We thank Dr Borstein and colleagues for their excellent and insightful publication “Pregnancy and pregnancy intention after experiencing infertility: A longitudinal study of women in Malawi”. We believe that this is an important issue globally, in both low and high resource settings, and would like to draw parallels with our recent work in the UK. We have similarly found a lack of research in this field. Our meta-analysis of the incidence of natural conception pregnancy after livebirth via assisted reproductive technology found that natural conception pregnancy is not uncommon and may occur in at least one in five women after having a baby via in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) (1). Like Borstein et al. we also identified a lack of consideration of pregnancy intention and continuous contraception use in the data as a potential reason why this incidence was a likely underestimate. Our qualitative study of UK women who had experienced spontaneous pregnancies after successful IVF (2) similarly provides evidence that women may experience both infertility and subsequent unintended pregnancy and that the contraceptive needs of this group are being overlooked. Our survey of postnatal women (post-spontaneous conception and post-IVF) showed strikingly low levels of postnatal contraceptive use in women who had had successful IVF pregnancies and higher levels of unintended pregnancy for those becoming pregnant subsequently compared to women who had not had fertility treatment (3). We would welcome more research in this field and collaboration between fertility and wider reproductive health experts globally.

Annette Thwaites, Geraldine Barrett, Jennifer Hall, and Judith Stephenson (UCL EGA Institute for Women’s Health, London, UK)


References:

1. Thwaites A, Hall J, Barrett G, Stephenson J. How common is natural conception in women who have had a livebirth via assisted reproductive technology? Systematic review and meta-analysis. Hum Reprod. 2023 Aug 1;38(8):1590-1600. doi: 10.1093/humrep/dead121. PMID: 37339780; PMCID: PMC10391314. Available at: https://academic.oup.com/...

2. Thwaites A, Hall J, Barrett G, Stephenson J. Contraception after in vitro fertilisation (IVF): a qualitative study of the views of women who have had spontaneous pregnancies after successful IVF. Reprod Health. 2022 Feb 8;19(1):40. doi: 10.1186/s12978-022-01349-2. PMID: 35135587; PMCID: PMC8822864. Available at:
https://reproductive-heal...

3. Thwaites A, Hall J, Barrett G, Stephenson J. A survey of postnatal contraception use: Does mode of conception matter?  In: Proceedings from the Royal College of Obstetricians and Gynaecologists World Congress; June 12-14 2023; London, UK. Abstract EP.0609.