Authors Walschaerts M, Bujan L, Isus F, Parinaud J, Mieusset R, Thonneau P
Review Date July 2012
Citation Hum Reprod 2012; 27(4):1184-90.
Most studies assessing the outcome of assisted reproductive technologies (ARTs) have reported live birth rates in couples focusing on the female factor infertility. However, infertility is a couple’s concern, and the majority of publications do not take into consideration the true impact of male infertility on having the desired number of children.
To provide evidence-based estimates of the long-term success rates in couples consulting for male infertility and who wish to have children.
In 2008, the authors did a retrospective cohort study to evaluate the probability of having a child during treatments at the Toulouse Male Sterility Centre in France, or after discontinuation of treatment, from 2000 through 2008. All men consulting for male infertility between 2000 and 2004 were included. Couples were followed for at least 4 years until discontinuation of treatment or delivery of a live infant. Data were collected via telephone interviews. Medical records were also studies to ascertain the cause of infertility, the type of treatments and reproductive outcomes (pregnancy with ART, non-ART pregnancy and natural pregnancy). Kaplan Meier estimates of cumulative live birth rates were calculated and logistic regression was done to determine factors associated with successful outcomes.
Contact was made with 1131 (65%) of the 1735 male partners by telephone. Of the 1131 respondents, 56% had become parents (60% if adoption is included), 28% after ART, 16% by natural pregnancy, 8% after non-ART treatment and 4% after ART in another centre. The cumulative rates of success reached 64% [95% confidence interval (CI), 60-67] for men ≤35 years and women ≤35 years after 9 years, and 31% (95% CI, 24-39) in older patients. With optimistic analysis, which assumes that patients for whom no information was available have the same chance of success in having a child as those whose reproductive outcome was known, the cumulative rate of success was 48% (95% CI, 45-50) in the 1735 couples.
A successful outcome was inversely associated with: age > 35 in male partner; age > 35 in female partner; duration of infertility at inclusion >24 months; and a semen infertility factor. Sperm donation was associated with a higher probability of a successful outcome.
More than half of couples consulting for male infertility succeeded in having a child. Male age over 35 years old appears as a key risk factor as well as the woman’s age, and these findings should encourage couples to attempt parenthood earlier.
Points to Note
- This is one of the few studies studying reproductive outcomes primarily for couples with male factor infertility.
- Results were similar to those for infertile women in that about 50% had a successful pregnancy outcome within eight years or treatment.
- A limitation of the study was the response rate of 65% – authors attempted to estimate success rates for the whole cohort, which were between 42% (assuming no pregnancies in non-responders for whom no information could be found) and 48% (assuming success rates in all non-responders equivalent to the rate in the sub-group of non-responders for whom information on outcomes could be located i.e. 26%).
- The result that about half of the couples with male factor infertility eventually succeed in becoming parents is encouraging for infertile men.
- Younger male age (<35 years) was an independent predictor of a successful outcome in addition to the well-known association with female age – important information for infertile couples wanting to have children.