One in five couples 'rushed into' fertility treatment

Thousands of couples diagnosed as infertile after a year of trying for a baby are being needlessly rushed into fertility treatment, a study has found.

Many of those who seek help would have conceived naturally in the second year, findings released at the European Society of Human Reproduction and Embryology in Vienna yesterday reveal.

They call into question the present definition of infertility, which rests on a failure to conceive after 12 months of regular sex.

David Dunson, of the US National Institute of Environmental Health Sciences in North Carolina, said provided there are no obvious medical reasons for suspecting infertility, most couples should wait another year before seeking assisted reproduction therapy such as in vitro fertilisation (IVF).

"Many times couples are recommended for assisted reproduction because of known problems, but often it's just the case that they haven't been able to conceive within a year, and in that case it may be overly hasty in recommending putting couples through assisted reproduction," Dr Dunson said.

"I think definitely we should think about redefining clinical infertility, possibly to two years.

"A lot of people interpreted the earlier data that showed a decline in fertility in the late 20s and 30s and said that maybe we should rush women to assisted reproduction when it's really not an inability to conceive, but a delay in conception most of the time," he said.

The study investigated 782 couples from six European countries, including Britain, and found that even when the woman was aged between 35 and 39, fewer than one in 10 failed to conceive after two years unless the male partner was over 40.

The statistic included couples that had been diagnosed as clinically infertile because they had not conceived within a year.

"Our data should provide some comfort that only a very small minority of couples without known reproductive disorders are unable to conceive naturally in their 30s," Dr Dunson said.

"Couples can expect to take longer to conceive as they age. [But] regardless of age, most women who fail to conceive within the first 12 menstrual cycles conceive naturally within the next 12."

In Britain, about 27,000 couples undergo fertility treatment each year and 20 per cent of these have no obvious medical reasons for not being able to conceive within a year of trying for a baby. These are the people who should be encouraged to wait for another year.

A rise in infertility rates over recent years, combined with the trend for many women to delay starting a family, has led to pressure for early fertility treatment.

But this would only be justified if there was clear evidence that some women suddenly become infertile during their 30s, rather than suffer a slow decline in fecundity, Dr Dunson said.

Fertility treatment is not only unnecessary in many cases, it also carries significant health risks, such as multiple pregnancies, low birth weight and birth defects, and it is best avoided if at all possible, he said.