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Abstract

To determine the frequency of live births following spontaneous pregnancy (BSP) and to examine their associated factors among couples who have unsuccessfully or successfully experienced fertility treatments. Retrospective cohort. Eight IVF centers. A total of 2,134 couples who began IVF treatment in the centers in 2000-2002 and were followed up by a postal questionnaire sent 7-9 years after they started treatment in the inclusion center. None. Rates of BSP and factors associated with BSP. Univariate and multivariate analyses were conducted using logistic regression. The BSP rate was 17% (218/1,320) among couples who had previously had a child through medical treatment and 24% (193/814) among couples who had remained childless after treatment. In both groups, the probability of BSP was higher among younger women and increased with a smaller number of IVF attempts. Probability was also higher when the cause of infertility was unexplained. Our results should give hope to couples who have been unsuccessfully treated by IVF, especially young couples with unexplained infertility. Nonetheless, it should be remembered that the BSP rates are cumulative rates observed over a long period of time and that these couples have a very low monthly probability of conceiving.
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Publisher’s Version/PDF in open access
on editor web site:
https://www.fertstert.org/article/S0015-0282(12)00396-2/pdf
Troude Pénélope, Bailly Estelle, Guibert Juliette, Bouyer Jean, La Rochebrochard Elise (de),
for the DAIFI Group, 2012, Spontaneous pregnancies among couples previously treated by
in vitro fertilization, Fertility and Sterility, 98(1), p. 63-68. DOI: 10.1186/1471-2288-12-
104.
Spontaneous pregnancies among couples previously
treated by in vitro fertilization
Pénélope Troude a,b,c,d, MD, Estelle Bailly a, MSc, Juliette Guibert e, MD, Jean Bouyer a,b,f,
PhD, and Elise de La Rochebrochard a,b,f, PhD, for the DAIFI Group
a Institut National d’Etudes Démographiques (INED), F-75020 Paris, France
b Inserm, CESP Center for Research in Epidemiology and Population Health U1018, F-94276
Le Kremlin-Bicêtre, France
c AP-HP, Hôpital Lariboisière, F-75475 Paris, France
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d Univ Paris Diderot, Sorbonne Paris Cité, Service de Santé Publique et Economie de la
Santé, F-75475 Paris, France
e Laboratoire de Procréation Médicalement Assistée, Institut Mutualiste de Montsouris, F-
75014 Paris, France
f Univ Paris-Sud, UMRS 1018, F-94276 Le Kremlin-Bicêtre, France
DAIFI Group members include: Institut National d’Etudes Démographiques (INED) - Institut
National de la Santé et de la Recherche Médicale (INSERM) Université Paris Sud XI: Elise
de La Rochebrochard (national coordinator), Annie Bachelot, Estelle Bailly, Jean Bouyer,
Juliette Guibert, Henri Leridon, Patricia Thauvin, Laurent Toulemon, Pénélope Troude;
Auvergne: Rusudan Peikrishvili, Jean-Luc Pouly (CHU Estaing, Clermont-Ferrand 63);
Basse-Normandie: Isabelle Denis, Michel Herlicoviez (CHU Clémenceau, Caen 14);
Franche-Comté: Christiane Joanne, Christophe Roux (CHR Saint-Jacques, Besançon 25);
Haute-Normandie: Catherine Avril, Julie Roset (Clinique Mathilde, Rouen 76); Ile-de-
France: Joëlle Belaisch-Allart, Olivier Kulski (Center Hospitalier des 4 Villes, Sèvres 92);
Jean-Philippe Wolf, Dominique de Ziegler (Cochin, Paris 75); Philippe Granet, Juliette
Guibert (Institut Mutualiste Montsouris, Paris 75); Provence-Alpes-Côte d’Azur: Claude
Giorgetti, Géraldine Porcu (Institut de Médecine de la Reproduction, Marseille 13).
None of the authors have any conflict of interest.
Corresponding author:
Dr Penelope Troude
Inserm CESP U1018
94276 Le Kremlin-Bicêtre
- 3 -
France
Tel. +33 1 45 21 21 50
Fax +33 1 45 21 20 75
E-mail: penelope.troude@inserm.fr
Capsule: Among couples previously treated by IVF, one in five has a live birth following a
spontaneous pregnancy. This should give hope to unsuccessfully treated couples, especially
young couples with unexplained infertility.
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ABSTRACT
Objective: To determine the frequency of live births following spontaneous pregnancy (BSP)
and to examine their associated factors among couples who have unsuccessfully or
successfully experienced fertility treatments.
Design: Retrospective cohort.
Setting: Eight French IVF centers.
Patients: 2,134 couples who began IVF treatment in the centers in 2000-2002 and were
followed up by a postal questionnaire sent 7-9 years after they started treatment in the
inclusion center.
Interventions: None.
Main outcome measures: Rates of live birth following spontaneous pregnancy, factors
associated with BSP. Univariate and multivariate analyses were conducted using logistic
regression.
Results: The BSP rate was 17% (218/1,320) among couples who had previously had a child
through medical treatment and 24% (193/814) among couples who had remained childless
after treatment. In both groups, the probability of BSP was higher among younger women
and increased with a smaller number of IVF attempts. Probability was also higher when the
cause of infertility was unexplained.
Conclusions: Our results should give hope to couples who have been unsuccessfully treated
by IVF, especially young couples with unexplained infertility. Nonetheless, it should be
remembered that the BSP rates are cumulative rates observed over a long period of time and
that these couples have a very low monthly probability of conceiving.
Keywords: Fertilization in vitro, spontaneous pregnancy, follow-up studies, France
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INTRODUCTION
The issue of live births following spontaneous pregnancy (BSP) among infertile couples who
have had in vitro fertilization (IVF) treatment may seem an unusual one in such a context (1)
and may appear anecdotal to physicians, especially if treatment has failed (2). However, in
view of some recent publications, BSP after IVF may not be such a rare occurrence.
The question of spontaneous pregnancies has been approached in studies on drop-out from
fertility care, since 5% to 7% of couples may have dropped out from the IVF waiting list
because of spontaneous pregnancy (3-5). Because these studies focused only on reasons for
treatment dropout, BSP that occurred at a later date were not taken into account. Some
studies have evaluated occurrence of BSP specifically among couples who previously had a
child through IVF and intracytoplasmic sperm injection (ICSI) (1, 2, 6). Reported BSP rates
ranged from 16% to 17% with a follow-up between two and five years. In another recent
study conducted in Denmark, rate of delivery after spontaneous pregnancy among couples
who had previously conceived through intrauterine insemination or assisted reproduction
techniques was 17% five years after treatment initiation (7). Other studies have focused on
couples who had been unsuccessfully treated by IVF or ICSI and the BSP rate varied
considerably (8-11). With various durations of follow-up (two to ten years), most of these
studies reported spontaneous pregnancy or BSP rates that ranged from 11% to 19%, except
one that observed a BSP rate as high as 32% (9).
