title: Fertility treatments and outcomes among couples seeking fertility care: data from a prospective fertility cohort in the United States.
abstract: OBJECTIVE
  To determine the relationship between number of fertility treatment cycles and pregnancy rates.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Eight community and academic infertility practices.
  
  
  METHODS
  Four hundred eight (408) couples presenting for an infertility evaluation.
  
  
  METHODS
  Face-to-face and telephone interviews and questionnaires.
  
  
  METHODS
  Incidence of pregnancy. Cox regression analysis compared the efficacy of cycle-based fertility treatments with no cycle-based fertility treatment after multivariable adjustment.
  
  
  RESULTS
  Couples using one to two medications-only cycles had a significantly higher pregnancy rate (hazard ratio [HR] 4.7 [95% confidence interval 1.3-16.6]), a benefit that did not persist after three or more cycles (HR 0.6 [0.1-3.2]). Couples using IUI for one (HR 2.9 [1.4-5.8]), two (HR 2.0 [0.9-4.5]), and three cycles (HR 4.5 [1.8-10.9]) were more likely to achieve a pregnancy. No additional benefit was seen for couples using four or more IUI cycles (HR 1.0 [0.4-2.6]). In vitro fertilization was associated with significant benefit for couples using one (HR 2.8 [1.5-5.2]) and two cycles (HR 2.2 [1.2-4.1]). Couples using three or more IVF cycles had a non-statistically significant higher likelihood of pregnancy (HR 1.3 [0.7-2.4]).
  
  
  CONCLUSIONS
  Cycle-based fertility treatments may offer a point of diminishing returns for infertile couples: two cycles of medications only, three cycles of IUI, and two cycles of IVF.
authors.affiliation: Department of Urology, University of California-San Francisco, San Francisco, California 94143-1695, USA. smithjf@urology.ucsf.edu
authors.forename: James F
authors.initials: JF
authors.lastname: Smith
authors.forename: Michael L
authors.initials: ML
authors.lastname: Eisenberg
authors.forename: Susan G
authors.initials: SG
authors.lastname: Millstein
authors.forename: Robert D
authors.initials: RD
authors.lastname: Nachtigall
authors.forename: Natalia
authors.initials: N
authors.lastname: Sadetsky
authors.forename: Marcelle I
authors.initials: MI
authors.lastname: Cedars
authors.forename: Patricia P
authors.initials: PP
authors.lastname: Katz
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007246:Infertility / Q000453:epidemiology* / Q000628:therapy*; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D011247:Pregnancy; D018873:Pregnancy Rate; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D027724:Reproductive Techniques, Assisted / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology