{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T04:53:06Z","timestamp":1791175986657,"version":"4.1.0"},"reference-count":52,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Infertility affects about one in six people worldwide over a lifetime, and\n                      <jats:italic>in vitro<\/jats:italic>\n                      fertilisation (IVF) is the mainstay of treatment for many of them. In India most IVF is delivered in private clinics and paid for out of pocket. The question is which factors determine whether an IVF cycle produces a pregnancy: the characteristics a patient arrives with, or the treatment decisions made once she is there.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study of 288 women who underwent IVF at a private fertility centre in Faridabad, Haryana, between April 2023 and October 2024. One record was analysed per woman, taken from her most recent cycle. The outcome was a positive serum beta-human chorionic gonadotropin (beta-hCG) test, the last outcome routinely documented at the centre. Donor-oocyte (recipient) cycles were analysed separately from autologous cycles, because success in a donor cycle depends on the donor rather than on the patient. Categorical associations were tested using Fisher\u2019s exact test. Independent predictors were identified using multivariable binomial logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Seventy-seven cycles (26.7%) used donor oocytes and 211 (73.3%) were autologous. The positive beta-hCG rate was 70.6% in autologous cycles and 54.5% in donor cycles (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.016). Within autologous cycles, two treatment decisions were associated with the outcome: intracytoplasmic sperm injection (ICSI) versus conventional IVF (76.0% versus 46.2%,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001) and frozen versus fresh embryo transfer (74.9% versus 51.3%,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.006). No demographic characteristic was associated with the outcome. After adjustment (\n                      <jats:italic>N<\/jats:italic>\n                      \u202f=\u202f210), conventional IVF carried lower odds than ICSI (adjusted odds ratio 0.16, 95% CI 0.06\u20130.42,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001) and frozen transfer higher odds than fresh (adjusted odds ratio 2.80, 95% CI 1.30\u20136.04,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.009). Oocyte yield was marginally associated (adjusted odds ratio 1.11 per oocyte, 95% CI 1.00\u20131.22,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.041). In absolute terms, ICSI corresponded to 32.5 percentage points and frozen transfer to 18.5 percentage points. Age was not associated with the outcome, although autologous cycles spanned only 22\u201342\u202fyears and the study was underpowered to detect age effects.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In autologous cycles at this centre, treatment decisions rather than patient demographics predicted a positive pregnancy test. The cohort was socioeconomically narrow and drawn from a single private centre. The absence of demographic effects should therefore not be read as evidence that social position does not matter. Social position might operate earlier, in determining who reaches a fertility centre at all.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1922605","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T04:35:18Z","timestamp":1791174918000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Treatment decisions, not patient demographics, predict a positive pregnancy test after autologous IVF: a retrospective cohort study from northern India"],"prefix":"10.3389","volume":"14","author":[{"given":"Rajesh","family":"Kamath","sequence":"first","affiliation":[{"name":"Department of Healthcare and Hospital Management, Prasanna School of Public Health, Manipal Academy of Higher Education","place":["Manipal, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gwendolen","family":"Rodrigues","sequence":"additional","affiliation":[{"name":"Department of Healthcare and Hospital Management, Prasanna School of Public Health, Manipal Academy of Higher Education","place":["Manipal, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saurabh","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Healthcare and Hospital Management, Prasanna School of Public Health, Manipal Academy of Higher Education","place":["Manipal, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nahima","family":"Akthar","sequence":"additional","affiliation":[{"name":"Directorate of Online Education, Manipal Academy of Higher Education","place":["Manipal, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rakshitha R.","family":"Shenoy","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education","place":["Manipal, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandesh","family":"Kini","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Kasturba Medical College, Manipal Academy of Higher Education","place":["Manipal, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,5]]},"reference":[{"key":"ref1","volume-title":"Infertility Prevalence Estimates, 1990\u20132021","year":"2023"},{"key":"ref2","volume-title":"National Family Health Survey (NFHS-5), 2019\u201321: India","year":"2021"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"287","DOI":"10.18502\/jri.v24i4.14156","article-title":"Infertility burden across Indian states: insights from a nationally representative survey conducted during 2019\u201321","volume":"24","author":"Agiwal","year":"2023","journal-title":"J Reprod 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Analysis of 100 prospectively recorded variables in 8,400 IVF\/ICSI single-embryo transfers","volume":"107","author":"Vaegter","year":"2017","journal-title":"Fertil Steril"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"2038","DOI":"10.1093\/humrep\/deaf179","article-title":"ART in Europe, 2020: results generated from European registries by ESHRE","volume":"40","author":"Smeenk","year":"2025","journal-title":"Hum Reprod"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"e1001356","DOI":"10.1371\/journal.pmed.1001356","article-title":"National, regional, and global trends in infertility prevalence since 1990: a systematic analysis of 277 health surveys","volume":"9","author":"Mascarenhas","year":"2012","journal-title":"PLoS Med"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1093\/hropen\/hoac051","article-title":"Infertility prevalence and the methods of estimation from 1990 to 2021: a systematic review and meta-analysis","volume":"2022","author":"Cox","year":"2022","journal-title":"Hum Reprod Open"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"10952","DOI":"10.18632\/aging.102497","article-title":"Global, regional, and national prevalence and disability-adjusted life-years for infertility in 195 countries and territories, 1990\u20132017: results from a global burden of disease study, 2017","volume":"11","author":"Sun","year":"2019","journal-title":"Aging (Albany NY)"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1007\/s41649-023-00253-6","article-title":"Assisted reproductive technology (regulation) act 2021: critique and contestations","volume":"16","author":"Kashyap","year":"2024","journal-title":"Asian Bioeth Rev"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"e240079","DOI":"10.1530\/RAF-24-0079","article-title":"The landscape of assisted reproductive technology access in India","volume":"5","author":"Tholeti","year":"2024","journal-title":"Reprod Fertil"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1093\/hropen\/hoad007","article-title":"Financial costs of assisted reproductive technology for patients in low and middle-income countries: a systematic review","volume":"2023","author":"Njagi","year":"2023","journal-title":"Hum Reprod Open"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"28","DOI":"10.4103\/0974-1208.178630","article-title":"Prevalence and predictors of infertility-specific stress in women diagnosed with primary infertility: a clinic-based study","volume":"9","author":"Patel","year":"2016","journal-title":"J Hum Reprod Sci"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"172","DOI":"10.4103\/jhrs.JHRS_134_17","article-title":"Sociocultural determinants of infertility stress in patients undergoing fertility treatments","volume":"11","author":"Patel","year":"2018","journal-title":"J Hum Reprod Sci"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"41","DOI":"10.31887\/DCNS.2018.20.1\/klrooney","article-title":"The relationship between stress and infertility","volume":"20","author":"Rooney","year":"2018","journal-title":"Dialogues Clin Neurosci"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"652","DOI":"10.1093\/humupd\/dms031","article-title":"Why do patients discontinue fertility treatment? 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