Fertility treatments and outcomes among couples seeking fertility care: data from a prospective fertility cohort in the United States.

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.