Abstract
The result of infertility treatment can be assessed accurately by the monthly fecundity rate and the cumulative pregnancy rate (CPR). The monthly fecundity rate, decreasing over time, and the time needed to reach the ultimate CPR are key factors in decision making. Depending on the clinical assessment, infertility treatment will be either with in vitro fertilization (IVF)/assisted reproduction technologies (ART) or with a diagnostic laparoscopy associated with reproductive surgery, which thereafter my require require IVF/ART. The comparison of IVF/ART treatment versus reproductive surgery is therefore the wrong debate as the CPR’s of reproductive surgery and of IVF are additive. Decisions should be based on the ultimate CPR’s and on effort and time, not on personal preferences. The large majority of women with infertility should have a diagnostic laparoscopy during which reproductive surgery can be performed if needed. IVF/ART treatment without a diagnosis decreases the ultimate CPR and is not without potentially serious adverse effects. Having excellent reproductive surgery readily available to patients, similar to the availability of IVF would increase CPR in women with infertility and decrease the overall cost.
Highlights
The result of infertility treatment can be assessed accurately by the monthly fecundity rate and the cumulative pregnancy rate (CPR)
in vitro fertilization (IVF) treatment and reproductive surgery are often considered as 2 opposing treatment alternatives and IVF is increasingly started without a laparoscopy and/or a clear diagnosis
The results of a treatment should be expressed by monthly fecundity rates (MFR) and cumulative pregnancy rates (CPR) (Fig. 1)
Summary
Duration of infertility, and with the skill of the individual surgeon or IVF center. To calculate exactly all these variables prohibitively large datasets would be necessary. IVF on the contrary emphasizes the pregnancy rate of each IVF cycle which is the MFR. A comparison of the results of IVF treatment and of reproductive surgery is intellectually attractive. Discontinuation of IVF treatment can occur for many reasons varying from the cost and effort of an IVF cycle, to poor responders, couples with a poor fertilization and/or with a reduced prognosis for other reasons such as age. For these reasons the CPR or the percentage of women that become pregnant out of those that started IVF is rarely available in the literature. To the best of our knowledge the real CPR of IVF rarely exceeds 60%–80%
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