Abstract
OBJECTIVE: The aim of this study was to assess the time to live birth following fertility treatments among couples attending fertility centres in Addis Ababa, Ethiopia, and to identify associated factors that could contribute to improving fertility treatment outcomes. DESIGN: A retrospective record review SETTINGS FERTILITY: Treatment centres that are found in Addis Ababa, Ethiopia. PARTICIPANTS: 411 infertile couples who have undergone fertility treatment at St. Paul's Hospital Millennium Medical College (SPHMMC) and Ethio Fertility and IVF Center in Addis Ababa from 2021 to 2023. METHODS: A retrospective record review was conducted using data from patient charts among 411 couples who received fertility treatments at SPHMMC and the Ethio Fertility and IVF Center in Addis Ababa. A simple random sampling technique was used to select samples from participants who started fertility treatments from March 2021 to February 2023. Data were collected by three nurses who work at the facilities using the data abstraction format under close supervision. Kaplan-Meier, life table, log-rank test and Cox regression were used to analyse the time-to-live birth and associated factors. RESULTS: Among the 411 couples who underwent fertility treatments, 33.1% achieved live birth, with most occurring between 8 and 12 months after treatment initiation. Women aged ≥35 years had a 63% lower adjusted hazard of live birth compared with those aged <35 years (adjusted HR (AHR)=0.63, 95% CI 0.40 to 0.99, p=0.047). Longer duration of infertility was associated with reduced hazards: 5-9 years (AHR=0.59, 95% CI 0.39 to 0.90, p=0.013) and 10-14 years (AHR=0.46, 95% CI 0.22 to 0.98, p=0.043) compared with <5 years. Intrauterine insemination was associated with a 52% lower hazard of live birth compared with in vitro fertilisation (AHR=0.48, 95% CI 0.27 to 0.85, p=0.011). Couples with ≥4 treatment cycles had significantly higher hazards of live birth compared with one cycle: four cycles (AHR=3.02, 95% CI 1.09 to 8.35, p=0.033) and five cycles (AHR=4.06, 95% CI 1.28 to 12.88, p=0.017). Fresh embryo transfer was associated with a 57% higher hazard of live birth compared with frozen transfer (AHR=1.57, 95% CI 1.11 to 2.22, p=0.012). CONCLUSION: Younger women and couples undergoing multiple treatment cycles achieve higher live birth rates, and assisted reproductive technology in Addis Ababa attains outcomes comparable to international standards. Expanding early infertility intervention, ensuring access to repeated treatment cycles nationwide and raising public awareness are essential.