Comparison between studies on BSP is difficult since the populations (infertile couples or
treated couples), outcome (pregnancy or live birth) and duration of follow-up differ
considerably. Moreover, most studies of unsuccessfully treated couples included less than
200 couples. Although the results varied widely, all published studies showed that BSP may
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occur after IVF in as many as one or two couples out of 10. Our objective was to estimate the
spontaneous live birth rate and to examine its associated factors among couples who had
received IVF treatment for infertility, whether successfully or unsuccessfully.
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MATERIALS AND METHODS
The DAIFI cohort
The DAIFI cohort (Outcome after In Vitro Fertilization treatment Initiation) is a retrospective
cohort including couples who had begun IVF treatment between 2000 and 2002 in one of the
eight participating French IVF centers (the inclusion centers). This study received
Institutional Review Board approval from the French Data Protection Authority
(authorization number 05-1334). Information on long-term outcome was collected by postal
questionnaire completed by the couples from 2008 through 2010. The questionnaire included
sociodemographic information, fertility and medical treatment history, occurrence of
spontaneous pregnancies and recourse to adoption. Of the 4,029 couples contacted, 2,321
completed the postal questionnaire. Analysis was restricted to 2,134 couples who were still
together at the time of study (187 separated couples were excluded).
Two study groups: successfully and unsuccessfully treated couples
The 2,134 couples were divided into two groups: the successfully treated group of 1,320
couples who had had a child during medical treatment and the “unsuccessfully treated group
of 814 couples who remained childless after medical treatment. Success during medical
treatments included all births following IVF treatment in the inclusion center as well as all
births following other medical treatments (ovarian stimulation, surgery, artificial
insemination with partner sperm or donor sperm, oocyte donation, IVF, ICSI, FET)
subsequently received in France or abroad.
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Births following spontaneous pregnancies
Births following spontaneous pregnancies (BSP) were declared by the couple in the postal
questionnaire. The date of the birth was recorded. Based on the medical records, information
on the dates of first and last IVF attempt in the inclusion center were collected. For
successfully treated couples, the date of birth following medical treatment was collected.
Statistical analyses
The occurrence and distribution of BSP were studied separately in each group. The two
groups were not compared as time of exposure to conception could vary between the two
groups and could not be properly controlled based on the retrospective data collected in this
study. In particular, periods of contraception may have differed between the two groups and
the corresponding dates were not asked because of the retrospective design of the study over
several years. Moreover, the exposure time was defined differently in each group: for
successfully treated couples, it was defined as the time since birth following treatment; for
unsuccessfully treated couples, it was defined as the time since the last attempt in the
inclusion center (i.e. last fresh or frozen embryo transfer).
The couples’ characteristics were analyzed in relation to BSP. Categorical variables were
compared using the chi-2 test, and quantitative variables were described as median, first and
third quartiles (Q1-Q3). Couples' characteristics included the woman’s and the man’s age at
the first IVF attempt (< 30, 30-34, 35-39, ≥ 40 years) and the highest educational level of the
couple (less than, equal to or higher than the French high school diploma). Medical
characteristics were extracted from the inclusion IVF center database and included type of
infertility (primary vs secondary), cause of infertility (female factor, male factor, mixed,
unexplained), its duration (defined as the interval between first attempting pregnancy and
first oocyte retrieval), characteristics at the first attempt in the inclusion center (number of
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oocytes retrieved, number of oocytes fertilized, number of embryos transferred, number of
embryos frozen), overall characteristics of treatment in the center (number of attempts,
number of frozen embryo transfers (FET), at least one embryo transferred, at least one
pregnancy obtained). Information on the path followed by the couples included treatments
before and after IVF in the inclusion center and initiation of adoption procedures.
Multivariate analyses were conducted to assess factors associated with BSP using logistic
regression. Multivariate models were adjusted for inclusion center and included the following
variables: the woman’s age, duration of infertility, cause of infertility, having a child before
IVF in the inclusion center and other variables associated with BSP with a P value <0.20.
Some variables were excluded because of colinearity, such as the man’s age. All statistical
analyses were performed using STATA/SE 10.0 (Stata Press, College Station, TX, USA).
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RESULTS
In the successfully treated group (n=1,320), the women’s median age at the first IVF attempt
in the inclusion center was 32 years (Q1-Q3[29-35]). Infertility was due to a female factor in
32%, a male factor in 37%, to both in 18% and was unexplained in 13%. Ninety-one percent
of live births were obtained through IVF in the inclusion center, 6.5% through IVF in another
center and 3% through other treatments (mainly artificial insemination). Among these
successfully treated couples followed up for a median of 6 years, 218 later had a spontaneous
live birth, a BSP rate of 17% (95% CI: 15%, 19%). BSP distribution over time is presented in
figure 1. Most BSP occurred during the third or fourth year after the birth following medical
treatment. The median time between the first birth following medical treatment and the birth
following spontaneous conception was 33 months [22-42].
In the unsuccessfully treated group (n=814), the women’s median age at the first attempt in
the inclusion center was 34 years [31-38]. Infertility was due to a female factor in 43%, a
male factor in 28%, to both in 17% and was unexplained in 12%. Eighteen percent of couples
had undergone other unsuccessful treatments after IVF in the inclusion center. Among the
814 unsuccessfully treated couples followed up for a median of 7 years since the last IVF
attempt in the inclusion center, 193 BSP were reported, or 24% (95% CI: 21%, 27%). The
median time elapsed since the initial pregnancy attempt was 6 years [5-7]. BSP distribution
over time since the last attempt in the inclusion center is presented in figure 2. Almost 60%
of BSP occurred during the first two years after the last IVF attempt in the inclusion center.
Characteristics of couples were compared in relation to BSP in the successfully treated group
and in the unsuccessfully treated group in Table 1. Five variables were significantly
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associated with BSP in both groups in the univariate analysis: BSP was more frequent when
the woman and the man were younger, when the infertility was unexplained, when the
technique used at the first attempt was IVF without ICSI and when the number of IVF
attempts undergone by the couple in the inclusion center was small. In the successfully
treated group, BSP was also more frequent when the couple had already had treatment before
attending the inclusion center and when the couple did not have FET in the inclusion center.
