Impact of delayed treatment on IVF outcomes

Researchers in a 2020 study found that delayed IVF treatment of 91 to 180 days had no impact on pregnancy outcomes for patients with diminished ovarian reserve (DOR).

This study looked at delayed treatment in the context of IVF clinic closures due to COVID-19, although this could be applied to anyone who is delaying treatment between their initial consultation and beginning their IVF cycle.

Whether or not this delay in treatment has an impact isn’t clear, and for some reproductive endocrinologists it’s a debatable subject. In particular, some clinicians are concerned about those with diminished ovarian reserve (DOR), who are considered to be the most at risk for reduced success due to a delay in treatment.

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Study details

This was a retrospective study at a single IVF institution. Participants had their first IVF cycle between 2012 and 2018. Immediate treatment was defined as beginning IVF within 90 days of their patient visit, and delayed treatment was between 91 and 180 days.

All cycles were evaluated as fresh transfers (no FETs, no PGS testing/PGT-A).

Results

1790 patients with DOR (AMH of <1.1 ng/ml) were a part of this study: 1115 began treatment within 90 days of their evaluation (immediate) and 675 between 91 and 180 days (delayed).

There were no differences between the immediate and delayed groups in terms of number of eggs retrieved (average 6.3), mature eggs (4.9), and fertilized eggs (3.5).

Pregnancy rates were comparable between these groups at 34.5% (immediate) vs 39.1% (delayed).

The live birth rate was also comparable between all patients at 21.1% (immediate) vs 23.0% (delayed).

There were no differences between biochemical pregnancies or miscarriages among those who were pregnant.

They also looked at participants with lower AMH (<0.5 ng/ml) as well as those who were >40 with an AMH of <1.1 ng/ml (the Bologna criteria for DOR).

In both cases they found no differences between the immediate and delayed groups in terms of pregnancy rates, live birth rates, and biochemical pregnancies. However, miscarriage rates were higher for women >40 with an AMH of <1.1 ng/ml in the immediate group (this was unexpected and may be due to the low number of participants).

Conclusions

This study found no difference in pregnancy rates, live birth rates, biochemical pregnancies, and miscarriages, between those who initiated treatment within 90 days compared to those who initiated treatment 91-180 days after consultation.

Overall, women with DOR may be considered poor-prognosis, and it’s reassuring that a delay of up to 180 days doesn’t have an impact on pregnancy/live birth rates.

This is also reassuring for women who are unable to begin IVF immediately after a consultation. For some it may take months before their insurance is settled, or an appointment becomes available, etc. So all women who experience a delay in starting IVF (of up to 180 days) may not experience reduced pregnancy outcomes, at least based on this research.

Reference

Romanski PA, Bortoletto 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 Jul 1;35(7):1630-1636. doi: 10.1093/humrep/deaa137. PMID: 32544225; PMCID: PMC7337822.

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About Embryoman

Embryoman (Sean Lauber) is a former embryologist and the founder of Remembryo, an IVF research and fertility education website. After working in an IVF lab in the US, he returned to Canada and now focuses on making fertility research more accessible. He holds a Master’s in Immunology and launched Remembryo in 2018 to help patients and professionals make sense of IVF research. Sean shares weekly study updates on Facebook, Instagram, and Reddit regularly. He also answers questions on Reddit or in his private Facebook group.

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