Differential effect of mode of conception and infertility treatment on fetal growth and prematurity

Abstract

Objectives To examine perinatal outcomes in pregnancies conceived by different methods: fertile women with spontaneous pregnancies, infertile women who achieved pregnancy without treatment, pregnancies achieved by ovulation induction (OI) and in vitro fertilization or intra-cytoplasmic sperm injection (IVF/ICSI). Methods Retrospective single-center cohort study including 200 fertile and 748 infertile women stratified according to infertility treatment. The outcome measurements were preterm delivery (PTD), small-for-gestational-age (SGA), gestational diabetes, placenta previa or preeclampsia. Results The overall rate of pregnancy complications was significantly increased in all infertility groups regardless of the infertility treatment (adjusted odds ratio (OR): infertile without treatment 2.3 versus OI 2.2 versus IVF/ICSI 3.4). While PTD was mainly associated to IVF/ICSI (adjusted OR: infertile without treatment 1.3 versus OI 1.6 versus IVF/ICSI 3.3), SGA was significantly associated to both OI and IVF/ICSI (adjusted OR: infertile without treatment 1.9 versus OI 2.7 versus IVF/ICSI 2.6). All these associations remained statistically significant after adjusting by maternal age and twin pregnancy. Conclusions This study confirms the higher prevalence of pregnancy complications in infertile women irrespectively of receiving infertility treatment or not, and further describes a preferential association of prematurity with IVF/ICSI, and SGA with treated infertility (OI and IVF/ICSI).

The Relationship of Assisted Reproductive Technology on Perinatal Outcomes in Triplet Gestations

“…Prior literature has shown that conception via ART is more detrimental that spontaneous conception. 15,16 Adverse effects of ART have been noted mainly in twin gestation studies and triplet studies when comparing chorionicity. 1,2,17 The biological plausibility is likely intrinsic to ART and maternal characteristics.…”

“…15 Other factors that may contribute to this theory include hormonal effects on the uterine lining, manipulation of the sperm and egg, in-vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) procedure itself, variations in the culture medium, length of time in culture, freezing and thawing mechanisms, delayed fertilization, medications used for stimulation, and luteal phase support. 13,15,16,18 The rising number of highorder gestation pregnancies can likely be attributed to mothers bearing children at an older age, widespread use of ART, and increased number of embryos being transferred. 6 Of the limited studies available, most are retrospective reviews with many focusing on twin gestation.…”

“…14 The initial study included 14 academic sites across the United States from 2004 to 2006. Briefly, gravid women with multiple gestation pregnancies between 16 and 20 weeks were randomized to receive 17P or placebo. Women were excluded if they had medical fetal reduction, major fetal anomalies, fetal death of either twin, presumed monoamniotic placenta, suspected twin-to-twin transfusion syndrome, growth discordance > 3 weeks, planned nonstudy progesterone therapy after 16 weeks, need for cerclage placement, major uterine anomaly, anticoagulation use, and chronic maternal diseases.…”

Association between infertility treatment and intrauterine growth: a multilevel analysis in a retrospective cohort study

“…For example, ovulation induction and fresh-embryo transfer are associated with an increased risk of small-for-gestational-age and lower birth weight compared with spontaneous conception. [5][6][7][8] As the use of FET is going to increase in the future, it is important to examine the association between FET and fetal growth. Several studies suggest that FET is associated with a higher birth weight Open access than spontaneous, fresh-embryo transfer and non-ART conceptions, 6 as well as with large-for-gestational-age neonates.…”

Maternal and perinatal characteristics of small-for-gestational-age newborns: Ten-year experience of a single center

“…In our study, the rates of ICSI pregnancies and major congenital anomalies/chromosomal anomalies/syndromes were significantly higher in the SGA group compared with the AGA group, in accordance with the literature ( 16 , 17 , 18 ). Zhu et al ( 18 ) and Valenzuela-Alcaraz et al ( 19 ) reported an increased incidence of SGA infants in women with a history of infertility with or without infertility treatment, and Valenzuela-Alcaraz et al ( 19 ) also described a preferential association of SGA with treated infertility, either by ovulation induction or ICSI. We were not able to compare the study and control groups with respect to this parameter because the history of infertility was not recorded in our data; thus, we can only say that ICSI is a risk factor for SGA, either by itself or due to the history of infertility, not specified in our study.…”