In the unsuccessfully treated group, BSP was also more frequent when the duration of
infertility was shorter and when two embryos were transferred at the first IVF attempt in the
inclusion center. Multivariate analysis is presented in Table 2. In both groups, the probability
of BSP decreased as the woman’s age increased and the number of IVF attempts in the
inclusion center was greater (P<0.001 for trend). Probability increased when infertility was
due to a female factor and above all when it was unexplained. Two variables were significant
in the multivariate analysis only in the unsuccessfully treated group: for these couples, the
probability of BSP also increased when the duration of infertility decreased and when at least
one embryo was transferred during treatment in the inclusion center.
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DISCUSSION
In a large sample of French couples undergoing IVF treatment for infertility, the rate of live
birth following spontaneous pregnancy was estimated to be 17% (15 to 19%) among
successfully treated couples and 24% (21 to 27%) among unsuccessfully treated couples.
Among unsuccessfully treated couples, 60% of BSP occurred in the two years following the
last IVF transfer, suggesting that BSP was the reason for IVF treatment discontinuation
(usually the duration between two attempts was no more than 18 months). Among
successfully treated couples, 58% of BSP occurred during the third and fourth years after the
first birth following medical treatment. Thus, the context of BSP is clearly quite different in
these two groups. Moreover, the BSP rate observed among successfully and unsuccessfully
treated couples cannot be directly compared because couples who had had a child through
fertility treatment had been exposed to the possibility of BSP during a shorter period of time
(because of the pregnancy period). Furthermore, couples who obtained the desired child
through fertility treatment may be less likely to try to conceive again and the study did not
include enough information to properly control for such differences in time of exposure to
conception between the two groups (for example contraceptive periods were unknown).
The BSP rate observed among successfully treated couples, 17%, was very close to the 16-
17% observed in other studies in Germany, Denmark and Japan (2, 6, 7). In our study, the
median time to BSP after the birth of a child following medical treatment was three years,
which is in accordance with previous reports (1, 2). The BSP rate observed among
unsuccessfully treated couples, 24%, appears to be slightly higher than most of those
previously reported in the literature, usually lower than 17% (8, 12, 13). However, one
English study has already reported a much higher BSP rate of 32% four to ten years after
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referral to a center, in couples who had ceased to try to conceive by assisted reproduction
techniques (9). Previous studies concerned samples of less than 250 couples, whereas our
study has been conducted on more than 800 unsuccessfully treated couples.
In prospective and retrospective cohort studies, information cannot be gathered for all
couples: in our cohort, 58% of contacted couples participated in the postal survey seven to
nine years after IVF initiation in the inclusion center. This participation rate is higher than
that (44%) observed in an English cohort of couples who had undergone IVF four to ten
years earlier (9). Most studies did not report their participation rates, which may have been
even lower. We cannot rule out the possibility that couples who had a BSP are more likely to
respond than couples who did not, and so published BSP rates may be slightly overestimated.
Regarding factors associated with BSP, for both successfully and unsuccessfully treated
couples the probability of BSP decreased as the woman’s age increased, as previously
reported in the literature (1, 6, 9, 14, 15). The cause of infertility was globally associated with
BSP among successfully treated couples and among unsuccessfully treated couples. The
proportion of BSP was higher for couples with unexplained infertility and lower for male-
factor infertility. Previously reported results on cause or type of infertility are mixed: cause or
diagnosis of infertility have been reported as associated factors in some studies (1, 9, 14) and
not in others (6, 15, 16). For unsuccessfully treated couples, we observed 32% of BSP among
couples with unexplained infertility while Cahill et al. reported 35% of spontaneous
pregnancy in this subpopulation within three years after IVF treatment (9). Other medical
characteristics also seemed linked to BSP, especially among unsuccessfully treated couples.
The proportion of BSP decreased when the number of IVF attempts increased in the
successfully and in the unsuccessfully treated groups, but the impact of this variable seemed
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much greater in the unsuccessfully treated group. Other variables were significant in the
multivariate model only among the unsuccessfully treated couples: duration of infertility and
at least one embryo transfer during the treatment in the inclusion center. Globally, factors
associated with BSP can be viewed as indicators of a better fertility prognosis, especially
among unsuccessfully treated couples: couples with BSP are younger and they have better
medical characteristics (shorter duration of infertility and at least one embryo transfer during
IVF treatment). Unexplained infertility appeared strongly associated with BSP (17), and
could probably also be interpreted as an indicator of better fertility prognosis compared with
couples whose infertility is of known origin, and particularly of male-factor origin. In the
unsuccessfully treated group, the BSP rate in couples with unexplained infertility and a
woman's age under 35 years was as high as 45% (n = 21/47; 95% CI: 30%, 60%).
Considering the 37 couples with the best prognostic factors (unexplained infertility, woman’s
age under 35 years and infertility duration 5 years), this rate even reached 57% (95% CI:
39%, 73%). This result is in agreement with a study conducted in the Netherlands on the
reasons for dropping out from a waiting list for IVF: spontaneous pregnancies occurred
mostly in couples with unexplained infertility and younger than 35 years (5). Based on these
results, it would be very interesting to develop further research with the specific aim of better
characterizing young couples with unexplained infertility. However, these couples only
represent a small proportion of all unsuccessfully treated couples, at least in our French
population.
To conclude, our results should give hope to couples who have previously been treated by
IVF, especially for unsuccessful young couples with unexplained infertility. Nonetheless, it
should be borne in mind that the published rates are cumulative BSP observed over a long
period of time. For example, if unsuccessfully treated couples had a cumulative BSP rate of
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24%, they had to wait a median of six years to have their child. This corresponds to a very
low monthly conception probability (fecundability) of around 0.44%, whereas fecundability
in the general population is estimated at 25% (18).
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1. Hennelly B, Harrison RF, Kelly J, Jacob S, Barrett T. Spontaneous conception after a
successful attempt at in vitro fertilization/intracytoplasmic sperm injection. Fertil Steril
2000;73:774-8.
2. Ludwig AK, Katalinic A, Jendrysik J, Thyen U, Sutcliffe AG, Diedrich K et al.
Spontaneous pregnancy after successful ICSI treatment: evaluation of risk factors in
899 families in Germany. Reprod Biomed Online 2008;17:403-9.
3. Brandes M, van der Steen JO, Bokdam SB, Hamilton CJ, de Bruin JP, Nelen WL et al.
When and why do subfertile couples discontinue their fertility care? A longitudinal
cohort study in a secondary care subfertility population. Hum Reprod 2009;24:3127-
35.
4. Horne G, Farrell C, Pease EH, Brison DR, Falconer DA, Lieberman BA. Waiting for in
vitro fertilization treatment: spontaneous and ART live births. Hum Fertil (Camb)
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5. van Dongen AJ, Verhagen TE, Dumoulin JC, Land JA, Evers JL. Reasons for dropping
out from a waiting list for in vitro fertilization. Fertil Steril 2009;94:1713-6.
