Early Clinical Outcomes and Associated Clinical Characteristics of Infertile Women on in-vitro Fertilization Treatment at a Tertiary Private Hospital in Kenya

Abstract Conclusions: Majority of the women who sought IVF treatment were married for at least five years, had 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 37.1%. Previous fertility treatment was significantly associated with favourable early clinical outcomes of IVF, while having a normal BMI and regular menstrual cycle does not significantly increase the likelihood of normal pregnancy after IVF. Background: Infertility is a major cause of marital conflict and influences the quality of life of couples and their wellbeing. One of the definitive treatments for infertility is in-vitro fertilization (IVF). Despite this, not all patients who receive IVF treatment have favourable desirable clinical outcomes due to multiple underlying patients and procedural characteristics. Objectives: To determine early clinical characteristics and outcomes among women undergoing in-vitro fertilization treatment at a private tertiary hospital and fertility centers in Kenya. Methods: This was a one-year observational prospective study involving 153 women undergoing invitro fertilization as definitive treatment for infertility at Mediheal fertility centers in Eldoret and Nairobi. 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 interviewer administered questionnaire. Pregnancy tests, first and second obstetric ultrasound were done on the 2nd, 6th and 12th week after IVF treatment in order to determine early clinical outcomes. 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). Results: The mean age of participants was 36.2 (± 5.7) years. Majority 140 (91.5%) were married, 132 (86.3%) had a tertiary level education, 109 (71.2%) had health insurance and 95 (62.1%) had tried to have children for at least five years. Primary infertility was diagnosed among 83 (54.2%) women, 120 (78.4%) had regular menstrual cycle, regular coitus (>4 times a month) was in % 71 (46.4%) and 112 (73.2%) women had reproductive disorders. Pregnancy tests done on the second and eighth week among 145 women, had a positivity rate of 51.7% (n=75). On the week 6 visit, 61 of 70 women who had an obstetric ultrasound had a normal pregnancy. At 12th week visit, all the 61 women returned for an obstetric ultrasound, with 52 being normal. The overall pregnancy success rates at weeks 2, 6 and 12 were 51.7%, 43.6% and 37.1% respectively. 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 follow-up 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 at 12 weeks after IVF treatment. Previous intrauterine insemination (IUI) was significantly associated with normal pregnancy outcome after 12 weeks of IVF treatment.