Many couples wanting a baby are rushing to demand treatment too soon, according to Dutch gynaecologist Dr Egbert te Velde.
He said that public awareness of fertility issues, along with the growing number of clinics competing for clients, had influenced people's perception of fertility.
"Many couples who seek help for a fertility problem want a child as soon as possible and often demand immediate treatment," he told the European Society of Human Reproduction and Embryology conference in Bologna, Italy, today (Wednesday 28 June).
But the chances of natural conception are often underestimated, possibly because infertility is generally defined as failure to become pregnant within a year of regular, unprotected intercourse. "Consequently, couples are inclined to think that if pregnancy has not occurred within this magic period they are infertile and need immediate treatment," he said.
In fact, nearly half of the women in a random population who have not become pregnant after a year will conceive naturally. Among couples where tests have shown no reason for infertility the probability of a natural pregnancy is even higher.
"Before considering treatment, couples should be counselled about their chances of conceiving spontaneously. Assisted reproductive technology is not without complications and side effects," said Dr te Velde, head of the Department of Reproductive Medicine at the Utrecht Medical Centre.
These include ovarian hyperstimulation syndrome which produces life-threatening complications in one to two per cent of women. There is the probability of multiple pregnancies with increased mortality and problems for the children as well as long-lasting social, emotional and financial impact on the parents.
"In our centre, where we usually do not transfer more than two embryos, the chance of twins is between 30 and 40 per cent. We consider that a high chance: it worries us so much that we seriously consider transferring only one embryo in certain categories of patients."
Dr te Velde said that prognostic models able to estimate the probability of spontaneous pregnancy in couples with unexplained infertility may help doctors and patients facing the 'to treat or not to treat' dilemma.
These models always take into account the age of the woman, the duration of infertility and whether or not it involves primary or secondary infertility. The results of tests such as sperm analysis are factored in as well.
"In the model we've developed we give the couple an estimate of their chances of conceiving naturally within a year. If they have, for example, an above 4 in 10 chance we usually advise the couple to wait. Many centres are inclined to treat couples as soon as possible and too few couples are being allowed the opportunity to conceive naturally."
Note: Programme number: O-174
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