6. Shimizu Y, Kodama H, Fukuda J, Murata M, Kumagai J, Tanaka T. Spontaneous
conception after the birth of infants conceived through in vitro fertilization treatment.
Fertil Steril 1999;71:35-9.
7. Pinborg A, Hougaard CO, Nyboe Andersen A, Molbo D, Schmidt L. Prospective
longitudinal cohort study on cumulative 5-year delivery and adoption rates among
1338 couples initiating infertility treatment. Hum Reprod 2009;24:991-9.
8. Osmanagaoglu K, Collins J, Kolibianakis E, Tournaye H, Camus M, Van Steirteghem
A et al. Spontaneous pregnancies in couples who discontinued intracytoplasmic sperm
injection treatment: a 5-year follow-up study. Fertil Steril 2002;78:550-6.
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9. Cahill DJ, Meadowcroft J, Akande VA, Corrigan E. Likelihood of natural conception
following treatment by IVF. J Assist Reprod Genet 2005;22:401-5.
10. Filetto JN, Makuch MY. Long-term follow-up of women and men after unsuccessful
IVF. Reprod Biomed Online 2005;11:458-63.
11. de La Rochebrochard E, Quelen C, Peikrishvili R, Guibert J, Bouyer J. Long-term
outcome of parenthood project during in vitro fertilization and after discontinuation of
unsuccessful in vitro fertilization. Fertil Steril 2009;92:149-56.
12. Osmanagaoglu K, Tournaye H, Camus M, Vandervorst M, Van Steirteghem A,
Devroey P. Cumulative delivery rates after intracytoplasmic sperm injection: 5 year
follow-up of 498 patients. Hum Reprod 1999;14:2651-5.
13. Brandes M, Hamilton CJ, de Bruin JP, Nelen WL, Kremer JA. The relative
contribution of IVF to the total ongoing pregnancy rate in a subfertile cohort. Hum
Reprod 2010;25:118-26.
14. Eijkemans MJ, Lintsen AM, Hunault CC, Bouwmans CA, Hakkaart L, Braat DD et al.
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Hum Reprod 2008;23:1627-32.
15. Kupka MS, Dorn C, Richter O, Schmutzler A, van der Ven H, Kulczycki A. Stress
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16. Vardon D, Burban C, Collomb J, Stolla V, Erny R. [Spontaneous pregnancies in
couples after failed or successful in vitro fertilization]. J Gynecol Obstet Biol Reprod
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17. Brandes M, Hamilton CJ, van der Steen JO, de Bruin JP, Bots RS, Nelen WL et al.
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18. Spira A. Epidemiology of human reproduction. Hum Reprod 1986;1:111-5.
- 19 -
Figure 1. Distribution of BSP over time since birth following treatments among successfully
treated couples (n = 218)
- 20 -
Figure 2. Distribution of BSP over time since last IVF attempt in the inclusion center among
unsuccessfully treated couples (n = 193)
- 21 -
Table 1. Live births following spontaneous conception (BSP) and characteristics of
successfully treated couples (n = 1,320) and unsuccessfully treated couples (n = 814).
Successfully treated
couples (n = 1,320)
Unsuccessfully treated
couples (n = 814)
P
% BSP
P
Woman’s age at 1st attempt (years)
<0.001
< 0.001
< 30
41.5
30-34
27.4
35-39
16.0
≥ 40
12.6
Man’s age at 1st attempt (years)
<0.001
0.001
< 30
26.2
30-34
30.7
35-39
21.6
≥ 40
15.7
Highest educational level of the
couple
0.445
0.782
< French high school diploma
25.3
French high school diploma
21.4
> French high school diploma
24.0
Duration of infertility (years)
0.951
<0.001
0-3
30.0
4-5
25.1
>5
9.9
Type of infertility
0.193
0.346
Primary
23.6
Secondary
27.3
Origin of infertility
0.001
0.038
Male
19.3
Female
26.6
Mixed
19.7
Unexplained
31.6
Previous child before IVF in
inclusion center
0.218
0.789
No
2.9
Yes
22.8
IVF technique at 1st IVF attempt
0.002
0.034
FIV
26.8
ICSI
20.1
Oocytes retrieved at 1st IVF attempt
0.277
0.425
0-6
22.0
7-15
23.7
16-40
28.3
- 22 -
Embryos transferred at 1st IVF
attempt
0.113
0.009
0-1
20.8
2
28.6
3-5
17.9
Number of IVF attempts in
inclusion center
0.016
0.001
1
31.8
2-4
22.5
5-14
12.4
Number of frozen embryo transfers
in inclusion center
0.018
0.598
0
23.3
≥ 1
25.1
At least one embryo transferred in
inclusion center
0.302
0.059
No*
14.1
Yes
24.5
* Couples may have been successfully treated in the center or subsequently treated in another
center: 15 couples who had no embryo transferred in the inclusion center were later
successfully treated elsewhere.
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Table 2. Factors associated with live births following spontaneous pregnancy in successfully and unsuccessfully treated infertile couples.
