The ultimate objective of infertility treatment is the delivery of a healthy child into a loving and supportive family environment. Infertility affects 15% of couples and it has been estimated that half of those couples who attend infertility clinics will be successful but equally about half do not achieve the baby they seek. New treatments for infertility enhance our chance of success but couples are delaying their pregnancies (Q9.5) and this reduces fertility. Furthermore, as the reputation of infertility treatment improves, couples with a poor prognosis continue to seek treatment whereas a few years ago they would have given up earlier.
Related Medical Abstracts - Click on the paper title:-
- Assisted reproductive technology in Europe, 2002. Results generated from European registers by ESHRE. (2006-01)
- Intra-uterine insemination for unexplained subfertility.(2006-02)
- A new era in ovulation induction.(2006-03)
- Letrozole induction of ovulation in women with clomiphene citrate-resistant polycystic ovary syndrome may not depend on the period of infertility, the body mass index, or the luteinizing hormone/follicle-stimulating hormone ratio.(2006-04)
- Comparison of letrozole and clomiphene citrate in women with polycystic ovaries undergoing ovarian stimulation. (2006-05)
- Clomiphene citrate--end of an era? A mini-review. (2005-01)
- Systematic review of the treatment of ovulatory infertility with clomiphene citrate and intrauterine insemination. (2004-01)
- Case series of a single centre's treatment of ovulatory infertility with clomiphene citrate and intrauterine insemination in 2002. (2004-02)
- Obstetric outcome among women with unexplained infertility after IVF: a matched case-control study. (2002)
- Assisted reproductive technology in Europe, 1997. Results generated from European registers by ESHRE (2001)
- Effective treatment of subfertility: Introducing the Cochrane Menstrual Disorders and Subfertility Group. (1999-01)
- Cumulative probability of clinical pregnancy and live birth after a multiple cycle IVF package: A more realistic assessment of overall and age-specific success rates? (1999-02)
- Pregnancy and birth rates after oocyte donation (1997)
- Cumulative pregnancy rates and pregnancy outcome after in-vitro fertilization: > 5000 cycles at one centre (1995)
- Pregnancies and births resulting from in vitro fertilization: French national registry, analysis of data 1986 to 1990 (1995)
- The results of in vitro fertilization-embryo transfer in couples with unexplained infertility failing to conceive with superovulation and intrauterine insemination (1995)
- Observations on 767 clinical pregnancies and 500 births after human in-vitro fertilization (1986)
How can we compare infertility treatments?
When comparing outcomes of various infertility treatments, we must make allowance for a variety of confounding factors. Couples seeking infertility treatment are likely to be slightly older and this confers a negative bias. Those who follow all possible treatment options including IVF tend to be educated and of higher socio-economic status and these confer a more positive influence. Treatment regimens using ovulation induction drugs and particularly gonadotrophins, are more likely to result in multiple pregnancy resulting in a higher birth rate but greater obstetric (childbirth) risks.
Results reported from individual departments are more likely to be from pioneers or those achieving the best results. National statistics and meta-analyses (Q33.23) indicate a more appropriate reflection of the situation. Treatment advances are occurring so frequently that trends are difficult to interpret. Intracytoplasmic sperm injection (ICSI -25), for example, has resulted in a fall in donor insemination treatment cycles.
Related Medical Abstracts - Click on the paper title:-
Are treatments for infertility improving?
New effective treatments arrive almost yearly. Some, such as mletrozole (12A) are surprisingly simple to use and cost very little whereas others like ICSI (25) are extremely complex and expensive.
