Article

Does subfertility explain the risk of poor perinatal outcome after IVF and ovarian hyperstimulation?

Leiden University, Leyden, South Holland, Netherlands
Human Reproduction (Impact Factor: 4.59). 12/2006; 21(12):3228-34. DOI: 10.1093/humrep/del311
Source: PubMed

ABSTRACT The primary objective of this study was to investigate whether subfertility explains poor perinatal outcome after assisted conception. A secondary objective was to test the hypothesis that ovarian hyperstimulation rather than the IVF procedure may influence the perinatal outcome.
Using data from a Dutch population-based historical cohort of women treated for subfertility, we compared perinatal outcome of singletons conceived after controlled ovarian hyperstimulation (COHS) and IVF (IVF + COHS; n = 2239) with perinatal outcome in subfertile women who conceived spontaneously (subfertile controls; n = 6343) and in women who only received COHS (COHS only; n = 84). Furthermore, we compared perinatal outcome of singletons conceived after the transfer of thawed embryos with (Stim + Cryo; n = 66) and without COHS (Stim - Cryo; n = 73).
The odds ratios (ORs) for very low birthweight (<1500 g) and low birthweight (1500-2500 g) were 2.8 [95% confidence interval (95% CI) 1.9-3.9] and 1.6 (95% CI 1.2-1.8) in the IVF + COHS group compared with the subfertile control group. The ORs for very preterm birth (<32 weeks) and for preterm birth (32-37 weeks) were 2.0 (95% CI 1.4-2.9) and 1.5 (95% CI 1.3-1.8), respectively. Adjustment for confounders did not materially change these risk estimates. The difference in risk between the COHS-only group and the subfertile group was significant only for very low birthweight (OR 3.5; 95% CI 1.1-11.4), but the association became weaker after adjustment for maternal age and primiparity (OR 3.1; 95% CI 1.0-10.4). No significant difference in birthweight and preterm delivery was found between the group of children conceived after ovarian stimulation/ovulation induction and (Stim + Cryo) and the group of children conceived after embryo transfer of thawed embryos in a spontaneous cycle without ovarian stimulation/ovulation induction (Stim - Cryo).
The poor perinatal outcome in this database could not be explained by subfertility and suggests that other factors may be important in the known association between assisted conception and poor perinatal outcome.

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    • "The etiology of these complications is likely diverse: the infertile population could be predisposed to diseases (Draper et al., 1999; Bahceci et al., 2005; Kapiteijn et al., 2006); epigenetic dysregulation, or altered placentation following in vitro culture are additional possibilities . Given the key role of the placenta throughout pregnancy, and the evidence of placental abnormalities in ART pregnancies, we hypothesized that ART may lead to suboptimal placentation that may cause impaired embryo development. "
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    Human Reproduction 08/2010; 25(8):2039-46. DOI:10.1093/humrep/deq165 · 4.59 Impact Factor
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    • "Potential IVF/ICSI associated adverse pregnancy outcomes that have been reported in previous studies include multiple births, birth defects, low birth weight, preterm birth, fetal growth restriction, maternal complications, and neonatal morbidity [5– 18]. However, except for multiple births, studies on the associations of IVF/ICSI with other adverse pregnancy outcomes have so far yielded inconsistent results [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15] [16] [17] [18]. Differences in study population and methodology are the main reasons for the inconsistent findings. "
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    European journal of obstetrics, gynecology, and reproductive biology 03/2010; 150(2):160-5. DOI:10.1016/j.ejogrb.2010.02.028 · 1.63 Impact Factor
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    • "In order to determine the details of adverse birth events in children conceived by ART, the majority of studies mentioned above consulted national or regional registries (Wennerholm et al. 1997, Kallen et al. 2005a, 2005b, Wang et al. 2005, Griesinger et al. 2008, Jacod et al. 2008). The studies by Kapiteijn et al. (2006) and Reefhuis et al. (2009) were predominantly based on interviews of mothers, who were asked to recall information regarding the preconceptional and pregnancy periods (method of conception, ethnicity, parity, duration of gestation, birth weight, etc). This method of data collection can lead to significant biases, and therefore extrapolations based in this kind of analysis have to be moderate. "
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