Successfully treated couples
(n = 1,320)
Unsuccessfully treated couples
(n = 814)
Univariate analysis
Multivariate analysis a
(n = 1,276)
Univariate analysis
Multivariate analysis a
(n = 787)
n
OR
95% CI
P
OR
95% CI
P
n
OR
95% CI
P
OR
95% CI
P
Woman’s age at 1st attempt (years)
< 30
79/368
1
<0.01b
1
<0.01b
49/118
1
<0.01b
1
<0.01b
30-34
111/607
0.82
0.59-1.13
0.75
0.53-1.07
87/317
0.53
0.34-0.83
0.50
0.31-0.82
35-39
25/302
0.33
0.20-0.53
0.30
0.18-0.49
43/268
0.27
0.17-0.44
0.24
0.14-0.43
≥ 40
3/42
0.28
0.08-0.93
0.25
0.07-0.86
14/111
0.20
0.10-0.40
0.18
0.09-0.38
Duration of infertility (years)
0.85
0.84
<0.01b
<0.01b
0-3
116/679
1
1
102/343
1
1
4-5
66/405
0.94
0.68-1.32
0.88
0.62-1.26
71/282
0.80
0.56-1.13
0.79
0.54-1.17
>5
33/196
0.98
0.64-1.50
1.01
0.64-1.59
16/170
0.25
0.14-0.43
0.25
0.14-0.46
Origin of infertility
<0.01
<0.01
<0.01
<0.01
Male
62/483
1
1
44/228
1
1
Female
74/419
1.46
1.01-2.10
1.55
1.05-2.30
92/346
1.51
1.01-2.27
1.75
1.09-2.79
Mixed
38/244
1.25
0.81-1.94
1.16
0.73-1.84
27/137
1.03
0.60-1.75
1.04
0.57-1.88
Unexplained
44/170
2.37
1.54-3.66
2.55
1.59-4.08
30/95
1.93
1.12-3.32
2.98
1.60-5.53
Number of attempts in inclusion center
<0.01b
<0.01b
<0.01b
<0.01b
1
94/464
1
1
68/214
1
1
2-4
110/732
0.69
0.51-0.94
0.65
0.47-0.89
113/503
0.62
0.44-0.89
0.39
0.26-0.60
5-14
14/123
0.51
0.28-0.92
0.44
0.23-0.82
12/97
0.30
0.16-0.59
0.15
0.07-0.32
At least one embryo transferred in inclusion center
Yes
217/1305
1
1
184/750
1
1
No
1/15
0.36
0.05-2.74
0.32
0.24
0.03-1.98
0.19
9/64
0.50
0.24-1.04
0.06
0.31
0.13-0.70
<0.01
Previous child before IVF
No
197/1160
1
1
165/691
1
1
Yes
21/160
0.74
0.46-1.20
0.22
0.81
0.46-1.40
0.45
28/123
0.94
0.59-1.48
0.79
1.03
0.60-1.79
0.91
a Adjusted for inclusion center; b p for trend
... Studies on this subject have shown that the cause of infertility affects both the outcome of IVF treatment and the spontaneous pregnancy status in the subsequent period. [3][4][5][6][7] While a higher frequency of spontaneous pregnancy after IVF has been reported in cases of unexplained infertility, studies have also described spontaneous pregnancy in cases where a normal ovulation cycle is achieved with treatment for other underlying conditions, such as polycystic ovary syndrome and endometriosis. [3][4][5][6][7] The features that increase the chance of spontaneous pregnancy after IVF treatment are predictable parameters and include younger female age, fewer IVF attempts, and shorter duration of infertility. ...
... [3][4][5][6][7] While a higher frequency of spontaneous pregnancy after IVF has been reported in cases of unexplained infertility, studies have also described spontaneous pregnancy in cases where a normal ovulation cycle is achieved with treatment for other underlying conditions, such as polycystic ovary syndrome and endometriosis. [3][4][5][6][7] The features that increase the chance of spontaneous pregnancy after IVF treatment are predictable parameters and include younger female age, fewer IVF attempts, and shorter duration of infertility. 3,[8][9][10] The results of the studies on this subject show that the most important determinant of spontaneous conception after IVF is the age of the woman and the cause of infertility. ...
... [3][4][5][6][7] The features that increase the chance of spontaneous pregnancy after IVF treatment are predictable parameters and include younger female age, fewer IVF attempts, and shorter duration of infertility. 3,[8][9][10] The results of the studies on this subject show that the most important determinant of spontaneous conception after IVF is the age of the woman and the cause of infertility. The number of studies examining the clinical features of couples who conceive spontaneously after successful or unsuccessful IVF applications are very few. ...
Article
OBJECTIVE: To examine the clinical features of cases with spontaneous pregnancy after successful or unsuccessful in vitro fertilization (IVF). STUDY DESIGN: IVF procedures performed in 2 IVF clinics between October 2014 and November 2020 were retrospectively analyzed. Ninety-five cases that conceived spontaneously after IVF treatment were included in the study. RESULTS: The mean age was 32.07±4.52 years, and the mean duration of infertility was 4.37±2.05 years. The etiology of infertility was PCOS in 36.84%, unexplained infertility in 33.68%, endometriosis in 11.58%, and PCOS+endometriosis in 11.58% of patients. Records showed that 8.42% of the cases had undergone laparoscopy and 16.84% had undergone hysteroscopy. The number of IVF attempts was 1 in 52.63% of the cases, and the outcome was negative in 31.58% of the cases. Among those with pregnancy after IVF, 64.21% resulted in a live birth. The period from the IVF procedure to spontaneous pregnancy was shorter than 3 years in 97.89% of the cases. CONCLUSION: The frequency of PCOS, unexplained infertility, and endometriosis diagnoses among those who had later conceived spontaneously was quite high. It appears that prolonging waiting time for spontaneous pregnancy in such cases can prevent unnecessary IVF procedures. (J Reprod Med 2021;66:337-341)
... Some caution should be taken in interpreting these results. First, the availability of ART might have supported provision of treatment to couples that would have eventually conceived without it (Cahill et al. 2005;de La Rochebrochard et al. 2009;Troude et al. 2012). This is a common limitation among analysis estimating the contribution of ART to the TFR (Hoorens et al. 2007). ...
Article
Full-text available
BACKGROUND Despite the widespread use of assisted reproductive technology (ART), few studies analyse its impact on the total fertility rate (TFR). Furthermore, very little is known about how ART affects fertility at older reproductive ages and contributes to family size. OBJECTIVE We aim to quantify the contribution of ART to total and age-specific fertility rates and in relation to the transition to first and subsequent births in Australia. METHODS Using data from a comprehensive clinical registry of ART treatments, age-specific ART and non-ART fertility rates were calculated and used to decompose the change in the TFR between 2010 and 2017 into ART and non-ART components. RESULTS ART represented an increasing and relevant contribution to the TFR, corresponding to an impact of the order of 4% to 5% per annum, or approximately to 1 in 20 births. Increasing fertility rates at age 33 and above exerted a positive effect on the overall TFR, and they were almost entirely attributable to the increasing use of ART. Women resorted to ART especially to have a first child. CONTRIBUTION This is the first study to provide a detailed examination of the contribution of ART to age-specific fertility rates and in relation to parity transition. While most studies focus on the impact of ART on the overall TFR, the importance of ART for the recovery of births at older reproductive ages could be underestimated.
... While patients undergoing IVF are deemed subfertile, a Cochrane review comparing IVF with expectant management in women with unexplained infertility revealed that 1% of women achieved spontaneous conception following expectant management for up to an average of 4 years [5]. Troude et al also studied 2,134 couples who underwent IVF and found that 24% of the couples achieved spontaneous pregnancies despite having failed IVF previously [6]. ...
Article
Full-text available
Serum progesterone levels performed prior to oocyte pick-up is commonly used to guide embryo transfer in in-vitro fertilization (IVF) cycles, as elevated levels can negatively influence pregnancy outcomes. However, levels associated with normal pregnancies should trigger clinicians to consider alternative causes such as a pre-existing pregnancy. We report a case of a 37-year-old patient who underwent controlled ovarian hyperstimulation in a gonadotrophin-releasing hormone antagonist cycle while having an undetected early pregnancy. No oocytes were retrieved at oocyte retrieval despite adequate follicular responses. Her serum progesterone level on the day of her trigger injection was 57.8 nmol/L. She was found to have a pregnancy of unknown location, detected 3 weeks after her oocyte retrieval and was subsequently treated with systemic methotrexate.
