Spontaneous conceptions within two years of having a first infant with assisted conception

Wynter, Karen; McMahon, Catherine; Hammarberg, Karin; McBain, John; Boivin, Jacky; Gibson, Frances; Fisher, Jane

doi:10.1111/ajo.12112

Cited by 5 publications

(6 citation statements)

References 16 publications

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“…More women in the current study had a spontaneous pregnancy after ART in contrast to the study by Pinborg et al where 18% conceived spontaneously; up to 7 years after, spontaneous pregnancies occurred in 28% of all couples . However, an Australian follow up within 2 years showed a higher prevalence of spontaneous pregnancies after both successful (33%) and unsuccessful (40%) ART treatment . A factor associated with both spontaneous pregnancies and successful ART in the current study was short duration of infertility.…”

Section: Discussioncontrasting

confidence: 82%

Live birth outcome, spontaneous pregnancy and adoption up to five years after undergoing assisted reproductive technology treatment

Volgsten

Schmidt

2017

Acta Obstet Gynecol Scand

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SummaryIntroductionThis study is part of a longitudinal cohort undertaken in both women and men to describe live birth outcome after undergoing assisted reproductive technology (ART) treatment in a clinical setting. Another objective was to follow women and men living with children from other alternatives after ART, such as adoption.Material and methodsA total of 439 (80.5%) women and 423 (77.6%) men were included in the baseline cohort (2005–2007). Live birth rate after ART was 24.8% at baseline. Up to 5 years later (2010–2011) the same participants were sent individual postal questionnaires (n = 439).ResultsOverall, 278 (63.3%) women and 183 (41.7%) men filled in and returned the questionnaire at follow up. The majority of women (91.7%) and men (93.4%) were living with children. A total of 225 (80.9%) women had a live birth at follow up. Of these, almost three of four (71.6%) had a live birth after ART and more than one of four (28.0%) after spontaneous pregnancies or both. Of these, 52 (26.1%) women had a subsequent live birth after successful ART and 26 (32.9%) women after unsuccessful ART. Nineteen (6.8%) women and 13 (7.1%) men had a child after adoption. Almost one of five (19.1%) women had no live birth at follow up.ConclusionThe majority of women and men were living with children, resulting from a live birth after ART, spontaneous pregnancy and/or adoption up to 5 years later. However, almost one of five had no live birth at follow up.

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Section: Discussioncontrasting

confidence: 82%

Live birth outcome, spontaneous pregnancy and adoption up to five years after undergoing assisted reproductive technology treatment

Volgsten

Schmidt

2017

Acta Obstet Gynecol Scand

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“…Women attending fertility services should be encouraged to pursue natural conception while waiting for treatment commencement, as well as during treatment, and not give up on their fertility even after treatment fails (Walschaerts et al, 2012;Wynter et al, 2013). Women of advanced maternal age with low natural fertility chances as well as low chances from treatment could potentially be counselled for donor oocyte treatment (Hogan et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

“…Upon receipt of the data, nine databases were excluded. Two did not record natural conception outcome as they were from RCTs that only performed an intention-to-treat analysis without recording treatmentindependent pregnancies (Steiner et al, 2015), one database was a RCT embedded in a cohort yielding duplicate data (Custers et al, 2012), one database was in a file format that could not be accessed (Mol et al, 2001), and in seven, the treatment-free follow-up time could not be accurately ascertained (Brandes et al, 2009;Gnoth et al, 2003;Osmanagaoglu et al, 2002;Walschaerts et al, 2012;Wynter et al, 2013). This resulted in nine included databases (n=4,379 women).…”

Section: Systematic Reviewmentioning

confidence: 99%

Age-related natural fertility outcomes in women over 35 years: a systematic review and individual participant data meta-analysis

