TREATMENT-RELATED AND TREATMENT-INDEPENDENT DELIVERIES AMONG INFERTILE COUPLES, A LONG-TERM FOLLOW-UP

Background. The aim of this hospital based long-term follow-up study w as to further elucidate resolved and unresolved infertility in relatio n to risk factors and perinatal outcome considering treatment-related and treatment independent pregnancies. Methods. The study included all couples attending the out-patient clinic of the Department of Gynecol ogy in Umea due to failure to initiate a pregnancy after at least 12 m onths during the period 1.1.1980-31.12.1989. Data from the Swedish Med ical Birth Registry consisting of all registered births during 1.1.198 0-31.12.1992 was linked to establish the number of children born. Resu lts. Six hundred and ninety-one couples were analyzed, out of which 42 % had a delivery outcome. Of these women, 53% conceived in relation to given treatment whereas 47% conceived treatment-independently. Women with ovulatory disorder had a cumulative delivery rate of 82%, whereas those with unexplained infertility and tubo-peritoneal pathology disp layed delivery rates of 57% and 31% respectively. Duration of infertil ity >3 years was the major negative prognostic factor among patients w ith unexplained infertility. The frequency of premature deliveries, lo w birth weight and perinatal mortality was increased among patients wi th treatment related pregnancies. Conclusion. For ovulatory disorders the prognosis for a resolved infertility is good. The results among pa tients with tubo-peritoneal pathology emphasizes the need of in vitro fertilization in modern treatment of infertility. Unexplained infertil ity is accompanied with a high rate of spontaneous pregnancies but pro longed duration is a negative prognostic factor for these patients. Ir respective of diagnosis, the perinatal outcome is worse in patients wi th treatment-related pregnancies.