... Today, there is no scientific way to differentiate the absolute exposure and effects of ART treatments among the pregnant population at a certain time; residual effects from previous fertility treatments for previous pregnancies, births, or failed attempts at pregnancy are also possible. 30 Due to limited sample size, we were unable to compare rates of perinatal mortality stratified by shorter intervals of gestational age; however, we have no reason to suspect our findings are inaccurate. Likewise, due to the small numbers of perinatal deaths among triplets and higher order gestations, we analyzed a combined population of twins and higher order gestations. ...
Article
Objective: This study aimed to compare trends and characteristics of assisted reproductive technology (ART) and non-ART perinatal deaths and to evaluate the association of perinatal mortality and method of conception (ART vs. non-ART) among ART and non-ART deliveries in Florida, Massachusetts, and Michigan from 2006 to 2011. Study design: Retrospective cohort study using linked ART surveillance and vital records data from Florida, Massachusetts, and Michigan. Results: During 2006 to 2011, a total of 570 ART-conceived perinatal deaths and 25,158 non-ART conceived perinatal deaths were identified from the participating states. Overall, ART perinatal mortality rates were lower than non-ART perinatal mortality rates for both singletons (7.0/1,000 births vs. 10.2/1,000 births) and multiples (22.8/1,000 births vs. 41.2/1,000 births). At <28 weeks of gestation, the risk of perinatal death among ART singletons was significantly lower than non-ART singletons (adjusted risk ratio [aRR] = 0.46, 95% confidence interval [CI]: 0.26-0.85). Similar results were observed among multiples at <28 weeks of gestation (aRR = 0.64, 95% CI: 0.45-0.89). Conclusion: Our findings suggest that ART use is associated with a decreased risk of perinatal deaths prior to 28 weeks of gestation, which may be explained by earlier detection and management of fetal and maternal conditions among ART-conceived pregnancies. These findings provide valuable information for health care providers, including infertility specialists, obstetricians, and pediatricians when counseling ART users on risk of treatment. Key points: · ART use is associated with a decreased risk of perinatal deaths prior to 28 weeks of gestation.. · ART perinatal mortality rates were lower than that for non-ART perinatal mortality.. · This study used linked data to examine associations between use of ART and perinatal deaths..
... As in our study, they showed that we should give hope, especially to young couples with unexplained infertility, although they might have to wait for a long time. They also reported that SPs mostly occurred in 2-4 years of successful or unsuccessful IVF attempts (11). Similar to our findings, another study determined that the younger women and also shorter duration of infertility had higher rate of spontaneous pregnancy after surgery (12). ...
Article
Background: The phenomenon of infertility may be derived from different factors - either in males or females or both genders, including few unexplained factors. It is generally managed by medical and surgical treatments. Objective: To find a relation of occurrence of spontaneous pregnancy (SP) with effective factors in infertility. Materials and methods: This cross-sectional study was conducted at two referral infertility centers (university and privacy center) in the southwest of Iran from March 2015 and March 2016 on 655 infertile couples, who were divided in two groups of with (n = 31) and without (n = 624) SP. The variables included female and male age, male smoking, male job, the place of living, the causes of infertility, the type and duration of infertility, and the subgroups of infertility causes. Results: Infertility may be caused due to both male- and female- related factors (47.5%). While female-related infertility was found in 31.5%, male-related infertility in 14.5%, and infertility due to unexplained factors in 6.6% of our patients. The rate of SP was 4.7%, which had a significant relation with the duration of infertility (p = 0.01), with women's age (p = 0.048), unexplained infertility (p = 0.001), and husband's job (p = 0.004). Conclusion: The occurrence of SP in infertile couples was related to age of the female partner, the duration of unexplained infertility, and the male partner's job.
Article
Introduction It is thought that both individuals are affected psychologically and sexually in couples experiencing abortion. In addition to the stress caused by infertility, sexual life may also be negatively affected in couples who experience psychogenic wear, such as abortion and curettage. The aim of this study is to evaluate male sexual functions in infertile couples with a history of abortion and male infertility component. Methods Five hundred forty-seven male patients’ data were evaluated retrospectively. Group 1 was the included the males of the couples without abortion history and the rest with abortion history was group 2. In addition to demographic data, abortion history, libido level, presence of morning erection and intercourse frequency were evaluated. Hormone levels of all patients were evaluated. After that we created sub-group 1 and sub-group 2 from these groups, respectively, due to whether the patients fulfilled the international index of erectile function (IIEF), Beck anxiety inventory (BAI) and Beck depression inventory (BDI). Results There were not any significant differences between the groups regarding psychiatric scale scores, hormone levels, libido, intercourse frequency and IIEF scores. Only orgasmic dysfunction was significant in the males of the couples with abortion history. Conclusion Man is not affected from abortion process in which woman get involved. Men only have orgasmic dysfunction when there is one or more abortion history in couples.
Article
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Prevalence rates of infertility show that one in every six couples worldwide have experienced fertility problems; however, there is still a relatively high chance of spontaneous conception for couples with unexplained infertility. Nevertheless, most existing research has focused on the infertility experience leading up to potential parenthood, rather than the actual parenting experience itself. Hence, this paper presents an in-depth exploration of the lived experiences and personal meaning of becoming parents of individuals affected by unexplained infertility. Semi-structured interviews were conducted, and transcripts were subjected to Interpretative Phenomenological Analysis (IPA). Four themes emerged: perception of fragility of life, father's embodied emotional connection with child, becoming a parent-identity shift, and imprint of infertility on relationships with a partner. The findings emphasize clinicians' and researchers' awareness of the need to process couple's grief and highlight the importance of addressing romantic relationship issues, experienced during the infertility period to facilitate couples transitioning to parenthood.
Chapter
An authoritative account of the causes of infertility that fully explores the clinical assessment of patients and covers the decision-making behind treatment options. The content follows the MRCOG syllabus as well as delving deeper into subjects covered by the RCOG Advanced Training Skills Modules (ATSMs), leaving readers well prepared for their examinations. Written by nationally recognised leaders in the field, this volume concisely reviews contemporary clinical practice. Using an aetiology-based approach, chapters discuss ovulatory dysfunction, endometriosis, male infertility, uterine/tubal factors and unexplained infertility. The increasing use of third-party reproduction and surrogacy is explored, along with the psychosocial aspects of this type of treatment. Ethical dilemmas surrounding reproductive medicine and their management are covered in depth. With an emphasis on practical approaches to the delivery and organisation of clinical and laboratory services, readers learn how to ensure the support and care they offer is of the highest quality.
