Obstetric outcome in women with subfertility

Obstetrics and Gynaecology, University of Aberdeen, Aberdeen, Scotland, United Kingdom
BJOG An International Journal of Obstetrics & Gynaecology (Impact Factor: 3.45). 05/2005; 112(5):632-7. DOI: 10.1111/j.1471-0528.2004.00489.x
Source: PubMed


It has been suggested that a history of subfertility is associated with increased obstetric and perinatal risks. It is unclear if the cause is inherent characteristics in the women or the fertility treatment.
To compare the obstetric and perinatal risks of singleton pregnancies in women with a history of subfertility in comparison with the general population.
Population cohort.
Aberdeen, Scotland.
Cases were women attending the Fertility Clinic between 1989 and 1999 who subsequently went on to have singleton pregnancies. Controls included the general population of women who delivered singletons over the same period.
We performed a retrospective cohort study to investigate the obstetric outcome of singleton pregnancies in women with subfertility. The general population of women who delivered singletons over the same period served as controls.
Obstetric and perinatal complications in singleton pregnancies.
Maternity records were available for a total of 1437 subfertile women and 21,688 controls. Subfertile women were older [mean (SD) age: 31 (4.7) years vs 27 (5.4) years, P < 0.01] and more likely to be primiparous (70% vs 65%, P < 0.001). After adjusting for age and parity, subfertile women were at increased risk of pre-eclampsia (OR 1.9, 95% CI 1.5-2.5), placenta praevia (OR 3.9, 95% CI 2.2-7.0) and placental abruption (OR 1.8, 95% CI 1.1-3.0), and more likely to undergo induction of labour (OR 1.5, 95% CI 1.3-1.6), caesarean section (OR 2.1, 95% CI 1.8-2.4) and instrumental delivery (OR 2.2, 95% CI 1.8-2.6), and deliver low birthweight (OR 1.4, 95% CI 1.3-1.7) and preterm (OR 1.7, 95% CI 1.2-2.2) infants. There were no differences between treatment-related and treatment-independent pregnancies.
Subfertile women are at higher risk of obstetric complications, which persist after adjusting for age and parity.

