The study for this year’s Human Reproduction keynote lecture to open the annual meeting found that a treatment delay of up to six months had little effect on outcome, even in ‘time-sensitive’ poor responders.
A delay in infertility treatment of up to six months has no negative effect on live birth rate for women with diminished ovarian reserve when compared to those having immediate IVF. This is the reassuring conclusion of a study selected for Human Reproduction keynote lecture scheduled to open this year’s virtual Annual Meeting.
This traditional opener is an honorary lecture given by the author of the most downloaded recent original paper from the four ESHRE journals. Altmetrics (lay press reports, tweets, Facebook likes) are also taken into account and this year Dr Phillip Romanski of the Weill Cornell Medical College in New York was invited to present details of his study, which was published in Human Reproduction last year.(1) Despite the paper’s popularity in 2020, it proved especially topical after the suspensions of ART during SARS-CoV-2 pandemic.
Romanski’s research interests focus on pregnancy outcomes and the effects of different treatment strategies in poor-prognosis patients. According to this retrospective study, a short postponement ‘does not have a clinical effect on implantation or fetal and pregnancy development’ in this population - although the results were only applied to patients who completed their IVF cycle.
Experience dictates that treatment delays can occur as a result of medical, logistical, financial reasons or, in more extreme scenarios, a pandemic. In response to the first wave of the SARS-CoV-2 pandemic, both ESHRE and ASRM – from ‘an abundance of caution’ - recommended the suspension of new infertility treatment cycles.(2,3). This inevitably caused concern for patients (and their clinics), especially in ‘time-sensitive’ poor ovarian reserve patients. While the definition of POR was standardised by an ESHRE working group in 2011 (the Bologna criteria) and in the knowledge that ovarian reserve gradually declines over time, the length of time by which a treatment delay becomes critical is still unclear.(4)
The effect of IVF postponement was tested in this Keynote Lecture study in 1790 women with poor ovarian reserve (AMH <1.1 ng/ml) having their first IVF cycle between 2012 and 2018. The ‘immediate’ treatment group (n = 1115) began stimulation within 90 days of their initial evaluation, whereas the ‘delayed’ group (n = 675) had to wait 91-180 days before starting. Data analysis showed comparable pregnancy and live birth rates in both the immediate and delayed groups (PR 34.5 % vs 39.1%, LBR 21.1% vs 23.0%), and even when evaluated in just those patients who reached embryo transfer (PR 39.2% vs 43.6%; LBR 23.9% vs 25.6%). No differences in biochemical pregnancies or miscarriage were observed, except for an increased miscarriage rate (31.9% vs 18.8%) in the immediate treatment subgroup of patients over 40.
These results, said the authors, are reassuring to both patients and providers as treatment outcomes seem unaffected by a short treatment delay. However, they are limited to a time-frame postponement of just 180 days, thus excluding any greater delay. A deeper investigation on further subgroups of patients should help counselling couples when unexpected delay occurs.
1. Romanski PA, Bortoletto P, Rosenwaks Z, Shattman GL. Delay in IVF treatment up to 180 days does not affect pregnancy outcomes in women with diminished ovarian reserve. Hum Reprod 2020; 35: 1630-1636. https://doi.org/10.1093/humrep/deaa137
2. See https://www.asrm.org/globalassets/asrm/asrm-content/news-and-publications/covid-19/covidtaskforce.pdf
3. Coronavirus Covid-19: ESHRE statement on pregnancy and conception. 2020. https://www.eshre.eu/Press-Room/ESHRE-News
4. Ferraretti AP, La Marca A, Fauser BCJM, et al. ESHRE consensus on the definition of ‘poor response' to ovarian stimulation for in vitro fertilization: the Bologna criteria. Hum Reprod 2011; 26: 1616–1624. doi.org/10.1093/humrep/der092