberapa multiplesiklus cyclesmenyebabkan resultpeningkatan intingkat increasedkelahiran cumulativehidup live birth rateskumulatif. DependingTergantung onpada thekelompok demographic groupdemografis, onesuatu studypenelitian reportedmelaporkan 45% tosampai 53% foruntuk threetiga attemptsupaya, anddan 51% tosampai 71% to -80% foruntuk sixenam attemptsupaya.<ref>{{en}} [http://www.npr.org/templates/story/story.php?storyId=99654924 Study: Sixth Time May Be Charm For In Vitro] by Patti Neighmond. ''Day to Day'', National Public Radio. 21 January 2009.</ref>
====Pregnancy rateTingkat kehamilan ====
PregnancyTingkat ratekehamilan maydapat bedidefinisikan defineddengan inberbagai various wayscara. In theDi UnitedAmerika StatesSerikat, thetingkat pregnancykehamilan rateyang useddigunakan by theoleh Society for Assisted Reproductive Technology and thedan Centers for Disease Control (andditampilkan appearingdalam intabel thepada tablebagian inTingkat thekeberhasilan Successdi Ratesatas) sectiondidasarkan above)pada aregerak basedjantung onjanin fetalyang heartdiamati motiondalam observedpemeriksaan in[[Ultrasonografi ultrasound examinationsmedis|USG]].
TheRingkasan tahun 2009 summaryyang compileddisusun by theoleh Society for Reproductive Medicine includedmencakup thedata followingberikut data forini theuntuk UnitedAmerika StatesSerikat:<ref name="2009 Clinic Summary Report"/>
{| class="wikitable"
! !! <35 !! 35-37 !! 38-40 !! 41-42
|-
| PregnancyTingkat kehamilan rate|| 47.,6 || 38.,9 || 30.,1 || 20.,5
|}
InPada tahun 2006, Canadianklinik-klinik clinicsdi reportedKanada anmelaporkan averagetingkat pregnancykehamilan rate ofrata-rata 35%.<ref name=canadians>{{en}} Branswell, Helen (15 December 2008) [http://web.archive.org/web/20090318062752/http://www.theglobeandmail.com/servlet/story/RTGAM.20081215.wivf1215/BNStory/National/?page=rss&id=RTGAM.20081215.wivf1215 Success rate climbs for in vitro fertilization]. The Canadian Press.</ref> ASuatu Frenchpenelitian studydi estimatedPerancis thatmemperkirakan bahwa 66% ofpasien patientsyang startingmemulai penggunaan IVF treatmentberhasil finallymemiliki succeed in having a childanak (40% duringselama theperawatan IVF treatment at the centre anddan 26% aftersetelah penghentian IVF discontinuation). AchievementKeberhasilan ofmemiliki havinganak asetelah child afterpenghentian IVF discontinuation was mainlyterutama duedisebabkan tooleh [[adoptionadopsi]] (46%) oratau [[spontaneouskehamilan#Inisiasi|kehamilan pregnancyspontan]] (42%).<ref>{{en}} {{cite journal |vauthors=de La Rochebrochard E, Quelen C, Peikrishvili R, Guibert J, Bouyer J | title = Long-term outcome of parenthood project during in vitro fertilization and after discontinuation of unsuccessful in vitro fertilization | journal = Fertil. Steril. | volume = 92 | issue = 1 | pages = 149–56 | year = 2008 | pmid = 18706550 | doi = 10.1016/j.fertnstert.2008.05.067 }}</ref>
==== Prediktor keberhasilan ====
