Expectant Management Before In vitro Fertilization in Women Aged 39 or Above and Unexplained Infertility Does Not...

Area of Science:

• Reproductive Medicine
• Infertility Research
• Public Health Policy

Background:

• Unexplained infertility affects many couples, with expectant management often considered before assisted reproductive treatments.
• Advanced maternal age (≥39 years) is associated with declining ovarian reserve and in vitro fertilization (IVF) success rates.
• The appropriateness of waiting policies for older women undergoing fertility treatments requires clarification.

Purpose of the Study:

• To compare the live birth rates between couples with unexplained infertility who opted for immediate IVF treatment versus those utilizing a waiting list for public, reimbursed IVF.
• To determine if a waiting policy is a suitable strategy for women of advanced reproductive age experiencing unexplained infertility.

Main Methods:

• A retrospective study comparing two groups of couples with unexplained infertility: one group accessing immediate, self-funded IVF and another group on a public IVF waiting list (approx. 1 year).
• Follow-up was conducted for 1 year after the last embryo transfer of the first IVF cycle.
• Cumulative live birth rates (cLBR) were calculated and compared using logistic regression and a two-sample Z test for equality of proportions.

Main Results:

• A total of 635 couples were evaluated (359 immediate group, 276 waiting group).
• The crude cumulative live birth rate (cLBR) was similar between the immediate group (19.5%) and the waiting group (20.7%).
• Logistic regression analysis showed no statistically significant difference in live birth rates between the two strategies, with an adjusted odds ratio of 0.69 (95% CI: 0.39-1.22).

Conclusions:

• The study found no statistically significant difference in cumulative live birth rates between immediate IVF access and a waiting list strategy for couples with unexplained infertility.
• These findings suggest that a waiting policy may be a viable option for some couples, even for women of advanced reproductive age.
• Further research is recommended to individualize infertility treatment strategies based on specific couple characteristics.