Short delay in IVF start may not affect live birth rates

A delay of up to 180 days in initiating in vitro fertilization (IVF) does not appear to affect live birth rates among women with infertility and diminished ovarian reserve, according to a retrospective cohort study presented at ESHRE 2021.

“There’s a biologic basis to believe that [patients with diminished ovarian reserve] are likely to be the most vulnerable to a delay in their treatment as they already have an increased risk for poor response to ovarian stimulation at baseline which may be further exaggerated over time,” said study author Dr Phillip Romanski from the Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical Center, New York, US.

“[W]e observed that a delay in initiating IVF treatment up to 180 days does not affect the live birth rate for women with diminished ovarian reserve when compared to women who initiate IVF treatment within 90 days of presentation,” he said.

Participants were women with infertility and diminished ovarian reserve (anti-Mŭllerian hormone [AMH] <1.1 ng/mL) who underwent treatment at the Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine. The population was limited to the 1,790 women who initiated their first ovarian stimulation cycle within 180 days of their initial consultation which resulted in an oocyte retrieval and a planned fresh embryo transfer between January 2012 and December 2018. Of these, 1,115 had immediate (1–90 days post-presentation) and 675 delayed (91–180 days post-presentation) treatment, respectively. Only the first ovarian stimulation cycle was included.

The mean duration between presentation and IVF initiation was 50.5 and 128.8 days in the immediate and delayed groups, respectively. The mean age of patients at IVF start were 39.1 and 38.9 years, respectively, and mean AMH was 0.56 and 0.57 ng/mL, respectively. A mean 6.3 and 6.6 oocytes, respectively, were retrieved, with 4.9 and 5.3 mature, and 2.0 and 2.1 embryos transferred.

The live birth rate after ≥24 weeks gestation was comparable between patients who underwent immediate and delayed IVF treatment (21.1 percent vs 23.0 percent; odds ratio [OR], 1.11, 95 percent confidence interval [CI], 0.88–1.42). [ESHRE 2021, abstract O-001]

Subgroup analysis showed similar live birth rates between the immediate and delayed treatment groups when the population was restricted to the 785 patients with AMH <0.5 ng/mL (16.0 percent vs 16.5 percent; OR, 1.02, 95 percent CI, 0.67–1.54) and the 829 patients aged ≥40 years with AMH <1.1 ng/mL (10.9 percent vs 12.8 percent; OR, 1.19, 95 percent CI, 0.76–1.87).

Overall pregnancy likelihood was also comparable between the immediate and delayed treatment groups (34.5 percent vs 39.1 percent; OR, 1.23). Among pregnant women, pregnancy loss did not significantly differ between groups (19.2 percent vs 17.8 percent; OR, 0.93).

Short delay: No cause for concern

In the early stages of the COVID-19 pandemic (March–April 2020), ESHRE released recommendations advocating for the suspension of new fertility treatments in order to prevent infection spread or potential COVID-19 complications in pregnancy, and support reallocation of necessary healthcare resources. These recommendations were made when little was known about the SARS-CoV-2 virus, and the guidelines were met with some criticism, said Romanski.

“Patients and providers were rightly concerned about the risks of what was at the time an indefinite suspension on initiating new treatment cycles and how this delay in treatment might negatively affect treatment outcomes,” he said.

“We know that over longer periods of time, over years, both the quantity and quality of ovarian reserve will decline significantly enough to result in worse infertility treatment outcomes with a lower chance in live birth,” he continued.

Other factors can also contribute to treatment delay, for instance, medical, financial, and logistical reasons. The question was if a temporary treatment suspension could negatively affect treatment outcomes.

“Providers and patients should be reassured that when a short-term treatment delay is deemed necessary for medical, logistical, or financial reasons, treatment outcomes will not be negatively affected,” concluded Romanski and co-authors.

However, Romanski noted that these findings should only be applied to women who are able to initiate IVF within 180 days of presentation.