Empty waiting-rooms in IVF clinics. How does a delay in treatment affect IVF birth rates?
Published 29 June 2020
Live birth rate unaffected by a six-month delay in first-cycle IVF patients with low ovarian reserve in a single-centre retrospective study.
‘Time-sensitive’ was an epithet frequently applied to infertility and its treatment when organisations and clinics made calls to end their COVID-19 hiatus. Of course, back in March, as the scale of the impending pandemic became clear, it was those same organisations who had urged the clinic closures in the first place, for protection of patients, staff and resources. But within a few weeks, to a chorus of disappointment and frustration from patients, both clinics and professional groups seemed united behind a ‘gradual and judicious resumption of care’. The use of healthcare resources ‘must be weighed against the time sensitive nature of infertility’, wrote the ASRM on 24 April, while a joint statement from ESHRE, ASRM and IFFS on 29 May declared that ‘infertility is time-sensitive, and prognosis worsens with age’.(1,2)
So just how time-sensitive? A new retrospective analysis of first-cycle IVF treatments in women with diminished ovarian reserve – and thus more likely to be ‘sensitive’ to a timeline of treatment – has found that a delay in treatment of up to 180 days did not affect their live birth rate when compared to that of women who started their IVF within 90 days of presentation.(3) ‘Providers and patients should be reassured that when a short-term treatment delay is deemed necessary for medical, logistic or financial reasons, treatment outcomes will not be affected,’ write the authors. A ‘more extreme scenario’, they add, might be the result of natural disaster or pandemic, as clinics indeed faced in March.
The study looked back at the treatment data of 1790 patients at the Weill Cornell Medical College in New York having a first cycle with planned fresh embryo transfer, and all with diminished ovarian reserve as defined by an AMH of <1.1 ng/ml. They were then stratified into two further groups depending on when they started treatment – either immediately or after a delay. This, write the authors, was according to a timeline of their own choice and, for the study, immediate treatment was defined as within 90 days of evaluation, and delayed treatment between 90 and 180 days. The majority (n = 1115) had their first cycle within the 90 days.
Overall, there were no statistical differences in live birth rate (after transfer) between the immediate and delayed treatment groups – 23.9% immediate and 25.6% delayed. There were two sub-group analyses of more severe forms of low ovarian reserve – in patients with an AMH <0.5 ng/ml and in patients over 40 years old with an AMH <1.1 ng/ml. Again, LBRs were similar - 0.5 AMH, immediate 18.8% and delayed 19.1, and over 40, immediate 12.3% and delayed 14.7%.
The authors, from the Cornell group of Zev Rozenwaks and Glenn Schattman, describe their results as ‘reassuring’, despite the unequivocal biological fact of a decline in ovarian reserve over time. And especially reassuring
to patients ‘who may feel anxious to begin their treatment and become frustrated when unexpected delays occur’, as clearly happened during this pandemic.(4)
The comparable LBRs remained evident when outcomes were analysed in all patients in the cohort, in just those who had an embryo transfer, or in only those who achieved a pregnancy.
The findings, suggest the authors, are reassuring for whatever the reason for treatment delay, and especially so in those concerned that ‘cycles are unable to start in a timely manner’. But, as the authors acknowledge, these findings are only applicable to a delay of up to 180 days – what they describe as ‘a short delay’. Patients whose delay was longer than 180 days were excluded from the study, but there must surely come a time when any accumulating delay will inevitably affect results. So the reassurance offered by the authors is confined to ‘short-term treatment delays’, but it may well mitigate patient frustration when unexpected delays occur.
3. Romanski PA, Bartoletto, P, Rosenwaks Z, Schattman GL. Delay in IVF treatment up to 180 days does not affect pregnancy outcomes in women with diminished ovarian reserve. Hum Reprod 2020; doi:10.1093/humrep/deaa137
4. See https://www.fertstertdialog.com/rooms/871-covid-19/posts/65837-the-emotional-impact-of-the-asrm-guidelines-on-fertility-patients-during-the-covid-19-pandemic
Get notified of new articles with our ESHRE newsletter.
Sign up and never miss an update