A new tool has been developed by scientists at the University of Aberdeen and NHS Grampian to help couples experiencing fertility problems predict their chances of conceiving a baby naturally, before embarking on IVF treatment.
Couples with fertility problems seeking treatment often underestimate their chances of conceiving on their own. The research, carried out at the University’s School of Medicine, Medical Sciences and Nutrition, found that one in eight (13%) couples who had been diagnosed with fertility problems went on to have a natural pregnancy within a year.
The findings, published in Human Reproduction Open, found some couples with fertility problems still have a chance of conceiving without any treatment. This is the first tool of its kind that can be used to estimate this chance for couples with any type of fertility problem.
Fertility problems are common, affecting one in six heterosexual couples. Referral to a specialist is advised for those who have been trying to conceive for more than 12 months, at which point tests are done to try to identify a cause that can be treated. Where initial treatments don’t work, IVF is usually offered as a next step. Some of these couples may conceive on their own in time but the chances of a pregnancy are very variable. Without any individualised information on what this chance might be, some may consider early IVF treatment which can be costly, invasive, and sometimes, not yet needed.
It is hoped the tool will help couples and their medical teams have more informed discussions about their fertility by providing an indication of the additional benefit of any planned treatment.
The study examined data from 7086 heterosexual couples from north-east Scotland and found 891 went on to have a natural conception within one year of diagnosis leading to live birth.
Longer duration of fertility problems, increasing female age and tubal fertility problems (when the fallopian tubes are blocked due to diseases, damage, scarring or obstructions) had the strongest influence on reducing the chance of having a baby naturally. Conversely, couples with a previous pregnancy or in whom no cause could be found (unexplained infertility) had the highest chances of live birth without any treatment.
Many couples diagnosed with fertility problems will undergo a variety of medical, surgical and assisted conception treatments, such as IVF, to increase their chances of having a baby. Previous fertility prediction tools either estimate the outcomes of treatment alone or focus solely on couples where no cause is found (unexplained infertility). This new tool is the first that can be used for couples with any type of fertility problem to understand what might happen if they keep trying by themselves. It could be a useful partner to existing IVF prediction tools to frame discussions about the added value of fertility treatment over and above this baseline.
The research was carried out by Dr Natalie Cameron (SCREDS Clinical Lecturer at the University of Aberdeen and Honorary Specialty Registrar at NHS Grampian), Dr David McLernon and Professor Siladitya Bhattacharya (Professor of Women’s Health at the University of Aberdeen’s Centre for Women's Health Research and Honorary Consultant Gynaecologist at NHS Grampian) from the University Aberdeen’s School of Medicine, Medical Science and Nutrition, as well as Kate Brian from the Fertility Alliance. It was funded in part by an NHS Grampian Charity Small Research Grant.
Dr Natalie Cameron, who led the research at the University of Aberdeen, said: “Fertility problems carry a significant emotional and psychological burden. Using health data from 7086 couples who were seen at NHS Grampian's Aberdeen Fertility Centre, we have developed a novel prediction tool that can estimate an individual couple’s chance of having a baby without treatment.
“A diagnosis of infertility does not necessarily mean that having a baby by themselves is impossible. Having an individual estimate of the chance of having a baby naturally can help to provide couples with context to balance discussions fertility treatment. Couples are sometimes tempted to pay for private fertility treatment early in their journey, and this tool can help them weigh up the benefits of this against their baseline chance of getting pregnant without it.
“Couples have told us that they would like more individualised, realistic information about what happens if they keep trying to conceive without treatment to help to manage expectations.
“Our research provides the context for policymakers, clinicians and couples to engage in informed discussions about the anticipated value of potential treatments and to understand which couples may benefit from earlier treatment to avoid delays in necessary care.”
Gwenda Burns, Chief Executive of The Fertility Alliance, said: “We welcome the development of this important new fertility calculator from the University of Aberdeen. For anyone experiencing fertility problems, uncertainty about what might happen next can be incredibly difficult, and having access to personalised, evidence-based information can help people feel better informed when considering their options.
“It is particularly important that this tool supports meaningful conversations between patients and healthcare professionals, helping people understand their individual circumstances and the potential benefits of treatment alongside their chances of conceiving naturally.
“There is no one-size-fits-all fertility journey, and decisions about whether and when to pursue treatment can be emotionally, physically and financially significant. We are proud that The Fertility Alliance contributed to this important research, ensuring that the voices and experiences of people affected by fertility problems remain at the heart of developments in fertility care.”
Clinical lead for NHS Grampian's Aberdeen Fertility Centre, Dr Nicola Marconi said: "As a facility with a proud history of contributing to clinical research, we are pleased to have played a part in this exciting study. We are committed to improving outcomes for patients through both clinical care and research, and this study highlights the value of collaborative research in translating scientific evidence into practical benefits. We hope the fertility calculator will provide people with clearer insights into their reproductive health and empower them to make informed choices about their future."
Lisa Duthie, Charity Lead at NHS Grampian Charity, said: “Starting a family can be a very emotional time for a couple, which is compounded if they face fertility problems. Information and support is often generalised, and doesn’t always provide clear, personalised information for couples which reflects their own personal circumstances.
“We are pleased to have been able to support this research by scientists at the University of Aberdeen, which will have a significant impact on those in Grampian and beyond who are facing fertility challenges.”
The fertility prediction calculator can be accessed here.