Treatment decision trends in the infertility patient journey from 78,958 cycles in a real-world database: impact of age, diagnosis, and year of treatment

Mottla, Gilbert L.; Richter, K.S.; Kaplan, B.; Hayward, Brooke; Mahony, M.C.

doi:10.1016/j.fertnstert.2017.02.078

Cited by 3 publications

(4 citation statements)

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“…Despite the impressive advances observed in the field of Reproductive Medicine in the last 40 years regarding infertility diagnosis and treatment, a constant concern as viewed by both clinicians and patients is the correct and timely diagnosis of the infertility factor involved, under the context of personalized medicine [6]. One of the most challenging conditions that clinicians are called to manage is infertility of unidentified aetiology, following the standard infertility investigation.…”

Section: Introductionmentioning

confidence: 99%

The Role of Laparoscopic Investigation in Enabling Natural Conception and Avoiding in vitro Fertilization Overuse for Infertile Patients of Unidentified Aetiology and Recurrent Implantation Failure Following in vitro Fertilization

Pantou¹,

Simopoulou

Sfakianoudis³

et al. 2019

JCM

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The present study aims to explore the effectiveness of laparoscopic surgery on women presenting with infertility, of unidentified aetiology according to the standard infertility investigation, and recurrent failed In Vitro Fertilization (IVF) attempts. Identifying and correcting possible underlying pathologies by laparoscopy may subsequently enable natural conception in an effort to address infertility and avoid IVF overuse. One-hundred and seven (107) women with unidentified aetiology of infertility and recurrent failed IVF attempts met the inclusion criteria. Laparoscopic surgery was performed as the endpoint of the patients’ diagnostic journey, aiming to identify a possible underlying factor as the cause of infertility. Sixty-two (62) out of 107 patients (57.94%) that underwent laparoscopy were diagnosed with endometriosis, 25 out of the 107 patients (23.3%) were diagnosed with periadnixal and pelvic adhesions, and 20 cases (18.69%) presented with no pathology and remained unexplained. Following identification and correction of endometriosis and pelvic adhesions, patients were invited to conceive naturally. For the patients that laparoscopic investigation failed to reveal any pathology they were categorized as unexplained infertility and were subjected to a single IVF cycle. Natural conception success rate within the first postoperative year was the primary outcome. Within the first postoperative year, 30 out of 62 patients (48.38%) diagnosed with endometriosis following laparoscopic investigation achieved a natural conception, and 28 out of them (93.4%) reported live-births. Additionally, 11 out of 25 patients (44%) diagnosed with periadnixal and pelvic adhesions achieved natural conception within the first operative year. Regarding the group of unexplained infertility patients, only four out of the 20 patients (20%) achieved clinical pregnancy in the first post-operative IVF cycle. In conclusion, laparoscopy appears to be a promising approach, addressing infertility, providing significant diagnostic findings, while avoiding IVF overuse regarding patients of unidentified infertility presenting with recurrent failed IVF attempts.

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Section: Introductionmentioning

confidence: 99%

The Role of Laparoscopic Investigation in Enabling Natural Conception and Avoiding in vitro Fertilization Overuse for Infertile Patients of Unidentified Aetiology and Recurrent Implantation Failure Following in vitro Fertilization

Pantou¹,

Simopoulou

Sfakianoudis³

et al. 2019

JCM

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show abstract

“…Although epigenetic and genetic causes are both determinants of successful embryo development, their effects on embryo quality from the male side have long been underestimated and insufficiently investigated [ 4 , 5 ]. According to former research, it is apparent that the rate of infertility rises with increased age in both males and females [ 6 , 7 ]. A previous case–cohort study reported the correlation between age and serum hormones or sperm parameters [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Associations between male reproductive characteristics and the outcome of assisted reproductive technology (ART)