Until the 1960s treatment options were very limited. Anovulatory infertility (Q9.17) has only been treatable by drugs since the early 1960s; success rates from medication are high. If investigation showed evidence of blocked Fallopian tubes, surgery may prove successful for between ten and twenty percent. If there was evidence of severe male infertility, donor insemination was a possibility; until the last few years no more than 2% of men with severe infertility problems could be treated by other means. The arrival of IVF twenty years ago and the subsequent development of ICSI seven years ago have changed the picture completely now only 2% of couples with severe male factor infertility cannot be treated. Cryopreservation (freezing for storage and later thawing and utilisation) of embryos and ova, and embryo biopsy (28) are remarkable technical achievements that merit consideration. The latest development involves culturing the embryos for five days to the blastocyst stage. Implantation of blastocysts provides higher implantation rates than with embryo transfer at two days. It is hoped that eventually only one embryo will be transferred on the fifth day with a 70% chance of an ongoing pregnancy. Each development requires scientific analysis and raises difficult ethical questions.
Sadly, a successful outcome from infertility treatment cannot be guaranteed. Even with IVF there is only an average 20% success rate per cycle or about 50% with three treatment cycles. The emotional toll during treatment cycles cannot be adequately estimated and, when there is failure, devastation and at times despair are inevitable. Some couples will give up relatively early. For others parenthood seems their only purpose in life and they travel the world seeking success.
The latest data from the USA shows that
Overall, 42% of ART transfer procedures resulted in a pregnancy, and
35% resulted in a live-birth delivery (delivery of one or more live-born
infants).2006-01In
the 1990s typical pregnancy rates were in the order of 20% (Figure
10.5)
A couple I have known for many years were found to have male factor infertility. They chose to wait for a miracle rather than accept AID (23). Now aged fifty the lady poured her heart out to me. The miracle never happened. For this couple, developments including ICSI have come too late. I explained that even if they had elected to pursue donor insemination, success would not have been guaranteed but they are left with an empty feeling, as they never tried.
For those unfortunate couples who do not meet with success from treatment they will at least know that they tried although it was not to be. There may be an option for them to pursue adoption.
Related Medical Abstracts - Click on the paper title:-
- Assisted reproductive technology surveillance--United States, 2003. (2006-01)
- Comparison of blastocyst transfer to day 3 transfer with assisted hatching in the older patient. (2002)
- Blastocyst transfer for patients with multiple assisted reproduction treatment failures: Preliminary experience (2001)
- The Human Rights Act (1998) and its impact on reproductive issues (2001).?
- Blastocyst culture: toward single embryo transfers. (2000)
- Assisted hatching increases the implantation and pregnancy rate of in vitro fertilization (IVF)-embryo transfer (ET), but not that of IVF-tubal ET in patients with repeated IVF failures (1997)
- Salpingectomy improves the pregnancy rate in in-vitro fertilization patients with hydrosalpinx (1996)?
- High fecundity rates following in-vitro fertilization and embryo transfer in antiphospholipid antibody seropositive women treated with heparin and aspirin (1994)
- Five decades of progress in management of the infertile couple (1994)?
- Assisted hatching in the
treatment of poor prognosis in vitro fertilization candidates (1994)
Please click on the required question.
- Q 11. 1 How successful is infertility treatment?
- Q 11. 2 How can we compare infertility treatments?
- Q 11. 3 How can we compare outcomes between different fertility units?
- Q 11. 4 Are treatments for infertility improving?
- Q 11. 5 Is there an increased chance of miscarriage following infertility treatment?
- Q 11. 6 Is there an increased chance of ectopic pregnancy following infertility treatment?
- Q 11. 7 What is a heterotopic pregnancy?
- Q 11. 8 What problems can occur with multiple pregnancy?
- Q 11. 9 What is selective termination of pregnancy?
- Q 11. 10 How can the pregnancy risks following infertility treatment be reduced?
- Q 11. 11 We have had infertility treatment which has been successful. How will our pregnancy be cared for?
- Q 11. 12 If we have infertility treatment, will our baby be healthy?
- Q 11. 13 What are the psychological effects of infertility? information?
- Q 11. 14 Where can I obtain more information?
- Q 11. 15 Support Groups.
Thank you for choosing to visit us.
This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.
I do hope that you find the answers to your women's health questions in the patient information and medical advice provided.
