Potential Fertility Gains from Reducing Ivf Waiting Times amid Ongoing Fertility Postponement: A Simulation Study

Julia Hellstrand , University of Helsinki
Alice Goisis, UCL
Rolf Granholm, University of Groningen
Mika Gissler, THL Finnish Institute for Health and Welfare
Cecilia H. Ramlau-Hansen, Department of Public Health, Research Unit for Epidemiology, Aarhus University
Mikko Myrskylä, Max Planck Institute for Demographic Research

In many health systems, postponed childbearing has increased the demand for fertility treatment beyond the capacity of public clinics, leading to waiting times that reduce IVF success rate particularly among older women. Yet, the population-level consequences of such delays remain poorly understood. This study quantifies the impact of reducing waiting times on live-birth probabilities among women seeking IVF treatment amid ongoing fertility postponement. We simulated fertility outcomes for 10 000 women aged 25–45 undergoing fertility treatment under three waiting-time scenarios (0-, 1-, and 2-year delays). Empirical, age-specific per-cycle probabilities of live birth were applied, and up to three IVF cycles were simulated. Further, we analyzed distinct populations defined by their average age at seeking treatment — 30 (younger, past), 35 (older, current), and 40 years (very old, future) — and observed that waiting times had a progressively larger effect as the age of the treatment-seeking population increased. For cumulative probabilities after 3 cycles, live-birth probabilities declined modestly with a 1-year delay for a treatment-seeking population with a mean age of 30 (from 68.6% to 67.7%), but reductions were larger for a treatment-seeking population with mean ages of 35 (from 57.7% to 55.1%) and 40 years (from 38.8% to 35.9%). A 2-year delay further reduced probabilities by 1.8, 4, and 4.8 percentage points, respectively. Reducing IVF waiting times can meaningfully improve treatment outcomes and support fertility, especially as the average age of treatment seekers continues to rise.

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 Presented in Session P1. Families, Fertility, and the Life Course 1