James, G., Mclindon, L. A., Hatch, J., Mol, B. W., & Turner, J. V. (2021). Pregnancy outcomes from a restorative infertility treatment model: a single centre case series. medRxiv. https://doi.org/10.1101/2021.04.14.21251044
James G, Mclindon LA, Hatch J, Mol BW, Turner JV. Pregnancy outcomes from a restorative infertility treatment model: a single centre case series. medRxiv. 2021. doi:10.1101/2021.04.14.21251044
James, Gabriel, et al. "Pregnancy outcomes from a restorative infertility treatment model: a single centre case series." medRxiv, 2021.
An estimated 57.4% of couples had a live birth by 24 months of care
An estimated 57 out of 100 couples had a live birth within 24 months (57.4%) in a retrospective case series of 162 couples at an Australian hospital fertility clinic from 2005 to 2010. An estimated 71 out of 100 couples with unexplained infertility had a live birth within 24 months (71.2%, among 74 couples). Both figures are Kaplan-Meier estimates.
About 6 in 10 couples had a live birth within 24 months at a hospital fertility clinic. Source: James G et al., 2021, DOI 10.1101/2021.04.14.21251044.Study at a glance, retrospective case series of 162 couples: An estimated 57.4% of couples had a live birth by 24 months. Source: James G et al., 2021, DOI 10.1101/2021.04.14.21251044.
Key Findings
The Kaplan-Meier cumulative live birth rate at 24 months was 57.4% among 162 couples, and the series recorded 58 live births.
Clinical pregnancy occurred in 44.4% of couples (72 of 162), and the median time to conception was 5.0 months (range 1-22).
Among 74 couples with unexplained infertility, 32 had a live birth (crude rate 43.2%), and the Kaplan-Meier rate at 24 months was 71.2%.
For the 48 couples with ovulatory disorders, the Kaplan-Meier rate was 47.5% at 12 months and 54.0% at 24 months.
Pregnancy outcomes included no twin deliveries (0.0%), 3 preterm births (5.2%), 9 miscarriages (12.5% of pregnancies) and 4 ectopic pregnancies (5.6% of pregnancies).
Interpretation
The study is a retrospective case series of couples who attended the clinic between 2005 and 2010. Infertility was defined as 12 or more months of intercourse without contraception and without conception. Couples who had tried IVF before were included, while couples with blocked tubes on both sides or no sperm in the semen were excluded. The median female age was 33.7 years, and infertility had lasted a median of 33.9 months. The Kaplan-Meier method adjusts the live birth count for couples whose follow-up ended early. The authors conclude that care should be personalized, with options other than immediate IVF considered.
RRM Context
Restorative reproductive medicine seeks the cause of infertility in both partners, works with the cycle and regards unexplained infertility as undiagnosed. Charting gives clinicians the cycle data for that search. In this series, 74 couples carried the unexplained label, the largest diagnostic group. General practitioners with extra training in fertility awareness provided the care at a hospital clinic.
Our editorial summary of this paper, not the article's abstract.
Abstract
Background
Infertility is a significant problem with multiple causes and a corresponding array of therapeutic options. In an era of increasing assisted reproductive treatments, few studies examine the role of conventional non-assisted reproductive treatments to address underlying behavioural, lifestyle and medical issues.
Aim
To assess outcomes from a conventional or non-assisted reproductive treatment approach.
Materials and Methods
Retrospective case series of 162 couples that attended an Australian, hospital-based, multidisciplinary fertility clinic between 2005 and 2010.
Results
There were 58 live births for all couples giving a crude live birth rate of 35.4% over a 24-month analysis period. When adjusted by Kaplan-Meier method, a 57.4% cumulative live birth rate (CLBR) was achieved. Couples had a median 33.9 months duration of infertility and the median female age was 33.7. For the 74 couples with an unexplained infertility diagnosis, 32 achieved a live birth at a crude rate of 43.2% or 71.2% CLBR when adjusted by Kaplan-Meier method.
Conclusions
This observational data indicates that reproductive medicine should have a personalized approach in which alternatives for immediate IVF are considered.
