Investigation of the infertile couple: a basic fertility work-up performed within 12 months of trying to conceive generates costs and complications for no particular benefit.
The current approach of the basic fertility work-up has been questioned recently in this journal. Based on new data on human fecundity, the authors advocated starting the fertility work-up after just 6 months of trying to conceive instead of the usual 12 months. In women younger than 39 years and with a regular cycle, there are several arguments why the basic fertility work-up should not be done earlier than after 12 months of child wish. Firstly, 50% of couples who have tried to conceive for 6 months without success will conceive in the next 6 months without any treatment. Secondly, the prevalence of fertility diseases is lower in couples who have been trying to conceive for 6 months as compared with those who have been trying for 12 months. Performance of a fertility work-up at this stage will lead to an increase in false-positive diagnoses compared with performing them at 12 months of subfertility. Thirdly, fertility treatment will have fewer additional effects in couples with good spontaneous conception prospects (6-12 months child wish), compared with subfertile couples who have poor prospects. At present, none of the available fertility treatments have success rates comparable with no intervention in these women, and postponement of treatment in such couples will prevent complications such as ovarian hyperstimulation syndrome and multiple pregnancies. We argue that the fertility work-up should not be offered to couples with a duration of child wish of <12 months, except for women with ovulation disorders and women of 39 years and older.
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands. j.w.vandersteeg@amc.nl
Jan W
JW
van der Steeg
Pieternel
P
Steures
Peter G A
PG
Hompes
Marinus J C
MJ
Eijkemans
Fulco
F
van der Veen
Ben W J
BW
Mol
D000328:Adult; D001723:Birth Rate; D003365:Costs and Cost Analysis; D005260:Female; D005306:Fertilization; D006801:Humans; D007247:Infertility, Female / Q000175:diagnosis* / Q000191:economics*; D007248:Infertility, Male / Q000175:diagnosis* / Q000191:economics*; D008297:Male; D012098:Reproduction; D018456:Reproductive Medicine / Q000191:economics / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome