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

Oleh:

Smith, James F. ; Eisenberg, Michael L. ; Millstein, Susan G. ; Nachtigall, Robert D. ; Sadetsky, Natalia ; Cedars, Marcelle I. ; Katz, Patricia P.

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: Fertility and Sterility (keterangan: ada di ClinicalKey) vol. 95 no. 01 (Jan. 2011), page 79-84.
Topik: Diminishing returns; infertility treatment; prospective cohort; decreasing efficacy; ART

Ketersediaan

Perpustakaan FK Nomor Panggil: F02.K.2011.02 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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Isi artikel

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.

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