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Hum. Reprod. Advance Access published online on October 24, 2009
Human Reproduction, doi:10.1093/humrep/dep341
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© The Author 2009. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

The relative contribution of IVF to the total ongoing pregnancy rate in a subfertile cohort

M. Brandes1,3, C.J.C.M. Hamilton1, J.P. de Bruin1, W.L.D.M. Nelen2 and J.A.M. Kremer2

1 Department of Obstetrics and Gynaecology, Jeroen Bosch Ziekenhuis, PO Box 90153, 5200 ME ‘s-Hertogenbosch, The Netherlands 2 Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands

3 Correspondence address. E-mail: m.brandes{at}jbz.nl

BACKGROUND: 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.

MATERIALS: 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.

RESULTS: 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).

CONCLUSIONS: 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.

Key words: IVF/cumulative pregnancy rate/spontaneous pregnancy/ongoing pregnancy

Submitted on May 6, 2009; resubmitted on August 17, 2009; accepted on August 24, 2009.


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