Spontaneous pregnancy after successful ICSI treatment: evaluation of risk factors in 899 families in Germany.

There are only scarce data on the incidence of spontaneous pregnancy in infertility patients. Contraception after infertility treatment is another topic that has been neglected so far. Therefore, a questionnaire was sent to 1614 couples with a child conceived by intracytoplasmic sperm injection (ICSI) aged 4-6 years. A total of 899 couples responded (response rate 55.7%). A total of 10.9% of couples had used contraception. Of the couples that had actively tried to conceive, 20.0% had conceived spontaneously, resulting in a live-birth rate of 16.4%. 74.5% of these pregnancies were conceived within 2 years after delivery. A further 26.6% of couples conceived again by ICSI, with a live-birth rate of 20.9%. Maternal age was the only prognostic factor for spontaneous conception. Parents of multiples after ICSI did not have a higher chance of spontaneous conception than parents of singletons. Couples can be counselled that one out of five couples conceive spontaneously after successful ICSI. Even when assuming that none of the families that were lost to follow-up had conceived spontaneously, one out of eight couples would have conceived spontaneously. Therefore, it is important to counsel patients about the possibility of natural conception and necessity to use contraception despite their history of subfertility.

Attitudes towards disclosure of conception mode in 899 pregnancies conceived after ICSI.

Little is known about parents' attitude towards disclosure of the mode of conception within families conceived by IVF or intracytoplasmic sperm injection (ICSI) and whether parental disclosure influences the child's emotional adjustment. A questionnaire was sent to 1614 families with ICSI children aged 5-6 years, which included the Strengths and Difficulties Questionnaire (SDQ). Data from 899 families (55.7%) could be evaluated. 2.3% (21/899) of the parents had already disclosed the mode of conception. The mean age at disclosure was 4.5 +/- 1.1 years. 65.6% (590/899) 'intended' to tell their child in future at a mean age of 11.8 +/- 3.6 years. The most common reasons for not disclosing were the opinion about a low level of relevance for the child and the wish to 'protect the child'. There was no evidence of an association between secrecy or disclosure and the emotional and behavioural adjustment of the child. Only a small minority of parents had disclosed the mode of conception by ICSI to their children at the age of 5.5 years. This is similar to what is known about disclosure in third-party reproduction families.