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    • "The reason for the differences in the obstetric outcomes in spontaneous pregnancies and pregnancies with either fresh or frozen embryo transfers is unclear. Several factors related to the reproductive laboratory technology itself (De Geyter et al., 2006; Ombelet et al., 2006; Shih et al., 2008; Pelinck et al., 2010a,b; Nelissen et al., 2012; Makinen et al., 2013) or the patient characteristics (Thomson et al., 2005; Romundstad et al., 2008) may be involved. One of the factors possibly affecting pregnancy outcomes is COH, which causes a supraphysiologic endocrine uterine environment and suboptimal endometrial development (Hansen et al., 2002; Chung et al., 2006; Kalra et al., 2011; Kansal Kalra et al., 2011), which may finally result in adverse obstetric outcomes (Hansen et al., 2002; Chung et al., 2006; De Geyter et al., 2006; Ombelet et al., 2006; Wennerholm et al., 2009; Pelinck et al., 2010a,b). "
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    ABSTRACT: Are there differences in estrogen and progesterone secretion in singleton pregnancies, up to Week 11, between spontaneous pregnancies, after controlled ovarian hyperstimulation and fresh embryo transfer (COH + ET) and after frozen embryo transfer in a spontaneous cycle (FET)?
    Human Reproduction 09/2014; 29(11). DOI:10.1093/humrep/deu223 · 4.57 Impact Factor
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    • "On sait que l'infertilité est en elle-même un facteur de risque de complications obsté tricales telles que les accouchement pré maturé s (Odd ratio [OR] = 1,38 [1,25–1,54]), le retard de croissance intra-uté rin (RCIU) (OR = 1,24 [1,16–1,45]), le petit poids de naissance (Odd ratio ajusté [aOR] = 1,4 [1,1–1,7]), la pré e ´ clampsie (aOR = 1,9 [1,4–2,5]), le placenta praevia (aOR = 3,9 [2,2–7,0]) ou encore le dé collement placentaire (aOR = 1,8 [1,1–3,0]) [9] [10] [11]. Il semble e ´ galement y avoir une augmentation significative des risques d'induction du travail (aOR = 1,5 [1,3–1,6]), d'extraction instrumentale (aOR = 2,2 [1,8–2,6]) et de cé sarienne (aOR = 2,1 [1,8–2,4]) [10] [11]. Il est lé gitime de se demander si l'endomé triose est un facteur de risque surajouté de complications obsté tricales. "
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    ABSTRACT: While association between endometriosis and infertility is well established, there are few studies about the impact of endometriosis on adverse pregnancy outcomes. The aim of this study was to determine the effect of endometriosis on obstetric outcomes and whether the severity of the disease had an influence on these. We performed a retrospective study to investigate the obstetric outcomes of a population of 1204 subfertile women, including 258 with endometriosis, who obtained, thanks to assisted reproduction technology, a singleton pregnancy evolving beyond embryonic stage. Two analyzes were performed. The first compared women with endometriosis to women with other causes of infertility. The second observed adverse pregnancy outcomes according to AFS-R stages of endometriosis. The overall rate of live birth children was 95.8%. In case of endometriosis, there was a significant increase of the incidence of preterm delivery, especially before 32weeks amenorrhea (6.2% vs 3.1% in the group "without endometriosis", P=0.03), antenatal bleeding (5.3% vs 2.2%, P=0.01) and placenta previa (4.9% vs 0.9%, P<0.0001). The incidence of gestational diabetes was significantly decreased (0.4% vs 2.7%, P=0.04). There was no correlation between endometriosis and cesarean section or preeclampsia, or between the AFS-R stage and adverse pregnancy outcomes. Endometriosis is a factor of obstetrical risk, independently of the infertility it causes. The AFS-R score does not seem to be representative of obstetric outcomes beyond first trimester of pregnancy for women with endometriosis.
    Gynécologie Obstétrique & Fertilité 03/2014; · 0.52 Impact Factor
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    • "Theoretically the lower birth weight in IVF singletons could be attributed to i. maternal and/or paternal characteristics associated with infertility; ii. the effects of ovarian stimulation on oocytes, endometrium or the endocrinology of the luteal phase or early pregnancy; or iii. IVF laboratory procedures such as ICSI or embryo culture conditions (42, 43). The implementation of suitable quality control has focused on the effectiveness of culture media in improving embryo morphology and it is fundamental to the success of an IVF laboratory (44). "
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    ABSTRACT: The aim of this study is to investigate the effect of ISM1 culture medium on embryo development, quality and outcomes of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles. This study compares culture medium commonly used in the laboratory setting for oocyte recovery and embryo development with a medium from MediCult. We have assessed the effects of these media on embryo development and newborn characteristics. In this prospective randomized study, fertilized oocytes from patients were randomly assigned to culture in ISM1 (MediCult, cycles: n=293) or routine lab culture medium (G-1TM v5; Vitrolife, cycles: n=290) according to the daily media schedule for oocyte retrieval. IVF or ICSI and embryo transfer were performed with either MediCult media or routine lab media. Embryo quality on days 2/3, cleavage, pregnancy and implantation rates, baby take home rate (BTHR), in addition to the weight and length of newborns were compared between groups. There were similar cleavage rates for ISM1 (86%) vs. G-1TM v5 (88%). We observed a significantly higher percentage of excellent embryos in ISM1 (42.7%) compared to G-1TM v5 (39%, p<0.05). Babies born after culture in ISM1 had both higher birth weight (3.03 kg) and length (48.8 cm) compared to G-1TM v5 babies that had a birth weight of 2.66 kg and a length of 46.0 cm (p<0.001 for both). This study suggests that ISM1 is a more effective culture medium in generating higher quality embryos, which may be reflected in the characteristics of babies at birth.
    International journal of fertility & sterility 07/2013; 7(2):108-15. · 0.47 Impact Factor
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