et al. 2017

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The present study was designed to investigate the relationships between indicators of male body mass index (BMI), age, reproductive hormone levels, semen parameters, and the outcomes of assisted reproductive technology (ART). The clinical data were collected from 636 couples who underwent ART between January, 2013 and December, 2015 at the reproductive center involved in our study. Pearson's correlation or Spearman rank correlation was applied to establish the relevant correlation coefficients. The correlation between influence factors' and pregnancy outcomes was analyzed using the Logistic regression model. Analyses were conducted using SPSS software. Male BMI was found to be negatively correlated with testosterone (T) (P<0.05), while follicle-stimulating hormone (FSH) was negatively correlated with semen parameters (P<0.05). Luteinizing hormone (LH) was found to be negatively correlated with total sperm count, normal sperm morphology, and abortion (all P<0.05). Clinical pregnancy was related to sperm concentration and female age (P<0.05), and live birth was found to be associated only with female age (P<0.05). Male BMI was associated with the secretion of reproductive hormones, but had no effect on sperm parameters or ART outcome. A higher male age was also negatively connected with the outcome of clinical pregnancy. Reproductive hormones were not associated with ART outcome. Sperm concentration and female age were important factors influencing ART clinical pregnancy, while the only significant factor influencing live birth was female age. Levels of obesity-related inflammatory indicators (i.e. free fatty acid (FFA), glutathione peroxidase (GSH-Px), human inhibin-B (IHNB), interleukin-1 (IL-1), insulin-like growth factor-1 (IGF-1), and reactive oxygen species (ROS)) also varied with degrees of BMI. The present study provides information on the associations between male reproductive characteristics and the outcome of ART, which may contribute to improved strategies to help couples achieve better pregnancy outcomes.

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“…Primary diagnosis and age have been shown to be significant drivers of initial treatment decisions and sequence ( P < .0001). 22 Patients with unexplained infertility and ovulation disorders, or polycystic ovary syndrome (PCOS) were more likely to begin with OI and move on to IVF, while older patients (>35 years) were more likely to start directly with IVF. More patients with infertility resulting from male factors or DOR tended to start with IVF compared with patients with ovulation disorders/PCOS.…”

Section: Discussionmentioning

confidence: 99%

“… 32 - 34 Older patients may be better served by initiating treatment with IVF rather than OI/IUI, given that IVF is associated with a faster time to pregnancy and live birth, and has higher success rates. 22 , 35 However, fast tracking to IVF may not be possible due to restrictions by payers.…”

Section: Discussionmentioning

confidence: 99%

Identifying Factors Associated with Discontinuation of Infertility Treatment Prior to Achieving Pregnancy: Results of a Nationwide Survey

Collura,

Hayward,

Modrzejewski

et al. 2024

Journal of Patient Experience

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The purpose of this mixed methods, cross-sectional patient survey was to characterize patient experience, to explore the frequency of and reasons for infertility treatment discontinuation and return to infertility treatments. Participants were recruited from United States patient support groups. Participants had received or were receiving ovulation induction (OI) with or without intrauterine insemination (IUI), with or without subsequent in vitro fertilization (IVF), or IVF with no other previous infertility treatment. Live birth was achieved by 62% of participants. Compared with participants treated with OI/IUI only, participants who underwent OI/IUI followed by ≥1 IVF cycle were less likely to consider discontinuing care (64% vs 77%; P = .014) or to discontinue treatment without achieving a pregnancy (40% vs 58%; P = .004). The most commonly cited reasons for treatment discontinuation were financial (62%) and psychological burden/treatment fatigue (58%). Expected versus actual time to pregnancy differed greatly. Continued desire for a child (60%) was the most frequently cited reason for continuing or resuming treatment. Expanded access to treatment, counseling and fostering realistic expectations regarding cumulative time to pregnancy may reduce treatment discontinuation.

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Treatment decision trends in the infertility patient journey from 78,958 cycles in a real-world database: impact of age, diagnosis, and year of treatment

Cited by 3 publications

References 0 publications

The Role of Laparoscopic Investigation in Enabling Natural Conception and Avoiding in vitro Fertilization Overuse for Infertile Patients of Unidentified Aetiology and Recurrent Implantation Failure Following in vitro Fertilization

The Role of Laparoscopic Investigation in Enabling Natural Conception and Avoiding in vitro Fertilization Overuse for Infertile Patients of Unidentified Aetiology and Recurrent Implantation Failure Following in vitro Fertilization

Associations between male reproductive characteristics and the outcome of assisted reproductive technology (ART)

Identifying Factors Associated with Discontinuation of Infertility Treatment Prior to Achieving Pregnancy: Results of a Nationwide Survey

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