Parenthood Rates in 1735 Couples: Impact of Male Infertility
Parenthood Rates in 1735 Couples: Impact of Male Infertility
BACKGROUND Most studies assessing the outcome of assisted reproductive technologies (ARTs) have reported live birth rates in couples by taking mainly the female factor into account. However, infertility is a couple's concern, and the majority of publications do not take into consideration the true impact of male infertility on having the desired number of children.
METHODS We carried out a follow-up study to evaluate the probability of having a child during treatments at the Toulouse Male Sterility Centre and after discontinuation from 2000 through 2008. Couples were followed for at least 4 years until discontinuation of treatment or delivery of a live infant.
RESULTS We were able to contact 65% of the 1735 male partners by telephone. Of the 1131 respondents, 56% had become parents (60% if adoption is included), 28% after ART, 16% by natural pregnancy, 8% after non-ART treatment and 4% after ART in another centre. The cumulative rates of success reached 64% [95% confidence interval (CI), 60–67] for men ≤35 years and women ≤35 years after 9 years, and 31% (95% CI, 24–39) in older patients. With optimistic analysis, which assumes that patients for whom no information was available have the same chance of success in having a child as those whose reproductive outcome was known, the cumulative rate of success was 48% (95% CI, 45–50) in the 1735 couples.
CONCLUSIONS More than half of couples consulting for male infertility succeeded in having a child. Male age over 35 years old appears as a key risk factor as well as the woman's age, and these findings should encourage couples to attempt parenthood earlier.
A couple's ability to conceive is a major social concern and an important public health issue. In developed countries, it is estimated that between 9 and 14% of couples will have difficulties in conceiving, and in France one couple in seven will consult for infertility during their reproductive life, with the origin of the disorder being shared between the man and the woman (Thonneau et al., 1991; Boivin et al., 2007). Nevertheless, constant progress in assisted reproductive technologies (ARTs) has been observed within the last decades, and has given real hope to these infertile couples. Worldwide in 2005, in 53 countries, a total of 601 243 ART procedures were performed and resulted in live births (de Mouzon et al., 2009). A recent report from the European Society of Human Reproduction and Embryology (ESHRE) indicated that in the 20 European countries which keep ART registers, 58 199 ART cycles resulting in deliveries were performed in 2006 (de Mouzon et al., 2010).
So far, most studies assessing ART have reported live birth rates only in infertile couples treated with IVF/ICSI (Witsenburg et al., 2005; Elizur et al., 2006; Sutcliffe and Ludwig, 2007). However, the treatment of infertile couples is not limited to ART, as they may also become parents through natural pregnancy, non-ART treatment or adoption. Very little information is available on the desire for children in infertile couples during and after discontinuation of treatment in an infertility centre. In a study analysing long-term reproductive outcome in 946 couples visiting a fertility clinic, 28% succeeded in having children through spontaneous pregnancies, 11% after IVF and 21% after other treatments (Donckers et al., 2011). In a study of 123 women who discontinued unsuccessful IVF, 57 finally succeeded in becoming parents, 46% through adoption, 42% by natural pregnancy and 12% through further IVF treatment (de La Rochebrochard et al., 2009).
Another major limitation of the existing literature is the rarity of published papers on reproductive outcomes in couples consulting for male infertility. Although it is now well established that infertility is a couple's concern, with the origin of the disorder being shared between male and female (Thonneau et al., 1993; Safarinejad, 2008), no information is given on men, as the very large majority of publications on ART outcomes focus on female infertility or on the fertility of both partners.
We conducted this study to provide evidence-based estimates of the long-term success rates in couples consulting for male infertility and who wish to have children.
Abstract and Introduction
Abstract
BACKGROUND Most studies assessing the outcome of assisted reproductive technologies (ARTs) have reported live birth rates in couples by taking mainly the female factor into account. However, infertility is a couple's concern, and the majority of publications do not take into consideration the true impact of male infertility on having the desired number of children.
METHODS We carried out a follow-up study to evaluate the probability of having a child during treatments at the Toulouse Male Sterility Centre and after discontinuation from 2000 through 2008. Couples were followed for at least 4 years until discontinuation of treatment or delivery of a live infant.
RESULTS We were able to contact 65% of the 1735 male partners by telephone. Of the 1131 respondents, 56% had become parents (60% if adoption is included), 28% after ART, 16% by natural pregnancy, 8% after non-ART treatment and 4% after ART in another centre. The cumulative rates of success reached 64% [95% confidence interval (CI), 60–67] for men ≤35 years and women ≤35 years after 9 years, and 31% (95% CI, 24–39) in older patients. With optimistic analysis, which assumes that patients for whom no information was available have the same chance of success in having a child as those whose reproductive outcome was known, the cumulative rate of success was 48% (95% CI, 45–50) in the 1735 couples.
CONCLUSIONS More than half of couples consulting for male infertility succeeded in having a child. Male age over 35 years old appears as a key risk factor as well as the woman's age, and these findings should encourage couples to attempt parenthood earlier.
Introduction
A couple's ability to conceive is a major social concern and an important public health issue. In developed countries, it is estimated that between 9 and 14% of couples will have difficulties in conceiving, and in France one couple in seven will consult for infertility during their reproductive life, with the origin of the disorder being shared between the man and the woman (Thonneau et al., 1991; Boivin et al., 2007). Nevertheless, constant progress in assisted reproductive technologies (ARTs) has been observed within the last decades, and has given real hope to these infertile couples. Worldwide in 2005, in 53 countries, a total of 601 243 ART procedures were performed and resulted in live births (de Mouzon et al., 2009). A recent report from the European Society of Human Reproduction and Embryology (ESHRE) indicated that in the 20 European countries which keep ART registers, 58 199 ART cycles resulting in deliveries were performed in 2006 (de Mouzon et al., 2010).
So far, most studies assessing ART have reported live birth rates only in infertile couples treated with IVF/ICSI (Witsenburg et al., 2005; Elizur et al., 2006; Sutcliffe and Ludwig, 2007). However, the treatment of infertile couples is not limited to ART, as they may also become parents through natural pregnancy, non-ART treatment or adoption. Very little information is available on the desire for children in infertile couples during and after discontinuation of treatment in an infertility centre. In a study analysing long-term reproductive outcome in 946 couples visiting a fertility clinic, 28% succeeded in having children through spontaneous pregnancies, 11% after IVF and 21% after other treatments (Donckers et al., 2011). In a study of 123 women who discontinued unsuccessful IVF, 57 finally succeeded in becoming parents, 46% through adoption, 42% by natural pregnancy and 12% through further IVF treatment (de La Rochebrochard et al., 2009).
Another major limitation of the existing literature is the rarity of published papers on reproductive outcomes in couples consulting for male infertility. Although it is now well established that infertility is a couple's concern, with the origin of the disorder being shared between male and female (Thonneau et al., 1993; Safarinejad, 2008), no information is given on men, as the very large majority of publications on ART outcomes focus on female infertility or on the fertility of both partners.
We conducted this study to provide evidence-based estimates of the long-term success rates in couples consulting for male infertility and who wish to have children.
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