To model the cumulative probability of pregnancy among couples with subfertility without a definitive diagnosis, according to different treatment strategies.
Design
A beta distribution of fecundity was fitted that reproduced the cumulative probability of pregnancy in prospective studies of natural fertility, and this distribution was applied to simulated cohorts starting with one million couples each. Probabilities of pregnancy were generated for each cycle of each couple.
Setting
Simulation study.
PATIENT(S): Hypothetic subfertile population.
INTERVENTION(S): After 2 or 4 years of attempting pregnancy and diagnostic evaluation to exclude anovulation, tubal obstruction, and severe male factor, simulated treatments were applied to the remaining nonpregnant couples, with treatment effects based on published literature.
MAIN OUTCOME MEASURE(S): Simulated cumulative probability of pregnancy.
RESULT(S): Initially, the cumulative probability of pregnancy was highest for early treatment with IVF, but over time, conservative treatment or frequent intercourse approached the same cumulative probability.
CONCLUSION(S): In couples without clear indications for IVF, the main benefit of early IVF may be to shorten time to pregnancy, a benefit that must be weighed against costs and potential adverse outcomes. Couples should be encouraged to maintain regular intercourse to maximize chances of pregnancy, even after unsuccessful treatment attempts.
subfertility cumulative pregnancy probability simulation study, unexplained infertility IVF versus conservative treatment comparison, Stanford Lynch subfertility treatment simulation fecundity model, time to pregnancy IVF versus natural fertility subfertile couples, beta distribution fecundity modeling cumulative pregnancy, unexplained subfertility expectant management versus assisted reproduction, frequent intercourse subfertility pregnancy probability conservative treatment, IVF cost benefit unexplained infertility time to pregnancy, subfertile couples treatment strategy comparison modeling study, natural fertility simulation diagnostic evaluation anovulation tubal factor
PMID 19328479 19328479 DOI 10.1016/j.fertnstert.2009.01.080 10.1016/j.fertnstert.2009.01.080
Cite this article
Stanford, J. B., Mikolajczyk, R. T., Lynch, C. D., & Simonsen, S. E. (2010). Cumulative pregnancy probabilities among couples with subfertility: effects of varying treatments. *Fertility and sterility*, *93*(7), 2175-2181. https://doi.org/10.1016/j.fertnstert.2009.01.080
Stanford JB, Mikolajczyk RT, Lynch CD, Simonsen SE. Cumulative pregnancy probabilities among couples with subfertility: effects of varying treatments. Fertil Steril. 2010;93(7):2175-2181. doi:10.1016/j.fertnstert.2009.01.080
Stanford, J. B., et al. "Cumulative pregnancy probabilities among couples with subfertility: effects of varying treatments." *Fertility and sterility*, vol. 93, no. 7, 2010, pp. 2175-2181.
Keywords
Computer Simulation, Female, Fertility/physiology, Humans, Infertility/therapy, Male, Models, Statistical, Pregnancy, Pregnancy Rate, Probability, Reproductive Techniques, Assisted/statistics & Numerical Data, Sensitivity and Specificity, Sexual Behavior/statistics & Numerical Data, Time Factors
Objective: To examine birth outcomes between children conceived with in vitro fertilization (IVF) or intrauterine insemination (IUI) and sibling births from unassisted conceptions.
Design: Retrospect...
Infertility > Assisted Reproductive Technology > IVF OutcomesPregnancy > Neonatal Outcomes > Birth Weight and Gestational AgeContraception/Comparison > ART vs Natural Conception > Sibling Studies
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