Human Reproduction, Vol 13, 1206-1209, Copyright © 1998 by Oxford University Press
JL Evers, HW de Haas, JA Land, JC Dumoulin and GA Dunselman
A long waiting list for in-vitro fertilization (IVF) offers the possibility
to study treatment-independent pregnancy rates in patients with severe
reproductive disorders. We performed a retrospective cohort study with a
nested case-control design in which the cases achieved a spontaneous
pregnancy while on the waiting list for IVF, or for IVF with
intracytoplasmic sperm injection (ICSI), and the controls did not become
pregnant while on the waiting list. Spontaneous pregnancies occurred in 76
of 1391 patients on the waiting list. Significant differences between
pregnant and non-pregnant patients were found for duration of subfertility
(couples on the IVF waiting list), and for progressive sperm motility and
basal 17beta-oestradiol (couples on the ICSI waiting list). The 12 months
cumulative pregnancy rate for patients on the waiting list was 2.4% (95% CI
1.2-3.9%) for tubal subfertility patients, 5.9 % (3.7-8.7%) for
longstanding unexplained subfertility patients, and 6.6% (4.5-9.3%) for
male subfertility patients. Of the 76 control patients, 21% of tubal
subfertility patients, 18% of unexplained subfertility patients, and 17% of
male subfertility patients achieved a pregnancy in their first IVF or ICSI
treatment cycle. We confirm that the treatment-independent pregnancy rate
in patients with severe reproductive disorders is low. More than 75% of the
spontaneous pregnancies in the tubal subfertility and unexplained
subfertility couples occurred during their first three months on the
waiting list, whereas spontaneous pregnancy rate in male subfertility
couples showed a more gradual but persisting increase. We conclude that one
cycle of IVF or ICSI is superior to 12 months of expectant management in
patients with severely impaired fertility due to tubal, unexplained or male
factors.
ARTICLES
Treatment-independent pregnancy rate in patients with severe reproductive disorders
Department of Obstetrics and Gynaecology, Academisch Ziekenhuis Maastricht and The University of Maastricht, The Netherlands.
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