Article

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

ABSTRACT

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: STUDY QUESTION 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)?
    Full-text · Article · Sep 2014 · Human Reproduction
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    • "It was initially assumed that these risks were a result of the use of ART and studies in the mouse demonstrate that in vitro culture media can indeed influence imprinting methylation (Market-Velker et al., 2010). However, a number of adverse outcomes appear to be independent of fertility treatment or the type of subfertility (Thomson et al., 2005; Messerlian et al., 2013) and there is increasing interest in the possibility that these problems and subfertility may have a common biological origin (Horsthemke and Ludwig, 2005; Ludwig et al., 2005; Haggarty et al., 2006; Sutcliffe and Ludwig, 2007). Whether the ultimate cause is the process of ART or the infertility itself, there is very little understanding of the biological mechanism. "
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    ABSTRACT: Is DNA methylation in buccal cell DNA from children born following IVF (in vitro fertilization) and ICSI (intra-cytoplasmic sperm injection) different from that of spontaneously conceived children? DNA methylation in the imprinted gene, small nuclear ribonucleoprotein polypeptide N (SNRPN), was higher in children conceived by ICSI and in those born to women with the longest duration of infertility regardless of the method of conception. Fertility treatment is associated with a small but significant increase in the risk of a range of adverse obstetric outcomes, birth defects and longer term sequelae, but the biological basis for this is unknown. A growing evidence base suggests that epigenetics may play a role in subfertility and the link between fertility and health. In this retrospective cohort study of children born between 2002 and 2008, we measured DNA methylation in paternally expressed gene 3 (PEG3), insulin-like growth factor II (IGF2), SNRPN, long interspersed nuclear element 1 (LINE1) and the insulin gene (INS) in buccal cell DNA from children born following IVF (n = 49) and ICSI (n = 20) and compared them with a matched spontaneous conception group (n = 86). Participants were identified from the Aberdeen Maternity and Neonatal Databank and IVF and ICSI pregnancies were matched to spontaneous conception pregnancies on year of birth and maternal age at delivery. Only singleton pregnancies following fresh embryo transfer were included. DNA methylation was determined by pyrosequencing. Regression with adjustment for covariates was used to determine the effect of infertility on offspring DNA methylation. SNRPN methylation in the offspring was linked to fertility treatment in the parents. This effect was specific to children conceived using ICSI and was apparent in the comparison of ICSI versus spontaneous conception (1.03%; 95% CI 0.10, 1.97; P = 0.031), ICSI versus standard IVF (1.13%; 95% CI 0.04, 2.23; P = 0.043) and ICSI versus standard IVF and spontaneous conception (1.05; 95% CI 0.15, 1.94; P = 0.023). In all comparisons, the use of ICSI was associated with a higher level of SNRPN methylation in the offspring. A higher level of SNRPN methylation in the offspring was also associated with a longer duration of infertility in the parents. This was observed in all cases of infertility (0.18% per year of infertility; 95% CI 0.02, 0.33; P = 0.026) and after excluding ICSI cases (0.21% per year of infertility; 95% CI 0.04, 0.37; P = 0.017). There was a significant increase in the level of LINE1 methylation with age between birth and 7 years (0.77% per year; 95% CI 0.49, 1.05; P < 0.001). Methylation in the INS gene decreased significantly over the same period (-0.46% per year; 95% CI -0.89, -0.03; P = 0.035). There was no evidence from this cross-sectional data that methylation within the imprinted genes changed over the first 7 years of life. The ICSI sample size was limited but the groups were carefully selected and well matched and the SNRPN findings were consistent across different outcomes. The results of this study provide support for a role for epigenetics, and imprinting in particular, in fertility. The specific changes point to possible long-term consequences of fertility treatment for the health and fertility of future generations. The authors report no conflict of interest in relation to this work. Funding was provided by the University of Aberdeen and the Scottish Government. Not applicable.
    Preview · Article · May 2014 · Human Reproduction
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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.
    Full-text · Article · Mar 2014 · Gynécologie Obstétrique & Fertilité
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