TheYang maintelah potentialdikemukakan factorssebagai thatfaktor-faktor influencepotensial pregnancyutama (andyang livemempengaruhi birth)tingkat rateskehamilan in(dan IVFkelahiran havehidup) beendalam suggestedIVF toyaitu beusia [[maternal age]], durationdurasi ofinfertilitas infertilityatau or subfertilitysubfertilitas, [[ basalHormon FSHperangsang folikel#Pengukuran|bFSH]] , and numberdan ofjumlah oocytesoosit, allsemuanya reflectingmencerminkan [[ OvaryOvarium# FunctionFungsi| ovarianfungsi functionovarium]].<ref> {{en}} {{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 }}</ref> OptimalUsia woman’swanita ageyang isoptimal adalah 23–39 yearstahun atpada timesaat ofpenanganan treatmentIVF.<ref name=nice/> ▼
[[File:Triple-line endometrium.jpg|thumb| A [[ triple-line endometriumEndometrium]] islapis-tiga associateddikaitkan withdengan betterhasil IVF outcomesyang lebih baik.<ref name="ZhaoZhang2012"> {{en}} {{cite journal|last1=Zhao|first1=Jing|last2=Zhang|first2=Qiong|last3=Li|first3=Yanping|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|year=2012|page=100|issn=1477-7827|doi=10.1186/1477-7827-10-100}}</ref>]] ▼====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 }}</ref> Optimal woman’s age is 23–39 years at time of treatment.<ref name=nice/>
[[Biomarka (kedokteran)|Biomarka]] yang mempengaruhi peluang kehamilan dengan IVF misalnya:
▲[[File:Triple-line endometrium.jpg|thumb|A [[triple-line endometrium]] is associated with better IVF outcomes.<ref name="ZhaoZhang2012">{{cite journal|last1=Zhao|first1=Jing|last2=Zhang|first2=Qiong|last3=Li|first3=Yanping|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|year=2012|page=100|issn=1477-7827|doi=10.1186/1477-7827-10-100}}</ref>]]
* Jumlah [[folikel antral]], dengan jumlah yang lebih tinggi memberikan tingkat keberhasilan lebih tinggi.<ref name=Broer2012>{{en}} {{cite journal |vauthors=Broer SL, van Disseldorp J, Broeze KA, Dolleman M, Opmeer BC, Bossuyt P, Eijkemans MJ, Mol BW, Broekmans FJ | 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 | pmc = | doi = 10.1093/humupd/dms041 }}</ref>
[[Biomarker (medicine)|Biomarkers]] that affect the pregnancy chances of IVF include:
* Kadar [[Antralhormon follicle countanti-Müllerian]], withdengan higherkadar countyang givinglebih highertinggi successmengindikasikan rates.lebih tingginya kemungkinan kehamilan,<ref name=Broer2012/>{{cite journalserta |vauthors=Broerkelahiran SL,hidup vansetelah Disseldorp JIVF, Broezebahkan KA,setelah Dollemanpenyesuaian M,usia.<ref Opmeername="IliodromitiKelsey2014">{{en}} BC,{{cite Bossuytjournal|last1=Iliodromiti|first1=S.|last2=Kelsey|first2=T. P,W.|last3=Wu|first3=O.|last4=Anderson|first4=R. Eijkemans MJ, Mol BW, Broekmans FJA.|last5=Nelson|first5=S. M.| title =The Addedpredictive valueaccuracy of ovariananti-Mullerian reservehormone testingfor onlive patientbirth characteristicsafter inassisted theconception: predictiona ofsystematic ovarian responsereview and ongoingmeta-analysis pregnancy:of An individual patient data approachthe literature| journal = Human Reproduction Update | volume = 19 20| issue = 1 4| pages = 26–36 | year = 2012 2014| pmid pages= 23188168 560–570| pmc issn= 1355-4786| doi = 10.1093/humupd/dms041 dmu003|pmid=24532220}}</ref>
* Faktor-faktor kualitas [[Semen (reproduksi)|cairan semen]] bagi penyedia sel sperma.
