“What should we to trying among expectant
management and IVF treatment?”
INTRODUCTION:
The bilateral
tubal blockage led to the starting of the clinical indications for IVF, which
has now reached to unexplained subfertility, which does not have an
identifiable cause (barrier) to conception. Not much evidence as results of
from randomized controlled trials could say that these couples got any positive
effect from IVF. What type of couples should look for more possibilities of
ongoing pregnancy with the help of IVF in comparison to expectant management?
SUMMARY:
In a recent
comparison, Eekelen et al1 compared results in couples having unexplained
subfertility and undergoing IVF (n = 40921) from registry data to those couples
who have a similar type of subfertility on expectant management. The couples on
expectant management (just intercourse) consisted of a prospective nationwide
Dutch cohort (n = 4875) as well as a retrospective regional cohort from
Aberdeen, Scotland (n = 975). Couples who attempted for less than a year to
conceive, tubal occlusion, cases of anovulation, severe or mild endometriosis
or male subfertility were not included. Couples on expectant management and
those who received IVF, their matching on the basis of their characteristics to
control for confounding were done. A model called Cox proportional hazards was
fitted by them which included patient characteristics, the process of IVF
treatment as well as their interactions to calculate the possibility of
conception of each individual in a year, either by expectant management or by
following IVF for all sets of patient characteristics. Conception leading to
ongoing pregnancy was the endpoint, which is defined as a foetus entering
gestational age near 12 weeks. When the adjusted 1year possibility was
calculated, it was found to be 47.9% (95% CI: 45.0–50.9) post IVF whereas after
expectant management it was found to be 26.1% (95% CI: 24.2–28.0). Calculating
the absolute difference resulted in being 21.8% (95%CI: 18.3–25.3) favouring
IVF in terms of average adjusted 1-year chances of conception. Factors like
duration of subfertility, female’s age and previous pregnancy record influenced
the effectiveness of IVF. Although IVF was found to be useful for women under
40 years of age, in case of women over 34 years, the one-year possibility of an
IVF conception fell gradually. In contrast, IVF was less effective in women
aged 40 or more, and the absolute difference chance is 10% or less in
comparison to expectant management. However, IVF was found to be less effective
in partners having a short period of secondary subfertility (< 1 year) who
were having 30% or more chances of neutral conception.
CONCLUSION:
In the case
of unexplained subfertile couples, when the woman is under 40, the chances of
conception are higher with IVF than expectant management. On the basis of
judgements on the gain in comparison to that of expectant management for a
couple, IVF should be used selectively.
REFERENCES:
1. R van
Eekelen, N van Geloven, M van Wely, S Bhattacharya, F van der Veen, M J
Eijkemans, D J McLernon. IVF for unexplained subfertility; whom should we
treat?, Human Reproduction, dez072, https://doi.org/10.1093/humrep/dez072
SOURCE:
https://www.indianfertilitysociety.org/fertility-news-volume-10-july-2019/
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