Should IVF be used as first-line treatment or as a last resort? A debate presented at the 2013 Canadian Fertility and Andrology Society meeting

Abstract

Infertility outcomes can be influenced by many factors. Although a number of treatments are offered, deciding which one to use first is a controversial topic. Although IVF may have superior efficacy in achieving a live birth with a reasonable safety profile, the availability of cheaper and less invasive treatments preclude its absolute use. For this reason, certain patient groups with 'good-prognosis' infertility are traditionally treated with less invasive treatments first. 'Good-prognosis' infertility may include unexplained infertility, mild male factor infertility, stage I or II endometriosis, unilateral tubal blockage and diminished ovarian reserve. Here, evidence behind the use of IVF as a first-line treatment is compared with its use as a last-resort option in women with 'good-prognosis' infertility.

Predictors of In Vitro Fertilization Outcomes in Women with Highest Follicle-Stimulating Hormone Levels ≥12 IU/L: A Prospective Cohort Study

“…Especially in patients with FSH above 18 IU/L in whom we have had minimal success in achieving a clinical pregnancy, let alone a live birth, counselling them against the use of IVF may be more reasonable. These patients should be informed that IVF's high financial, physical and physiological burdens are significant, particularly when there is minimal hope of pregnancy [ 25 ]. Therefore, having a set FSH cut-off as part of an overall assessment to allow patients into an IVF program seems acceptable for the above reasons.…”

Endometriosis and in vitro fertilisation (Review)

“…An inquiry that emerges at this point is whether IVF should be preferred as a first-line treatment or as a resort. Clear IVF indications consist of infertility due to tubal bilaterality, advanced endometriosis stage that has led to tubal dysfunction, menopausal state requiring egg donation, preimplantation screening for genetically inherited pathologies and in case of severe male factor infertility (i.e., pathological spermogram) ( 27 , 71 , 72 ). In addition to those, IVF/ICSI represent the gold standard in the cases of severe male contribution to decreased fecundity.…”

Response: IVF and intrauterine insemination cannot be compared

“…We are delighted that our article debating whether IVF should be used as a first-line treatment or as a last resort (Huang et al, 2015) has initiated some correspondence (Bahadur, 2015), since the main purpose of a debate is to stimulate discussion. In his Letter to the Editor, Dr Bahadur concludes that 'simple comparisons between IVF and IUI cannot be made' and that 'autonomy of decision-making should not be eroded through unfounded information'.…”