* [[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|last1=Iliodromiti|first1=S.|last2=Kelsey|first2=T. W.|last3=Wu|first3=O.|last4=Anderson|first4=R. A.|last5=Nelson|first5=S. M.|title=The predictive accuracy of anti-Mullerian hormone for live birth after assisted conception: a systematic review and meta-analysis of the literature|journal=Human Reproduction Update|volume=20|issue=4|year=2014|pages=560–570|issn=1355-4786|doi=10.1093/humupd/dmu003|pmid=24532220}}</ref>
* Tingkat [[fragmentasi DNA]]<ref>{{en}} {{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 = Hum Reprod | volume = 25 | issue = 7 | pages = 1594–608 | date = May 2010 | pmid = 20447937 | doi = 10.1093/humrep/deq103 }}</ref> sebagaimana diukur, misalnya, berdasarkan [[uji komet]], usia maternal lanjut, dan kualitas semen.
* Factors of [[semen quality]] for the sperm provider.
* LevelWanita ofdengan genotipe [[DNA fragmentationFMR1]] spesifik-ovarium, seperti ''het-normal/rendah'', secara signifikan menurunkan peluang kehamilan dalam IVF.<ref name="Gleicher 2010">{{en}} {{cite journal |vauthors=SimonGleicher LN, BrunborgWeghofer GA, StevensonLee MIH, LuttonBarad D, McManus J, Lewis SEDH | title = ClinicalFMR1 significanceGenotype ofwith spermAutoimmunity-Associated DNAPolycystic damageOvary-Like inPhenotype assistedand Decreased reproductionPregnancy outcomeChance | journal = HumPLoS ReprodONE | volume = 255 | issue = 712 | pages = 1594–608e15303 | dateyear = May 2010 | pmid = 2044793721179569 | pmc = 3002956 | doi = 10.10931371/humrep/deq103journal.pone.0015303 }}</ref> as measured e.g. by [[Comet assay]], [[advanced maternal age]] and [[semen quality]].
* ProgesteroneElevasi elevationprogesteron (PE) onpada the day ofhari [[ finalinduksi maturationmaturasi (IVF)|inductionakhir]] ofdikaitkan finaldengan maturation]]tingkat iskehamilan associatedyang withlebih lowerrendah pregnancydalam rates insiklus IVF cyclespada inwanita womenyang undergoingmenjalani ovarianstimulasi stimulationovarium usingmeggunakan GnRHgonadotropin analoguesdan andanalog gonadotrophinsGnRH.<ref name=Venetis> {{en}} {{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 | pmc = | doi = 10.1093/humupd/dmt014 }}</ref> AtPada thissaat timetersebut, compareddibandingkan todengan akadar progesteroneprogesteron leveldi belowbawah 0 .,8 ng/ml, akadar level betweenantara 0 .,8 anddan 1 .,1 ng/ml confers anmemberikan [[ oddsrasio ratiopeluang]] of pregnancy ofkehamilan approximatelysekitar 0 .,8, anddan akadar level betweenantara 1 .,2 anddan 3 .,0 ng/ml confersmemberikan anrasio oddspeluang ratiokehamilan of pregnancy of betweenantara 0 .,6 anddan 0 .,7.<ref name=Venetis/> OnDi thesisi other handlain, progesteroneelevasi elevationprogesteron doestampaknya nottidak seemmemberikan topenurunan conferkesempatan auntuk decreasedhamil chancedalam ofsiklus pregnancypembekuan–pencairan indan frozen–thawedsiklus cycles and cyclesdengan withdonasi eggsel donationtelur.<ref name=Venetis/> ▼* Women 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 | year = 2010 | pmid = 21179569 | pmc = 3002956 | doi = 10.1371/journal.pone.0015303 }}</ref>
