Determinants of Pregnancy Outcomes after Assisted Reproductive Therapy: A Sample from the West Bank, Palestine

Abstract

Abstract Objective: Infertility is a public health issue with a huge impact on the well-being of affected couples. Despite the traditional valuing of fertility within the Palestinian society, no studies were conducted to detect the determinants of pregnancy outcome in Palestine. This paper aims at detecting the characteristics and pregnancy outcome after assisted reproductive technology (ART) of a sample of the Palestinian society. Materials & Methods: A retrospective observational study was carried out at Razan Medical Center for Infertility. Subjects were assigned 2 categories based on the type of infertility, 7 different categories according to the cause of infertility, and 3 categories for the modality of treatment. Age at marriage, age at presentation, duration of infertility, in addition to regularity of menstruation were also studied. Biochemical pregnancy was considered the endpoint for the purpose of analysis. Results: We reviewed the files of 459 subjects diagnosed with infertility. Of the studied subjects, 79.74% had primary infertility, while 20.26% had secondary. According to diagnosis, 28.85% were found to be infertile due to anovulation, 2.86% due to endometriosis, 16.74% attributed to male factor, 3.3% had tubal damage, while 34.80% had no explainable cause. 13.43% of cases were multifactorial. Four biochemical markers were assessed in our study, thyroid-stimulating hormone (TSH) (x̄=2.32±2.46), leutinizing hormone (LH) (x̄=6.71±4.90), follicle-stimulating hormone (FSH) (x̄=6.59±6.11), and human prolactin (hPRL) (x̄=41.88±6.50). The menstrual cycle was regular in 70.58% of subjects, in contrast to 29.41% with irregular cycles. Female mean age at presentation 22.76±5.58, while their mean age of marriage was 22.76±4. Mean duration of infertility was 3.97±6.87. Patients were treated via 3 modalities, ovarian stimulation (2.2%), intrauterine insemination (IUI) (29.58%), and intracytoplasmic sperm injection (ICSI) (68.21%), with a rate of success of 51.85%. Of the studied factors, only diagnosis, FSH, and modality of treatment had a significant impact on the outcome, with p-values of 0.040, 0.003, and <.0.001, respectively. Conclusions: there is a strong relationship between diagnosis prior to intervention, level of FSH and treatment modality on successful outcome of ART. ICSI was found to be superior to other modalities of treatment. We recommend starting with ICSI to save patient time & effort.