Expectant Management
We also occasionally recommend or support a patient’s wish for expectant management (no intervention). In fertility is not the same as sterility. Infertility is better thought of as sub-fertility. Even the most severe cases will occasionally win the reproductive lottery and achieve a successful pregnancy spontaneously. The internet chat rooms teem with examples of women who conceived unexpectedly after years of infertility treatment. Remember that fertility is a “team sport” where the normal male or female component can sometimes overcome the other deficiency. Or, despite a poor ovarian reserve, a normal healthy egg might one day be ovulated.
Infertility can be approached mathematically as a monthly probability of pregnancy. For example, we believe that the normal monthly fertility rate in humans is about 20%. If every month 20% of the remaining women become pregnant then after 12 months 90% have conceived and 10% have not. This is exactly what we find in nature – about 10% of the population is infertile at the end of 1 year of trying. Mathematically, 100% of women will be pregnant given an infinite number of attempts. Most of us do not have that much time, so we start looking for causes of infertility after 6-12 months depending on the age of the woman. About 65% of couples with unexplained infertility will achieve a pregnancy within 6 years so expectant management is a viable though low probability, option. We would be foolish not to acknowledge that treatment independent pregnancies occur. We strive to place the results of our diagnostic evaluation in perspective and to attempt to predict the likelihood of pregnancy in a given time frame either with or without treatment. Some patients choose to proceed with treatment and others prefer to watch and wait. We are comfortable with either approach.
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