* CharacteristicsKarakteristik ofsel-sel cells from thedari [[cumulus oophorus]] and thedan [[membrana granulosa]], whichyang aredengan easilymudah aspirateddiaspirasi duringselama [[ oocytepengambilan retrievaloosit transvaginal|pengambilan oosit]]. TheseSel-sel cellstersebut areterkait closelyerat associateddengan withoosit theserta oocyteberbagi andlingkungan-mikro shareyang the same microenvironmentsama, anddan thetingkat rateekspresi ofgen-gen expressiontertentu ofdalam certainsel-sel genestersebut interkait suchdengan cellstingkat arekehamilan associatedyang withlebih highertinggi oratau lowerlebih pregnancy raterendah.<ref> {{en}} {{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> ▼▲* Progesterone elevation (PE) on the day of [[final maturation (IVF)|induction of final maturation]] is associated with lower pregnancy rates in IVF cycles in women undergoing 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 | pmc = | doi = 10.1093/humupd/dmt014 }}</ref> At this time, compared to a progesterone level below 0.8 ng/ml, a level between 0.8 and 1.1 ng/ml confers an [[odds ratio]] of pregnancy of approximately 0.8, and a level between 1.2 and 3.0 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/>
* AnKetebalan endometrial thicknessendometrium (EMT) of lesskurang thandari 7 mm decreasesmenurunkan thetingkat pregnancykehamilan ratedengan byrasio anpeluang [[odds ratio]] of approximatelysekitar 0 .,4 compareddibandingkan to andengan EMT oflebih overdari 7 mm. HoweverNamun, suchketebalan lowserendah thicknessitu rarelydikatakan occursjarang terjadi, and any routinedan usesetiap ofpenggunaan thisrutin parameter isini regardeddipandang astidak notdapat justifieddibenarkan.<ref name="KasiusSmit2014"> {{en}} {{cite journal|last1=Kasius|first1=A.|last2=Smit|first2=J. G.|last3=Torrance|first3=H. L.|last4=Eijkemans|first4=M. J. C.|last5=Mol|first5=B. W.|last6=Opmeer|first6=B. C.|last7=Broekmans|first7=F. J. M.|title=Endometrial thickness and pregnancy rates after IVF: a systematic review and meta-analysis|journal=Human Reproduction Update|volume=20|issue=4|year=2014|pages=530–541|issn=1355-4786|doi=10.1093/humupd/dmu011}}</ref> ▼▲* 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 mm decreases the pregnancy rate by an [[odds ratio]] of approximately 0.4 compared to an EMT of over 7 mm. However, such low thickness rarely occurs, and any routine use of this parameter is regarded as not justified.<ref name="KasiusSmit2014">{{cite journal|last1=Kasius|first1=A.|last2=Smit|first2=J. G.|last3=Torrance|first3=H. L.|last4=Eijkemans|first4=M. J. C.|last5=Mol|first5=B. W.|last6=Opmeer|first6=B. C.|last7=Broekmans|first7=F. J. M.|title=Endometrial thickness and pregnancy rates after IVF: a systematic review and meta-analysis|journal=Human Reproduction Update|volume=20|issue=4|year=2014|pages=530–541|issn=1355-4786|doi=10.1093/humupd/dmu011}}</ref>
[[Faktor risiko]] lainnya yang berpengaruh pada hasil IVF misalnya:
Other [[Risk factor|determinants]] of outcome of IVF include:
* [[TobaccoMerokok smokingtembakau]] reducesmenurunkan the chances ofkemungkinan IVF producingmenghasilkan akelahiran livehidup birth bysebesar 34% anddan increasesmeningkatkan therisiko riskkehamilan ofIVF anberakhir IVFdengan pregnancykeguguran miscarrying bysebesar 30%.<ref name=dh2009>{{en}} [http://web.archive.org/web/20110103051232/http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_101070 Regulated fertility services: a commissioning aid – June 2009]. Department of Health UK. 18 June 2009</ref>
