Assisted Reproduction Should Be Postponed for Healthy Women

July 08, 2002

July 9, 2002 — Investigators presenting on July 3 at the European Society of Human Reproduction and Embryology in Vienna, Austria, caution against recommending assisted reproductive technology (ART) too soon. In a study of more than 700 European couples, almost all were able to conceive within two years, even women aged 35 to 39, provided their male partner was younger than 40.

"In the absence of clinical indicators of infertility in addition to a long time to pregnancy, it may be appropriate to delay assisted reproduction until the couple has failed to conceive naturally in 18 to 24 months," lead investigator David Dunson, from the National Institute of Environmental Health Sciences in North Carolina, says in a news release. "There is a large amount of normal variability in fertility and many couples having below average, but normal fertility may fail to conceive within a year. This is particularly true for older couples, many of whom fail to conceive within the first year but are successful in the second."

The European Study of Daily Fecundability enrolled 782 women, aged 18 to 40 years, from seven centers in Paris; London; Milan, Italy; Verona, Italy; Lugano, Switzerland; Dusseldorf, Germany; and Brussels, Belgium; and it included data on 7,288 menstrual cycles. Even when the woman was aged 35 to 39 years, fewer than one in 10 failed to conceive after two years unless the male partner was older than age 40.

"On average the time to pregnancy increases with the age of the woman," Dunson says. "But, regardless of age, most of the women who failed to conceive within the first 12 cycles conceived in the next 12."

The percentage failing to conceive within a year was 8% for women aged 19 to 26; 13%-14% for women aged 27 to 34; and 18% for women aged 35 to 39. Only 3% of 19- to 26-year-olds, 6% of 27- to 34-year-olds, and 9% of 35- to 39-year-olds failed to conceive in the second year, provided the male partner was younger than 40.

For women in their late 30s, male age contributed significantly to infertility. The percentage of failures after one year for women aged 35 to 39 rose from 18% to 28% if the male partner was older than 40. After the second year, the failure rate was 9% with male partners younger than 40 and 16% with male partners older than 40.

Dunston suggests that couples should be patient and doctors should not intervene too quickly with ART unless there are known reasons for a couple not conceiving naturally within a year.

"Fertility treatment, such as IVF and ICSI, can result in an increased risk of multiple pregnancies, pregnancy complications, low birth weight, major birth defects and long-term disability among surviving infants," he says. "The chance of success with ART decreases with age, while the side effects increase in prevalence."

ESHRE Annual Meeting. July 3, 2002.

Reviewed by Gary D. Vogin, MD


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as: