How effective is assisted reproduction technology? A model assessment

Area of Science:

• Reproductive Medicine
• Computational Biology
• Biostatistics

Background:

• Conceptions after infertility treatment are often misattributed to the treatment itself.
• Subfecund couples, not just totally sterile ones, may conceive naturally without intervention.

Purpose of the Study:

• To evaluate the effectiveness of assisted reproduction technology (ART) compared to natural conception over time.
• To analyze the impact of treatment delay on live birth rates in infertile couples.

Main Methods:

• A Monte Carlo simulation model incorporating conception probability, miscarriage risk, and age-dependent sterility.
• Modeling couples seeking ART after a delay (D) in spontaneous conception attempts.
• Comparing live birth rates from ART with those from 1-2 years of continued natural conception attempts.

Main Results:

• At age 30, ART shows double the conception rate (30%) compared to natural conception (15%).
• Beyond age 41, ART offers no significant advantage over natural conception over two years (15% at 41, 7% at 45).
• Reducing the delay (D) to seek ART does not improve overall live birth rates unless spontaneous conception attempts continue.

Conclusions:

• The potential for spontaneous conception, particularly in unexplained infertility, should be considered in treatment decisions.
• Initiating ART without allowing sufficient time for natural conception may not be the most efficient strategy.
• ART effectiveness is age-dependent and should be weighed against natural conception probabilities.