Clinical characteristics and early outcomes of in vitro fertilization treatment among women attending a private fertility center in Eldoret, Kenya

Abstract

Background: Infertility has been identified as a global reproductive health concern with a greater burden in countries with limited resources. It is also a major cause of marital instability and affects the quality of life and wellbeing of the affected. Although in-vitro fertilization (IVF) has been considered a definitive treatment of infertility, not all post-IVF outcomes are favorable. This could be attributed to procedural issues as well as the patient‘s sociodemographic and clinical characteristics. However, there is limited local data addressing the clinical characteristics that affect early IVF outcomes among women seeking the services. Objectives: This study aimed to determine clinical characteristics and early outcomes among women undergoing in-vitro fertilization treatment at Mediheal Hospital and Fertility Center in Eldoret, Kenya. Methods: This was a one-year prospective cohort study involving 153 women undergoing invitro fertilization as a definitive treatment for infertility at Mediheal Fertility Centre. The participants were sampled consecutively over a nine-month accrual period and followed up at 2, 6, and 12 weeks of IVF treatment. Sociodemographic characteristics were collected using an interviewer-administered questionnaire. Pregnancy tests, first and second (obstetric ultrasound was done on the 2nd, 6th, and 12th week after IVF treatment to determine early clinical outcomes. Data analysis conducted using R statistical computing software (R Core Team, 2017). Pearson Chi-Square test and independent samples t-test were used to compare Clinical and Sociodemographic Characteristics and early clinical outcomes. Logistic regression model was used to assess the determinants of IVF success (critical value ≤0.05). Odds Ratios were computed at 95% confidence interval. Results: A total of 153 women with a mean age of 36.2 (± 5.7) years were enrolled. Majority, 140 (91.5%) were married, 132 (86.3%) had a tertiary level education and 109 (71.2%) had health insurance and a median body mass index was 26.2 IQR: 23.5, 29.1) kg/m2. Primary infertility was reported among 83 (54.2%) women, 120 (78.4%) had regular menstrual cycle, 71 (46.4%) had regular coitus (>4 times a month) while 112 (73.2%) had reproductive disorders. On the first follow-up visit (2 weeks post IVF) 8 women were lost to follow-up hence pregnancy tests was done on 145 women of which 75 (49%) were positive and 70 (45.8%) were negative and were dropped from the study. On the second visit (6 weeks post IVF) 5 women were lost to follow -up leaving 70 women for an obstetric ultrasound of which 61(39.9 %) were normal pregnancies with 3 (4.3%) ectopic pregnancies and 6 (8.6% ) miscarriages. At the third visit (12 weeks post IVF), all the 61 women returned for an obstetric ultrasound, with 52 (34%) being normal while 6 (9.8%) had miscarriage, 2 (3.3%) had vanishing twins and 1 (1.6%) had blighted ovum. Although majority of the assessed characteristics were not associated with early IVF outcomes, women with a regular menstrual cycle (AOR=1.089; 95% CI: 0.741, 1.599) and primary infertility (AOR=1.051; 0.748, 1.477) were more likely to have positive pregnancy tests on the first followup visits. A normal BMI (AOR=2.216; 0.663, 7.405) and regular menstrual cycle (AOR=1.406; 0.398, 4.973) increased the likelihood of normal pregnancy after 12 weeks following IVF treatment. Previous infertility treatment was significantly associated (p=0.032) with normal pregnancy outcomes after 12 weeks of IVF treatment. Conclusions: Majority of the women who seek IVF treatment are married for five or more years, have a tertiary level of education, formally employed with health insurance and reproductive disorders. The overall pregnancy success rate 12 weeks after IVF treatment at Mediheal fertility centers is 34%. Previous infertility treatment is significantly associated with favorable early clinical outcomes of IVF treatment. Recommendations: More women should seek health insurance as a way of financing IVF treatment. Previous fertility treatment should be encouraged prior to IVF treatment to improve early clinical outcomes. Future studies should assess reasons for loss to follow-up and validate this study‘s findings in a public healthcare facility.