* A [[bodyIndeks massmassa indextubuh]] (BMI) overdi atas 27 causesmenyebabkan akecenderungan 33%penurunan decreasetingkat inkelahiran likelihoodhidup tosebesar have33% asetelah livesiklus birth after the first cycle ofpertama IVF, compareddibandingkan to those with adengan BMI betweenantara 20 anddan 27.<ref name=dh2009/> AlsoSelain itu, pregnantwanita womenhamil whoyang aremengalami obeseobesitas havejuga highermemiliki ratestingkat oflebih [[miscarriage]]tinggi dalam mengalami keguguran, [[gestationaldiabetes diabetesgestasional]], [[hypertensiontekanan darah tinggi]], [[thromboembolismtrombosis|tromboembolisme]], anddan problemsmasalah-masalah duringselama [[childbirth|deliverypersalinan]], asserta wellmengarah aspada leadingpeningkatan torisiko anjanin increased risk of fetalmengalami [[congenitalkelainan abnormalitybawaan]].<ref name=dh2009/> IdealIndeks massa bodytubuh massyang indexideal isadalah 19–30.<ref name=nice/>
* Oklusi tubal [[Salpingectomybedah laparoskopik|laparoskopik]] oratau [[laparoscopicsalpingektomi]] tubalsebelum occlusion beforepelaksanaan IVF treatmentmeningkatkan increasespeluang chancesbagi forwanita women withdengan [[hydrosalpingeshidrosalping]].<ref name=nice>{{en}} [http://www.webcitation.org/5rhjtxNOs Nice.org] {{Cite book|title=Fertility: Assessment and Treatment for People with Fertility Problems |publisher=RCOG Press |location=London |year=2004 |isbn=1-900364-97-2 |oclc= }}</ref><ref name=Farquhar2013/>
* SuccessKeberhasilan withmemperoleh previouskelahiran pregnancyhidup anddan/oratau livekehamilan birthterdahulu increasesmeningkatkan chancespeluang.<ref name=nice/>
* LowAsupan alcoholkafein/caffeinealkohol intakeyang increasesrendah successmeningkatkan ratetingkat keberhasilan.<ref name=nice/>
* TheJumlah numberembrio ofyang embryosdipindahkan transferreddalam insiklus the treatment cyclepelaksanaan.<ref name=ii2011>{{en}} [http://www.ivf-infertility.com/ivf/standard/factors/couples.php Factors affecting IVF success – February 2011], from IVF-infertility.com</ref>
* [[EmbryoKualitas qualityembrio]]
* SomeBeberapa studiespenelitian alsojuga suggestmengemukakan thekalau [[autoimmunepenyakit diseaseautoimun]] mayturun alsomemainkan playperan adalam rolemenurunkan intingkat decreasingkeberhasilan IVF successkarena ratesmengganggu byimplantasi interferingembrio withsecara propertepat implantationsetelah of the embryo after transferpemindahan.<ref name="Gleicher 2010"/>
Aspirin isterkadang sometimesdiresepkan prescribeduntuk towanita womendengan for the purpose of increasing thetujuan chancesmeningkatkan ofkemungkinan conceptionperkandungan bymelalui IVF, buttetapi theretidak isada insufficientcukup evidencebukti toyang showmemperlihatkan that it actually worksefektivitasnya.<ref name="pmid21833951">{{en}} {{cite journal |vauthors=Siristatidis CS, Dodd SR, Drakeley AJ | title = Aspirin for in vitro fertilisation | journal = Cochrane Database Syst Rev | volume = | issue = 8 | pages = CD004832 | year = 2011 | pmid = 21833951 | doi = 10.1002/14651858.CD004832.pub3 }}</ref><ref>{{en}} {{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 | 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 | pmc = | doi = 10.1093/humupd/dmr007 }}</ref>
