Prognosis
The prognosis is highly dependent on female age, infertility diagnosis, and the treatment plan.
With expectant management
Because few couples are genuinely infertile (i.e., unable to conceive) there remains the potential for couples having regular intercourse to conceive without intervention. They may be better deemed subfertile. It is important that claims of success for any treatment modality are set against the background fecundity of the subfertile group in question.[194]
With clomifene
Clomifene is highly successful at inducing ovulation in patients with an intact hypothalamic ovarian axis. It is important to note that women with polycystic ovary syndrome will respond to clomifene approximately 73% of the time. The probability of pregnancy is 36%.[195] Of the pregnancies, approximately 10% will be twins; higher-order multiples occur in <1% of clomifene pregnancies.
With gonadotrophin therapy
The overall success rate for treatment with injectable gonadotrophins is approximately 20% to 22% per cycle in the properly selected patient. Approximately 30% of these pregnancies are multiple gestations, and higher order pregnancies occur if monitoring is suboptimal. In patients >35 years of age, the pregnancy rates are significantly decreased.[196]
With IVF
IVF is the most successful treatment for infertility, regardless of diagnosis. In 2021, 453 fertility clinics in the US performed 413,776 assisted reproductive technology cycles in 238,126 patients with the intent to transfer at least one embryo. These cycles resulted in the births of 97,128 infants.[10] The final cumulative outcome per egg retrieval cycle was 50.7% live births in women aged under 35 years using their own eggs.[173] This declined with age: 36.3% for women aged 35-37 years; 23.3% for women aged 38-40 years; 7.9% for women aged over 40 years.[173] Age-related decline is less significant in embryo transfer cycles using donor eggs or embryos (range 37.4% to 50.0% across all recipient ages) because donors are typically in their 20s or early 30s.[10] There are international variations in success rates for assisted reproductive techniques. Local guidance documents should be consulted.[174][175]
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