Background
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.
Aim
To provide evidence-based estimates of the long-term success rates in couples consulting for male infertility and who wish to have children.
Methods
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.
Results
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.
Conclusion
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.