A 2013Sebuah [[systematictinjauan reviewsistematis|reviewtinjauan]] anddan [[metaanalysismeta-analisis]] oftahun 2013 atas [[randomiseduji controlledacak trialterkendali]]s of [[acupunctureakupunktur]] assebagai ansuatu [[adjuvantterapi therapyadjuvan]] indalam IVF foundtidak nomenemukan overallmanfaatnya benefit,secara andkeseluruhan. concludedDisimpulkan thatperlunya anstudi apparentlebih benefitlanjut detectedterhadap insuatu amanfaat subsetnyata ofyang publishedditemukan trialsdalam wheresebuah thebagian controlpengujian groupyang (thosedipublikasikan notdi usingmana acupuncture)kelompok experiencedkontrol a(yang lowertidak thanmenggunakan averageakupunktur) ratemengalami oftingkat pregnancykehamilan requireslebih furtherrendah study,dari duerata-rata, tokarena theterdapat possibilitykemungkinan ofadanya [[publication bias publikasi]] anddan otherfaktor factorslainnya.<ref>{{en}} {{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 | 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>
ASebuah tinjauan [[Cochrane review(organisasi)|Cochrane]] camememperlihatkan tobahwa the result thatluka endometrial injury performed inyang thedilakukan monthpada priorbulan tosebelum [[Controlledhiperstimulasi ovarianovarium hyperstimulationterkontrol|ovarianhiperstimulasi hyperstimulationovarium]] appearedtampaknya tomeningkatkan increaseangka bothkelahiran thehidup livemaupun birthangka ratekehamilan andklinis clinicaldalam pregnancyIVF ratejika indibandingkan IVFdengan comparedtanpa with noluka endometrial injury. HoweverNamun, thereterdapat was a lack ofkekurangan data reportedyang ondilaporkan theseputar ratesangka-angka ofhasil adverseyang outcomesmerugikan suchseperti as miscarriagekeguguran, multiplekehamilan pregnancykembar, painrasa nyeri anddan/oratau bleedingpendarahan.<ref name=Farquhar2013>{{en}} {{cite journal |vauthors=Farquhar C, Rishworth JR, Brown J, Nelen WL, Marjoribanks J | title = Assisted reproductive technology: an overview of Cochrane Reviews | journal = Cochrane Database Syst Rev | volume = 8 | issue = | pages = CD010537 | year = 2013 | pmid = 23970457 | doi = 10.1002/14651858.CD010537.pub2 }}</ref>{{Update inline|reason=Updated version https://www.ncbi.nlm.nih.gov/pubmed/25532533|date=June 2016}}
ForBagi womenwanita, intake ofasupan [[antioxidantantioksidan]]s (such asseperti [[N-acetyl-cysteineasetilsistein]], [[melatonin]], [[vitamin A]], [[vitamin C]], [[vitamin E]], [[folicasam acidfolat]], [[inositol|myo-inositol]], [[zincseng]] oratau [[selenium]]) hasbelum notdikaitkan beendengan associatedpeningkatan withsignifikan aangka significantlykelahiran increasedhidup [[liveatau birthangka rate]]kehamilan orklinis clinicaldalam [[pregnancyIVF rate]]sebagaimana indilaporkan IVFdalam accordingtinjauan to [[Cochrane review]]s.<ref name=Farquhar2013/> OnDi thesisi other handlain, antioksidan oral antioxidantsyang givendiberikan tokepada thepria menseiring indengan couplesfaktor laki-laki withatau malesubfertilitas factoryang ortak unexplaineddapat subfertilitydijelaskan resultedmenghasilkan inangka significantlykelahiran higherhidup liveyang birthlebih ratetinggi indalam IVF.<ref name=Farquhar2013/>
ASebuah [[Cochranetinjauan review]]Cochrane intahun 2013 camememperlihatkan tobahwa thetidak resultada thatbukti thereyang isdapat nodiidentifikasi evidencemengenai identifieddampak regardingrekomendasi thegaya effecthidup of prepra-conceptionkonsepsi lifestylepada advicekemungkinan onhasil thekelahiran chance of a live birth outcomehidup.<ref name=Farquhar2013/>-->
== Sejarah ==
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