Expectations of assisted conception for infertility

• Published in: BMJ Vol. 304; no. 6840; pp. 1465 - 1469
• Main Authors: Hull, M. G., Eddowes, H. A., Fahy, U., Abuzeid, M. I., Mills, M. S., Cahill, D. J., Fleming, C. F., Wardle, P. G., Ford, W. C., McDermott, A.
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 06.06.1992; British Medical Association; BMJ Publishing Group LTD
• Subjects: Adult; Age Factors; Artificial insemination; Birth Rate; Birth rates; Embryos; England; Female; Fertilization; Fertilization in Vitro; Gamete Intrafallopian Transfer; Humans; Infertility, Female - therapy; Infertility, Male - therapy; Insemination, Artificial, Homologous; Male; Men; Ova; Pregnancy; Pregnancy rate; Prognosis; Spermatozoa; Superovulation; England
• ISSN: 0959-8138; 1468-5833; 1756-1833
• DOI: 10.1136/bmj.304.6840.1465

OBJECTIVE--To provide reliable prognostic information for couples seeking assisted conception. DESIGN--Analysis of four years' practice (1988-91). SETTING--Private university service linked with NHS reproductive medicine services. PATIENTS--804 couples with various causes of subfertility, median duration five years, median age of women 34 years. INTERVENTIONS--1280 completed cycles: 950 in vitro fertilisation, 144 gamete intrafallopian transfer, and 186 intrauterine insemination and superovulation. MAIN OUTCOME MEASURES--Pregnancy and birth rates per cycle and cumulative pregnancy and take home baby rates per couple. RESULTS--In women under 40 years and men with normal sperm, whatever the cause of infertility, results with in vitro fertilisation improved steadily reaching a pregnancy rate per cycle of 30% (95% confidence interval 26% to 35%) during 1990-1 and birth rate per cycle of 29% (23% to 35%) in 1990. Pregnancy and birth rates for gamete intrafallopian transfer were 36% (28% to 44%) and 26% (17% to 37%) and for intrauterine insemination 18% (12% to 24%) and 16% (10% to 22%). After six cycles cumulative probability of pregnancy was 82% and cumulative take home baby rate 70%. Considering only in vitro fertilisation and gamete intrafallopian transfer after four cycles the pregnancy rate was 78% (66% to 91%). CONCLUSIONS--Conception is less likely in women over 40 and men with sperm dysfunction. For other couples the prognosis for a live birth is at least as good as for fertile couples if they persist with treatment.