A concise infertility work-up results in fewer pregnancies
J A M Hamilton1, J W van der Steeg1, C J C M Hamilton1
1Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands.
Human Reproduction Open
|September 24, 2021
Summary
An extensive infertility work-up resulted in higher pregnancy success rates compared to a concise approach. Reintroducing comprehensive evaluations may improve fertility outcomes within a year.
Area of Science:
- Reproductive Medicine
- Infertility Diagnostics
- Clinical Trials
Background:
- Cost-effectiveness studies have led to less comprehensive infertility work-ups.
- Many fertility centers now use a
- one-stop
- approach.
Purpose of the Study:
- To compare pregnancy success rates between concise and extensive infertility work-ups.
- To evaluate the impact of diagnostic comprehensiveness on fertility outcomes.
Main Methods:
- A historically controlled cohort study comparing 795 couples with extensive work-up (2012-2013) and 752 with concise work-up (2014-2015).
- Follow-up was 1 year for both groups.
- Key investigations included history, ultrasound, semen analysis, HSG, and hormonal tests, varying by group.
Main Results:
- The extensive work-up group had significantly higher ongoing pregnancy rates (58.7% vs. 46.8%) within 1 year (P < 0.001).
- More pregnancies occurred during the work-up in the extensive group (14.7% vs. 6.5%).
- Fewer investigations were performed in the concise group, with less frequent and later use of hysterosalpingography (HSG).
Conclusions:
- An extensive infertility work-up is associated with higher ongoing pregnancy rates.
- Reconsidering comprehensive diagnostic approaches may improve fertility success.
- Further verification in a randomized controlled trial is recommended.
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