JMIR Publications

ABSTRACT

Background:

Approximately one in seven couples experience subfertility, many of whom have lifestyles that negatively affect fertility, such as poor nutrition, low physical activity, obesity, smoking or alcohol consumption. Reducing lifestyle risk factors prior to pregnancy or assisted reproductive technology (ART) treatment contribute to the improvement of reproductive health but cost-implications are unknown.

Objective:

To evaluate reproductive, maternal pregnancy and birth outcomes, and the costs of preconception lifestyle intervention programmes in subfertile couples and obese women undergoing ART.

Methods:

We evaluated lifestyle intervention programmes (Smarter Pregnancy, an online tool), LIFEstyle, a smoking cessation programme for men and mindfulness mental health support) using a hypothetical model based on quantitative parameters from published literature and expert opinion. The model population was based on data from the Netherlands.

Results:

All model-based analyses of the lifestyle interventions showed a reduction of in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI) or intrauterine insemination (IUI) treatments to achieve pregnancy and a take home baby for couples in the Netherlands. Smarter Pregnancy was modelled to have the largest increase in spontaneous pregnancy rate (13.0%), the largest reduction in potential ART treatments (3.1% for IVF, 2.0% for ICSI and 7.8% for IUI), and reduction of intrauterine growth restriction of 2.6% per couple. Among obese subfertile women, LIFEstyle was modelled to show a reduction in the occurrence of gestational diabetes, maternal hypertensive pregnancy complications and preterm births by 4.4%, 3.8% and 3.0%, respectively, per couple. Modelled cost-savings per couple per year were €41, €360, €513, €586 and €1,163 for smoking cessation, mindfulness, Smarter Pregnancy, Smarter Pregnancy + LIFEstyle and LIFEstyle interventions, respectively.

Conclusions:

Although we modelled the potential impact on reproductive outcomes and costs of fertility treatment, rather than collected real-world data, our model suggests that of the lifestyle interventions in encouraging healthier behaviours, all are likely to be cost effective, and appear to have positive effects on reproductive, maternal pregnancy and birth outcomes. Further real-world data is required to determine the cost-effectiveness of pre-conception lifestyle interventions and their effects on reproductive health. We believe that further implementation of the lifestyle app Smarter Pregnancy also designed for subfertile couples seeking assistance to become pregnant is likely to be cost-effective and allow reproductive health outcomes to be collected.