Spontaneous conceptions following successful ART are not associated with premature referral.
OBJECTIVE
What is the rate of spontaneous live births after successful IVF treatment in a cost-free environment, and were couples who achieved a spontaneous live birth referred prematurely?


CONCLUSIONS
Despite unlimited IVF treatments offered free of charge, the spontaneous live birth rate following successful IVF remained unchanged compared with that cited in previous literature. Couples were not referred prematurely to IVF before fully utilizing other less invasive treatments.


BACKGROUND
A significant number of infertile couples, who achieve their first live birth through assisted reproductive technology (ART), subsequently achieve a second live birth spontaneously. As IVF has become more widely available, it is used in less severe cases of infertility, perhaps explaining a rise in the subsequent spontaneous live birth rate after successful treatments.


METHODS
This retrospective cohort study was performed at a university-based tertiary medical center. The study population included women aged <35 years, with primary infertility, referred for their first IVF treatment to the Sheba Medical Center IVF unit between 2001 and 2002 and followed up for 7 years. The primary outcome was spontaneous live birth rate following successful ART. Relevant data were obtained from the patient files and supplemented by a standardized telephone questionnaire.


METHODS
Of the 171 couples who met the study inclusion criteria, 6 refused to participate in the questionnaire and 31 couples were lost to follow-up. Of the 134 couples who participated, 109 achieved a first live birth with ART. After achieving their first live birth with ART, seven couples who began using contraception or separated or divorced were excluded.


RESULTS
Of 102 couples who continued unprotected intercourse after successful ART, 22 subsequently achieved their second live birth spontaneously (21.6%). The women who achieved a second birth spontaneously were not referred earlier to IVF, and actually performed a higher number of ovulation induction cycles before initiating IVF, compared with women who did not conceive spontaneously.


CONCLUSIONS
This is a retrospective cohort study, and findings should be reaffirmed with a larger prospective randomized study comparing retreatment to achieve a second pregnancy with attempting to conceive spontaneously.


CONCLUSIONS
Our data suggests that young patients (<35 years), who previously conceived with IVF, without utilizing ICSI and with no known tubal pathology, should consider attempting to conceive spontaneously.


BACKGROUND
No funding was obtained for this study and the authors have no competing interests.
Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, Petach-Tikva, Israel. y.lande@gmail.com
Yechezkel
Y
Lande
Daniel S
DS
Seidman
Ettie
E
Maman
Micha
M
Baum
Jehoshua
J
Dor
Ariel
A
Hourvitz
D000328:Adult; D001723:Birth Rate; D015331:Cohort Studies; D005260:Female; D005306:Fertilization; D005307:Fertilization in Vitro; D005500:Follow-Up Studies; D006801:Humans; D007246:Infertility / Q000628:therapy; D050498:Live Birth; D011247:Pregnancy; D018873:Pregnancy Rate; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D027724:Reproductive Techniques, Assisted / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome