Document Detail


Fertility treatments and outcomes among couples seeking fertility care: data from a prospective fertility cohort in the United States.
MedLine Citation:
PMID:  20659733     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To determine the relationship between number of fertility treatment cycles and pregnancy rates.
DESIGN: Prospective cohort study.
SETTING: Eight community and academic infertility practices.
PATIENT(S): Four hundred eight (408) couples presenting for an infertility evaluation.
INTERVENTION(S): Face-to-face and telephone interviews and questionnaires.
MAIN OUTCOME MEASURE(S): Incidence of pregnancy. Cox regression analysis compared the efficacy of cycle-based fertility treatments with no cycle-based fertility treatment after multivariable adjustment.
RESULT(S): Couples using one to two medications-only cycles had a significantly higher pregnancy rate (hazard ratio [HR] 4.7 [95% confidence interval 1.3-16.6]), a benefit that did not persist after three or more cycles (HR 0.6 [0.1-3.2]). Couples using IUI for one (HR 2.9 [1.4-5.8]), two (HR 2.0 [0.9-4.5]), and three cycles (HR 4.5 [1.8-10.9]) were more likely to achieve a pregnancy. No additional benefit was seen for couples using four or more IUI cycles (HR 1.0 [0.4-2.6]). In vitro fertilization was associated with significant benefit for couples using one (HR 2.8 [1.5-5.2]) and two cycles (HR 2.2 [1.2-4.1]). Couples using three or more IVF cycles had a non-statistically significant higher likelihood of pregnancy (HR 1.3 [0.7-2.4]).
CONCLUSION(S): Cycle-based fertility treatments may offer a point of diminishing returns for infertile couples: two cycles of medications only, three cycles of IUI, and two cycles of IVF.
Authors:
James F Smith; Michael L Eisenberg; Susan G Millstein; Robert D Nachtigall; Natalia Sadetsky; Marcelle I Cedars; Patricia P Katz;
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, N.I.H., Extramural     Date:  2010-07-25
Journal Detail:
Title:  Fertility and sterility     Volume:  95     ISSN:  1556-5653     ISO Abbreviation:  Fertil. Steril.     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2010-12-20     Completed Date:  2011-01-21     Revised Date:  2013-07-10    
Medline Journal Info:
Nlm Unique ID:  0372772     Medline TA:  Fertil Steril     Country:  United States    
Other Details:
Languages:  eng     Pagination:  79-84     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Urology, University of California-San Francisco, San Francisco, California 94143-1695, USA. smithjf@urology.ucsf.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Cohort Studies
Female
Humans
Infertility / epidemiology*,  therapy*
Kaplan-Meier Estimate
Male
Multivariate Analysis
Pregnancy
Pregnancy Rate*
Prognosis
Proportional Hazards Models
Prospective Studies
Reproductive Techniques, Assisted / statistics & numerical data*
United States / epidemiology
Grant Support
ID/Acronym/Agency:
HD37074/HD/NICHD NIH HHS; P01 HD037074/HD/NICHD NIH HHS; P01 HD037074-010003/HD/NICHD NIH HHS
Investigator
Investigator/Affiliation:
Nancy Adler / ; Mary Croughan / ; Lauri Pasch / ; Steven Gregorich / ; Jonathan Showstack /
Comments/Corrections

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