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The Outcome study examines the fate of 4083 patients beginning IVF in 41 IVF centres, between January 2010 and December 2013. Cumulative live birth rate per patient (CLBR), the best reflection of IVF efficacy, is rarely presented in publications as it requires long-term follow-up, including all successive cycles, and pregnancies outcome. Analysis of international publications shows an average CLBR of 41.6 % and a drop-out rate of 49.5 %, both greatly varying by country and IVF centres. Because of the frequency with which patients change centre (8%), the Outcome study distinguishes patients with a past history of IVF in another centre (CLBR = 47.2 %) and patients undergoing their first true cycle (CLBR = 56.4 %). Survival techniques by Competing Risk, intended to take account of drop-out and lost to follow-up, assessed the overall CLBR as being 65.4 %. Differences in performance between centres are considerable for both CLBR (32–64%) and Performance Index, taking account of the number of cycles required to achieve a pregnancy (2–5). Multiple variance logistic regression analysis shows that the indicators influencing performance are age, parity, number of oocytes, smoking habit and overweight. These indicators are independent each other and are influencing performance in a high significant way. After adjusting for these indicators, the differences between centres are reduced but remain large and very significant. No centre appears to have specific expertise in the management of patients with adverse indicators. The Outcome study therefore confirms that the large differences in performance between centres are not explained by a difference in the treated population.
Article
Full-text available
Unexplained infertility is one of the most common diagnoses in fertility care. The aim of this study was to evaluate the outcome of current fertility management in unexplained infertility. In an observational, longitudinal, multicentre cohort study, 437 couples were diagnosed with unexplained infertility and were available for analysis. They were treated according to their prognosis using standing national treatment protocols: (i) expectant management-IUI-IVF (main treatment route), (ii) IUI-IVF and (iii) directly IVF. Primary outcome measures were: ongoing pregnancy rate, patient flow over the strategies, numbers of protocol violation and drop out rates. A secondary outcome measure was the prediction of ongoing pregnancy and mode of conception. Of all couples 81.5% (356/437) achieved an ongoing pregnancy and 73.9% (263/356) of the pregnancies were conceived spontaneously. There were 408 couples (93.4%) in strategy-1, 21 (5.0%) in strategy-2 and 8 (1.8%) in strategy-3. In total, 33 (7.6%) couples entered the wrong strategy. There were 104 couples (23.8%) who discontinued fertility treatment prematurely: 26 on doctor's advice (with 4 still becoming pregnant) and 78 on their own initiative (with 33 still achieving a pregnancy). Predictors for overall pregnancy chance and mode of conception were duration of infertility, female age and obstetrical history. Overall success rate in couples with unexplained infertility is high. Most pregnancies are conceived spontaneously. We recommend that if the pregnancy prognosis is good, expectant management should be suggested. The prognosis criteria for treatment with IUI or IVF needs to be investigated in randomized controlled trials.
Article
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Although in vitro fertilization (IVF) was introduced more than 30 years ago, its exact role in the spectrum of fertility treatments has never been studied in an unselected population. The aim of this study was to visualize the contribution of IVF to the ongoing pregnancy rates in a cohort of newly referred subfertile couples. All new subfertile couples (n = 1391) that were referred to our fertility clinic by their general practitioner between January 2002 and December 2006 were included. Fertility care was provided according to the national Dutch fertility guidelines. Data on diagnosis, treatment, mode of conception and pregnancy outcome were documented. If follow-up data were missing, couples were contacted. Cumulative pregnancy curves were constructed for the whole cohort and per diagnostic group. As per December 2008 the overall ongoing pregnancy rate was 72.0% (n = 1001). Almost half of the pregnancies were conceived spontaneously (45.6%), 19.2% after ovulation induction (OI), 14.0% after intrauterine insemination (IUI) and 21.2% after IVF. A quarter (n = 349) of couples received IVF treatment, which was successful in 60% of cases. IVF had the largest contribution to ongoing pregnancies in patients with 'tubal factor', 'endometriosis' and 'male factor' (45, 45 and 37%, respectively) while in couples with 'unexplained subfertility' and 'ovulation disorders' the contribution to ongoing pregnancies of IVF was limited (13 and 4.5%, respectively). In a cohort of subfertile couples, most pregnancies were conceived spontaneously. The contribution of IVF to ongoing pregnancy rates was comparable to those of OI and IUI. Compared with the pre-IVF era, couples with 'endometriosis', 'tubal factor' and 'male subfertility' have benefited most from its introduction.
Article
Full-text available
A substantial number of subfertile couples discontinues fertility care before achieving pregnancy. Most studies on dropouts are related to IVF. The aim here is to examine dropout rates at all stages of fertility care. We analysed a consecutive cohort of 1391 couples, referred to our secondary care hospital between January 2002 and December 2006. Discontinuation rates were studied at six stages. Stage I: immediately after first visit, Stage II: during diagnostic workup, Stage III: after finishing diagnostic workup but before treatment, Stage IV: during or after non-IVF treatment, Stage V: during IVF, Stage VI: after at least 3 cycles of IVF. Reasons to discontinue and spontaneous pregnancy rates after discontinuation were secondary outcomes. In our cohort 319 couples dropped out of fertility care, 76.8%, [95% confidence interval (CI): 72.2-81.4] on their own initiative and 23.2% (95% CI: 18.6-27.8) on doctor's advice. Percentage (95% CI) of couples discontinuing per stage were: Stage I 6.0% (3.4-8.6), Stage II 3.4% (1.5-5.5), Stage III 35.7% (30.5-41.0), Stage IV 23.5% (18.9-28.2), Stage V 17.9% (13.7-22.1) and Stage VI 13.5% (9.7-17.2). Main reasons for dropout (%, 95% CI) were 'emotional distress' (22.3%, 17.7-26.8), 'poor prognosis' (18.8%, 14.5-23.1) and 'reject treatment' (17.2%, 13.1-21.4). The spontaneous ongoing pregnancy rate after discontinuation was 10% (6.7-13.3). About half of the couples stopped before any fertility treatment was started and one-third stopped after at least one IVF cycle. The main reasons for withdrawal were emotional distress and poor prognosis. This insight may help to improve quality of patient care by making care more responsive to the needs and expectations of subfertile couples.
