Cumulative pregnancy probabilities among couples with subfertility: effects of varying treatments
Presented at the 21st Annual Meeting of the Society for Pediatric and Perinatal Epidemiologic Research, Chicago, Illinois, June 23–24, 2008.
Received 15 December 2008; received in revised form 6 January 2009; accepted 9 January 2009. published online 31 March 2009.
Objective
To model the cumulative probability of pregnancy among couples with subfertility without a definitive diagnosis, according to different treatment strategies.
Design
A beta distribution of fecundity was fitted that reproduced the cumulative probability of pregnancy in prospective studies of natural fertility, and this distribution was applied to simulated cohorts starting with one million couples each. Probabilities of pregnancy were generated for each cycle of each couple.
Setting
Simulation study.
Patient(s)
Hypothetic subfertile population.
Intervention(s)
After 2 or 4 years of attempting pregnancy and diagnostic evaluation to exclude anovulation, tubal obstruction, and severe male factor, simulated treatments were applied to the remaining nonpregnant couples, with treatment effects based on published literature.
Main Outcome Measure(s)
Simulated cumulative probability of pregnancy.
Result(s)
Initially, the cumulative probability of pregnancy was highest for early treatment with IVF, but over time, conservative treatment or frequent intercourse approached the same cumulative probability.
Conclusion(s)
In couples without clear indications for IVF, the main benefit of early IVF may be to shorten time to pregnancy, a benefit that must be weighed against costs and potential adverse outcomes. Couples should be encouraged to maintain regular intercourse to maximize chances of pregnancy, even after unsuccessful treatment attempts.
aDepartment of Family and Preventive Medicine, Division of Public Health, University of Utah, Salt Lake City, Utah
bEunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, Maryland
cDepartment of Public Health Medicine, University of Bielefeld, Bielefeld, Germany
dDivision of Epidemiology, Ohio State University College of Public Health, Columbus, Ohio
Reprint requests: Rafael Mikolajczyk, M.D., Department of Public Health Medicine, School of Public Health, University of Bielefeld, P.O. Box 100131, D-33501 Bielefeld, Germany (FAX: +49 (0)521 106-2968).
J.S. has nothing to disclose. R.M. has nothing to disclose. C.L. has nothing to disclose. S.S. has nothing to disclose.
Supported by Eunice Kennedy Shriver National Institute of Child Health and Human Development Intramural Research Program, National Institutes of Health, Bethesda, Maryland.
ABSTRACT