Prioritizing IVF treatment in the post-COVID 19 era
| Autor: | Abha Maheshwari, Ben W.J. Mol, Rik van Eekelen, Mariam Begum Ratna, David J. McLernon, Siladitya Bhattacharya |
|---|---|
| Přispěvatelé: | Epidemiology and Data Science, Center for Reproductive Medicine, APH - Personalized Medicine, APH - Methodology |
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Male
unexplained infertility Time Factors Datasets as Topic Health Services Accessibility Cohort Studies 0302 clinical medicine Pregnancy Obstetrics and Gynaecology Prospective Studies Prospective cohort study Birth Rate Unexplained infertility 0303 health sciences education.field_of_study 030219 obstetrics & reproductive medicine Obstetrics Rehabilitation Obstetrics and Gynecology IVF Female Original Article Live birth infertility COVID 19 Cohort study Maternal Age Infertility Adult medicine.medical_specialty Population Fertilization in Vitro live birth Time-to-Treatment 03 medical and health sciences Spontaneous conception medicine Humans education Pandemics 030304 developmental biology business.industry Health Priorities SARS-CoV-2 COVID-19 prediction models medicine.disease AcademicSubjects/MED00905 United Kingdom Reproductive Medicine Models Organizational business Predictive modelling |
| Zdroj: | Human Reproduction (Oxford, England) Human Reproduction Human reproduction (Oxford, England), 36(3), 666-675. Oxford University Press Bhattacharya, S, Maheshwari, A, Ratna, M B, van Eekelen, R, Mol, B W & McLernon, D J 2021, ' Prioritizing IVF treatment in the post-COVID 19 era : a predictive modelling study based on UK national data ', Human reproduction (Oxford, England), vol. 36, no. 3, pp. 666-675 . https://doi.org/10.1093/humrep/deaa339 |
| ISSN: | 0268-1161 |
| DOI: | 10.1093/humrep/deaa339 |
| Popis: | STUDY QUESTION Can we use prediction modelling to estimate the impact of coronavirus disease 2019 (COVID 19) related delay in starting IVF or ICSI in different groups of women? SUMMARY ANSWER Yes, using a combination of three different models we can predict the impact of delaying access to treatment by 6 and 12 months on the probability of conception leading to live birth in women of different age groups with different categories of infertility. WHAT IS KNOWN ALREADY Increased age and duration of infertility can prejudice the chances of success following IVF, but couples with unexplained infertility have a chance of conceiving naturally without treatment whilst waiting for IVF. The worldwide suspension of IVF could lead to worse outcomes in couples awaiting treatment, but it is unclear to what extent this could affect individual couples based on age and cause of infertility. STUDY DESIGN, SIZE, DURATION A population-based cohort study based on national data from all licensed clinics in the UK obtained from the Human Fertilisation and Embryology Authority Register. Linked data from 9589 women who underwent their first IVF or ICSI treatment in 2017 and consented to the use of their data for research were used to predict livebirth. PARTICIPANTS/MATERIALS, SETTING, METHODS Three prediction models were used to estimate the chances of livebirth associated with immediate treatment versus a delay of 6 and 12 months in couples about to embark on IVF or ICSI. MAIN RESULTS AND THE ROLE OF CHANCE We estimated that a 6-month delay would reduce IVF livebirths by 0.4%, 2.4%, 5.6%, 9.5% and 11.8% in women aged LIMITATIONS, REASONS FOR CAUTION Major sources of uncertainty include the use of prediction models generated in different populations and the need for a number of assumptions. Although the models are validated and the bases for the assumptions are robust, it is impossible to eliminate the possibility of imprecision in our predictions. Therefore, our predicted live birth rates need to be validated in prospective studies to confirm their accuracy. WIDER IMPLICATIONS OF THE FINDINGS A delay in starting IVF reduces success rates in all couples. For the first time, we have shown that while this results in fewer babies in older women and those with a known cause of infertility, it has a less detrimental effect on couples with unexplained infertility, some of whom conceive naturally whilst waiting for treatment. Post-COVID 19, clinics planning a phased return to normal clinical services should prioritize older women and those with a known cause of infertility. STUDY FUNDING/COMPETING INTEREST(S) No external funding was received for this study. B.W.M. is supported by an NHMRC Practitioner Fellowship (GNT1082548) and reports consultancy work for ObsEva, Merck, Merck KGaA, Guerbet and iGenomics. S.B. is Editor-in-Chief of Human Reproduction Open. None of the other authors declare any conflicts of interest. TRIAL REGISTRATION NUMBER N/A. |
| Databáze: | OpenAIRE |
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