Article
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The objective was to assess crude 5-year delivery rates after assisted reproductive technology (ART) treatment, intrauterine inseminations (IUI), spontaneous conceptions (SC) and adoptions in a large infertile cohort. A prospective longitudinal survey comprised 1338 infertile couples starting public infertility programmes offering IUIs and three free ART cycles during 2000-2001. The cohort was cross-linked with the National Medical Birth Register to obtain delivery rates for all 1338 couples. More detailed data were available from 817 women responding to a 5-year follow-up questionnaire (response rate 74.7%). Fifty-seven percent (466/817) of the couples had received treatment prior to inclusion in the study with an average of 4.1+/-2.8 infertility treatments before referral. Of the 1338 couples, 69.4% had at least one delivery within 5-years of follow-up. For women <35 years 74.9% had delivered compared with 52.2% of those aged > or =35 years. The mean number of children was 1.6, and 52.1% had more than one child. Of the 817 women who provided questionnaire data, 18.2% (149/817) delivered after SC, two-thirds of these after a previous ART delivery. Adoption of a child occurred for 5.9% (48/817) of the women. Positive prognostic factors for delivery were male infertility, female age <35 years, <3 years of infertility and less than three previous treatment cycles. A crude delivery rate of 69.4% in the total population 5 years after referral to tertiary hospital centres with 6.6% deliveries after SC in the subpopulation responding to the questionnaire indicates a high efficacy of modern infertility treatments.
Article
Full-text available
To explore the long-term outcome of patients who began IVF treatment by considering not only treatment outcome in the center but also the parenthood project outcome after discontinuation of unsuccessful IVF. Retrospective cohort follow-up study. Two French IVF centers. Seven hundred twenty-four patients who began IVF treatment in 1998. Postal and phone contacts with unsuccessful IVF patients. Long-term outcome of parenthood project. Of the 724 patients, a minimum of 53% and a maximum of 81% finally succeeded in their parenthood project during or after IVF treatment (depending on the hypotheses that the 204 patients not contacted either failed or succeeded in their parenthood project). An intermediate hypothesis gave an estimation of 66% of patients finally succeeding in having a child (40% during IVF treatment in the center and 26% after). Achievement of the parenthood project after IVF discontinuation was due mainly to adoption of a child (46%) or a birth following a spontaneous pregnancy (42%). Unsuccessful patients should not lose hope, because nearly half may subsequently succeed in having a child.
Article
To determine the incidence of couples dropping out of the in vitro fertilization (IVF) waiting list and to describe the couples' reasons. Prospective cohort study. Fertility center in an academic hospital. 674 women placed consecutively on the IVF waiting list between June 2000 and July 2003. None. Number of dropouts and reasons for dropping out. Follow-up information was collected in 2005 and 2008. Of the 674 couples on the waiting list, 87% started IVF, and 13% dropped out before starting their first IVF cycle. Follow-up data were obtained for 85 of 86 patients (98.8%): 37% dropped out because of spontaneous pregnancy, 36% for personal reasons (passive censoring), and 27% for medical reasons (active censoring). Most of the pregnancies occurred within 3 months after the patient had been placed on the waiting list (30 of 32, 94%). Of the 54 censored couples, four became pregnant. On a 6-month waiting list for IVF, 13% of the couples dropped out before starting treatment. The single most important reason for dropout was (spontaneous) pregnancy. Most of these pregnancies occurred within 3 months, which suggests that psychological factors such as stress relief after being placed on the waiting list might be operative.
Article
There are only scarce data on the incidence of spontaneous pregnancy in infertility patients. Contraception after infertility treatment is another topic that has been neglected so far. Therefore, a questionnaire was sent to 1614 couples with a child conceived by intracytoplasmic sperm injection (ICSI) aged 4-6 years. A total of 899 couples responded (response rate 55.7%). A total of 10.9% of couples had used contraception. Of the couples that had actively tried to conceive, 20.0% had conceived spontaneously, resulting in a live-birth rate of 16.4%. 74.5% of these pregnancies were conceived within 2 years after delivery. A further 26.6% of couples conceived again by ICSI, with a live-birth rate of 20.9%. Maternal age was the only prognostic factor for spontaneous conception. Parents of multiples after ICSI did not have a higher chance of spontaneous conception than parents of singletons. Couples can be counselled that one out of five couples conceive spontaneously after successful ICSI. Even when assuming that none of the families that were lost to follow-up had conceived spontaneously, one out of eight couples would have conceived spontaneously. Therefore, it is important to counsel patients about the possibility of natural conception and necessity to use contraception despite their history of subfertility.
Article
This study on the epidemiology of human fertility emphasizes the study and analysis of several parameters. These include: the measure and distribution of fertility. The incidence of sterility is low (3-5% of couples) and the fecundability of fertile couples is approximately 30% per cycle. Approximately 7% of newly-formed couples per year will undergo complex treatment for infertility. The results of clinical and diagnostic explorations. Among infertile couples, the woman is responsible in approximately 60% of cases, and the man in approximately 25% of cases, and both of these factors may be associated. Clinical and diagnostic explorations are negative in approximately 18% of couples and the infertility is termed idiopathic. 'Normal' sperm characteristics vary according to age, seasonal or environmental factors. Female factors varying as a function of age, menstrual cycle, ovulation and functional status of the genital organs. Infertility in both partners leads to specific difficulties for epidemiological analyses, where the base unit is not an individual.
To determinate the true incidence of treatment-independent pregnancy in an in vitro fertilization programme. To establish and to compare the characteristics of couples with and without spontaneous pregnancy. To analyze the outcome of pregnancies. Retrospective. In Vitro Fertilization Unit, Conception's Hospital, Marseille, France. 594 couples having attempted one or more IVF procedures. The study concerned low-fertility couples (484) ruling our true sterile couples (110). Spontaneous pregnancies occurred in 54 couples (11.2%). The characteristics of the two populations were not statistically different, except a shorter duration of infertility (p < 0.05) in spontaneous pregnancies. The rate of ectopic pregnancies in the spontaneous pregnancies was statistically higher than that observed in IVP pregnancies (12% versus 6.5%). The fertility rare of these couples was very low (0.38%). Spontaneous pregnancies in vitro fertilization programmes are not rare. The evaluation of the results of the in vitro fertilization requires taking the possible spontaneous pregnancies into account.
Article
To investigate the incidence of spontaneous conception after the birth of infants conceived through IVF in couples with subfertility caused by endometriosis, a mild male factor, or unexplained factors, and to identify clinical conditions related to the occurrence of spontaneous conception. Retrospective analysis. Department of Obstetrics and Gynecology, Akita University School of Medicine, Akita, Japan. One hundred forty-two women who conceived through IVF and 25 of the 142 women who subsequently conceived spontaneously. Patient characteristics and IVF data were obtained from hospital records, and follow-up data were collected through telephone interviews. Cumulative conception rate. The cumulative conception rate at 60 months after the delivery of infants conceived through IVF was 18%, with most conceptions occurring within 2 years of delivery. Proportional hazard analysis indicated that patient age was the most important clinical variable related to the occurrence of spontaneous conception. This study provides information that will be useful in counseling subfertile couples who have conceived through the use of IVF.