Time to pregnancy in subfertile women in German gynecological practices: analysis of a representative cohort of more than 60,000 patients

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Abstract
The aim of this study was to assess the time from the first subfertility diagnosis to pregnancy (TTP) and to elucidate factors influencing TTP for patients in German gynecological practices comprising a representative sample and provide a realistic picture of the current situation in Germany. The study collective included all women with first-time diagnoses of female infertility (ICD: N97) or unfulfilled desire for children (ICD: Z31) from the representative database (IMS Disease Analyzer). Demographic data on patients such as their age (ranges 18–25, 26–30, 31–35, 36–40 or 51–50) and information on previous pregnancies and births and concomitant diseases were collected. Data pertaining to 61,815 women from 433 gynecological practices in Germany with a first diagnosis of female infertility or an unfulfilled desire for children were analyzed. The period of data collection was between January 1, 2001 to December 31, 2012 (=144 months). The mean observation period for the patients after the first gynecological consultation was 1,420 days (=47.3 months), with a standard deviation of 879 days. A total of 22,744 patients became pregnant during the first year of observation (36.8 %). The highest cumulative pregnancy rate was seen in women between 18 and 30 years of age (74.8 %). The older the women were, the lower the cumulative pregnancy rate became (18.1 % in the group of 41- to 50-year-old women). Cox regression calculations showed that the following factors considerably impaired the chances of pregnancy: age, endometriosis, diabetes mellitus, ovarian dysfunction, PCOS, previous infection of the genitourinary tract. In contrast, a couple of factors were proven to increase pregnancy rates, namely previous use of hormonal contraceptives, private insurance, previous birth, previous pregnancy and progesterone therapy (at any time). Along with information about reproductive physiology, such as decreasing fertility with maternal age, counseling in daily practice should also include individual factors influencing fertility. It is of the utmost importance to further increase public awareness of the impact of advanced female and male age on the reproductive outcome so that people can make well-informed decisions on when to start a family.

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