Academic Journal
IVF for unexplained subfertility; whom should we treat?
| Title: | IVF for unexplained subfertility; whom should we treat? |
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| Authors: | David J. McLernon, N. van Geloven, Siladitya Bhattacharya, R van Eekelen, M. van Wely, F. van der Veen, M.J.C. Eijkemans |
| Contributors: | Biostatistiek Onderwijs, Biostatistiek Onderzoek, Infection & Immunity, Circulatory Health, JC onderzoeksprogramma Infectious Diseases, JC onderzoeksprogramma Methodology, University of Aberdeen.Other Applied Health Sciences, University of Aberdeen.Grampian Data Safe Haven (DaSH), University of Aberdeen.Institute of Applied Health Sciences, University of Aberdeen.Medical Statistics, University of Aberdeen.Academic Obstetrics and Gynaecology: AMND |
| Source: | Hum Reprod van Eekelen, R, van Geloven, N, van Wely, M, Bhattacharya, S, van der Veen, F, Eijkemans, M J & McLernon, D J 2019, 'IVF for unexplained subfertility; whom should we treat?', Human reproduction (Oxford, England), vol. 34, no. 7, pp. 1249-1259. https://doi.org/10.1093/humrep/dez072 |
| Publisher Information: | Oxford University Press (OUP), 2019. |
| Publication Year: | 2019 |
| Subject Terms: | Adult, Infertility/therapy, Pregnancy Rate, PREDICTION, Supplementary Data, Cox proportional hazards, Fertilization in Vitro, R Medicine (General), individual prognoses, survival analysis, treatment registry, 03 medical and health sciences, 0302 clinical medicine, ASSISTED REPRODUCTIVE TECHNOLOGY, Pregnancy, SINGLE EMBRYO-TRANSFER, Obstetrics and Gynaecology, unexplained subfertility, Journal Article, Humans, Fertilization in Vitro/statistics & numerical data, Watchful Waiting, 10. No inequality, COUPLES, expectant management, Retrospective Studies, OUTCOMES, MEDICINE, Watchful Waiting/statistics & numerical data, G17.04, matching, cohort, R1, natural conception, 3. Good health, PREGNANCY, EUROPEAN REGISTERS, Reproductive Medicine, IVF, Infertility, SURVIVAL, Original Article, Female, Other, Maternal Age |
| Description: | STUDY QUESTION Which couples with unexplained subfertility can expect increased chances of ongoing pregnancy with IVF compared to expectant management? SUMMARY ANSWER For couples in which the woman is under 40 years of age, IVF is associated with higher chances of conception than expectant management. WHAT IS KNOWN ALREADY The clinical indications for IVF have expanded over time from bilateral tubal blockage to include unexplained subfertility in which there is no identifiable barrier to conception. Yet, there is little evidence from randomized controlled trials that IVF is effective in these couples. STUDY DESIGN, SIZE, DURATION We compared outcomes in British couples with unexplained subfertility undergoing IVF (n = 40 921) from registry data to couples with the same type of subfertility on expectant management. Those couples on expectant management (defined as no intervention aside from the advice to have intercourse) comprised a prospective nation-wide Dutch cohort (n = 4875) and a retrospective regional cohort from Aberdeen, Scotland (n = 975). We excluded couples who had tried for PARTICIPANTS/MATERIALS, SETTING, METHODS We matched couples who received IVF and couples on expectant management based on their characteristics to control for confounding. We fitted a Cox proportional hazards model including patient characteristics, IVF treatment and their interactions to estimate the individualized chance of conception over 1 year—either following IVF or expectant management for all combinations of patient characteristics. The endpoint was conception leading to ongoing pregnancy, defined as a foetus reaching a gestational age of at least 12 weeks. MAIN RESULTS AND THE ROLE OF CHANCE The adjusted 1-year chance of conception was 47.9% (95% CI: 45.0–50.9) after IVF and 26.1% (95% CI: 24.2–28.0) after expectant management. The absolute difference in the average adjusted 1-year chances of conception was 21.8% (95%CI: 18.3–25.3) in favour of IVF. The effectiveness of IVF was influenced by female age, duration of subfertility and previous pregnancy. IVF was effective in women under 40 years, but the 1-year chance of an IVF conception declined sharply in women over 34 years. In contrast, in woman over 40 years of age, IVF was less effective, with an absolute difference in chance compared to expectant management of 10% or lower. Regardless of female age, IVF was also less effective in couples with a short period of secondary subfertility (1 year) who had chances of natural conception of 30% or above. LIMITATIONS, REASONS FOR CAUTION The 1-year chances of conception were based on three cohorts with different sampling mechanisms. Despite adjustment for the three most important prognostic patient characteristics, namely female age, duration of subfertility and primary or secondary subfertility, our estimates might not be free from residual confounding. WIDER IMPLICATIONS OF THE FINDINGS IVF should be used selectively based on judgements on gain compared to continuing expectant management for a given couple. Our results can be used by clinicians to counsel couples with unexplained subfertility, to inform their expectations and facilitate evidence-based, shared decision making. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by Tenovus Scotland [grant G17.04]. Travel for RvE was supported by the Amsterdam Reproduction & Development Research Group [grant V.000296]. SB reports acting as editor-in-chief of HROpen. Other authors have no conflicts. |
| Document Type: | Article Other literature type |
| File Description: | image/pdf; application/pdf |
| Language: | English |
| ISSN: | 1460-2350 0268-1161 |
| DOI: | 10.1093/humrep/dez072 |
| Access URL: | https://aura.abdn.ac.uk/bitstream/2164/14494/1/190313_IVF_vs_EM_cohorts_revised_final.pdf https://pubmed.ncbi.nlm.nih.gov/31194864 https://www.ncbi.nlm.nih.gov/pubmed/31194864 https://www.narcis.nl/publication/RecordID/oai%3Adspace.library.uu.nl%3A1874%2F388747 https://researchinformation.amsterdamumc.org/en/publications/ivf-for-unexplained-subfertility-whom-should-we-treat https://aura.abdn.ac.uk/bitstream/2164/14494/1/190313_IVF_vs_EM_cohorts_revised_final.pdf https://pubmed.ncbi.nlm.nih.gov/31194864/ https://abdn.pure.elsevier.com/en/publications/ivf-for-unexplained-subfertility-whom-should-we-treat https://research.vumc.nl/en/publications/56b2f0ab-c519-4c0a-bdd9-03e0ac81cabb https://dspace.library.uu.nl/handle/1874/388747 |
| Rights: | CC BY NC |
| Accession Number: | edsair.doi.dedup.....b28fb500f6b89a278f1c66c163a6ed6b |
| Database: | OpenAIRE |
| ISSN: | 14602350 02681161 |
|---|---|
| DOI: | 10.1093/humrep/dez072 |