et al. 2020

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STUDY QUESTION What is the rate of natural conception leading to ongoing pregnancy or livebirth over 6–12 months for infertile women of age ≥35 years? SUMMARY ANSWER Natural conception rates were still clinically relevant in women aged 35 years and above and were significantly higher in women with unexplained infertility compared to those with other diagnoses. WHAT IS KNOWN ALREADY In recent years, increasing numbers of women have attempted to conceive at a later age, resulting in a commensurate increase in the need for ART. However, there is a lack of data on natural fertility outcomes (i.e. no interventions) in women with increasing age. STUDY DESIGN, SIZE, DURATION A systematic review with individual participant data (IPD) meta-analysis was carried out. PubMed, MEDLINE, EMBASE, the Cochrane Library, clinicaltrials.gov were searched until 1 July 2018 including search terms ‘fertility service’, ‘waiting list’, ‘treatment-independent’ and ‘spontaneous conception’. Language restrictions were not imposed. PARTICIPANTS/MATERIALS, SETTING, METHODS Inclusion criteria were studies (at least partly) reporting on infertile couples with female partner of age ≥35 years who attended fertility services, underwent fertility workup (e.g. history, semen analysis, tubal status and ovulation status) and were exposed to natural conception (e.g. independent of treatment such as IVF, ovulation induction and tubal surgery). Studies that exclusively studied only one infertility diagnosis, without including other women presenting to infertility services for other causes of infertility, were excluded. For studies that met the inclusion criteria, study authors were contacted to provide IPD, after which fertility outcomes for women of age ≥35 years were retrieved. Time to pregnancy or livebirth and the effect of increasing age on fertility outcomes after adjustment for other prognostic factors were analysed. Quality of studies was graded with the Newcastle–Ottawa Scale (non-randomised controlled trials (RCTs)) or the Cochrane Risk of Bias tool (for RCTs). MAIN RESULTS AND THE ROLE OF CHANCE We included nine studies (seven cohort studies and two RCTs) (n = 4379 women of at least age 35 years), with the observed composite primary outcome of ongoing pregnancy or livebirth occurring in 429 women (9.8%) over a median follow-up of 5 months (25th to 75th percentile: 2.5–8.5 months). Studies were of moderate to high quality. The probability of natural conception significantly decreased with any diagnosis of infertility, when compared with unexplained infertility. We found non-linear effects of female age and duration of infertility on ongoing pregnancy and tabulated the predicted probabilities for unexplained infertile women aged 35–42 years with either primary or secondary infertility and with a duration of infertility from 1 to 6 years. For a 35-year-old woman with 2 years of primary unexplained infertility, the predicted probability of natural conception leading to ongoing pregnancy or livebirth was 0.15 (95% CI 0.11–0.19) after 6 months and 0.24 (95% CI 0.17–0.30) after 12 months. For a 42-year-old woman, this decreased to 0.08 (95% CI 0.04–0.11) after 6 months and 0.13 (95% CI 0.07–0.18) after 12 months. LIMITATIONS, REASONS FOR CAUTION In the studies selected, there were different study designs, recruitment strategies in different centres, protocols and countries and different methods of assessment of infertility. Data were limited for women above the age of 40 years. WIDER IMPLICATIONS OF THE FINDINGS Women attending fertility services should be encouraged to pursue natural conception while waiting for treatment to commence and after treatment if it is unsuccessful. Our results may aid in counselling women, and, in particular, for those with unexplained infertility. STUDY FUNDING/COMPETING INTEREST(S) S.J.C. received funding from the University of Adelaide Summer Research Scholarship. B.W.M. is supported by a NHMRC Investigator grant (GNT1176437), B.W.M. reports consultancy for ObsEva, Merck, Merck KGaA, iGenomix and Guerbet. B.W.M. reports research support by Merck and Guerbet. PROSPERO REGISTRATION NUMBER CRD42018096552.

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“…Minor adhesisiolysis and fulguration of superficial endometriotic implants lead to spontaneous pregnancies in 37% of patients in 12-16 mo. 18 Both medical and surgical treatment of pelvic pathology arrests the progression of disease. 19 In our study 9 of 84 (PR 10%) ladies with previous history of fertility enhancing pelvic surgery conceived during the COVID crisis spontaneously.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of cases of spontaneous conceptions during COVID-19 outbreak and lock down: multicentric retrospective analytic study

Patil

2022

Int J Reprod Contracept Obstet Gynecol

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Background: With lockdown and cessation of non essential, life saving treatment options couples registered at ART centres were dismayed. The aspirations of numerous couples and their families were left in a lurch. Unexpectedly cases of spontaneous conceptions in this pool of patients were a ray of hope.Methods: In this multicentric retrospective analytic study, we evaluated all cases of spontaneous pregnancies and compared them with the cohort of couples registered at our ART centers. The objective of the study was to study impact of pandemic on ART registered couples.Results: Comparisons showed that the patients who had conceived were younger with a shorter duration of infertility. More of unexplained infertile patients conceived as compared to those with known etiology. Genital tuberculosis remained constant subset of patient who conceived spontaneously as before. Conclusions: Age and duration of infertility remains important prognostic indicator for spontaneous conception in Infertile couples. The pandemic had positive impact on conception rate in our clientele.

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Spontaneous conceptions within two years of having a first infant with assisted conception

Abstract: Discussion about contraception is recommended if women with ARTC first infants do not wish to have more children or wish to delay subsequent pregnancies.

Cited by 5 publications

References 16 publications

Live birth outcome, spontaneous pregnancy and adoption up to five years after undergoing assisted reproductive technology treatment

Live birth outcome, spontaneous pregnancy and adoption up to five years after undergoing assisted reproductive technology treatment

Age-related natural fertility outcomes in women over 35 years: a systematic review and individual participant data meta-analysis

Evaluation of cases of spontaneous conceptions during COVID-19 outbreak and lock down: multicentric retrospective analytic study

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