Fertility treatments and the risk of preterm birth among women with subfertility: a linked-data retrospective cohort study

Abstract

Background In vitro fertilization (IVF) births contribute to a considerable proportion of preterm birth (PTB) each year. However, there is no formal surveillance of adverse perinatal outcomes for less invasive fertility treatments. The study objective was to describe associations between fertility treatment (in vitro fertilization, intrauterine insemination, usually with ovulation drugs (IUI), or ovulation drugs alone) and preterm birth, compared to no treatment in subfertile women. Methods The Fertility Experiences Study (FES) is a retrospective cohort study conducted at the University of Utah between April 2010 and September 2012. Women with a history of primary subfertility self-reported treatment data via survey and interviews. Participant data were linked to birth certificates and fetal death records to asses for perinatal outcomes, particularly preterm birth. Results A total 487 birth certificates and 3 fetal death records were linked as first births for study participants who completed questionnaires. Among linked births, 19% had a PTB. After adjustment for maternal age, paternal age, maternal education, annual income, religious affiliation, female or male fertility diagnosis, and duration of subfertility, the odds ratios and 95% confidence intervals (CI) for PTB were 2.17 (CI 0.99, 4.75) for births conceived using ovulation drugs, 3.17 (CI 1.4, 7.19) for neonates conceived using IUI and 4.24 (CI 2.05, 8.77) for neonates conceived by IVF, compared to women with subfertility who used no treatment during the month of conception. A reported diagnosis of female factor infertility increased the adjusted odds of having a PTB 2.99 (CI 1.5, 5.97). Duration of pregnancy attempt was not independently associated with PTB. In restricting analyses to singleton gestation, odds ratios were not significant for any type of treatment. Conclusion IVF, IUI, and ovulation drugs were all associated with a higher incidence of preterm birth and low birth weight, predominantly related to multiple gestation births.

Incidence of complications among in vitro fertilization pregnancies

“…The prevalence of preterm birth in our study was much higher than the global prevalence, with a quarter (25.9%) of the newborns being preterm. Advanced maternal age is recorded in the literature as a risk factor for very premature birth, but in our study, there was no correlation between the age of mothers and prematurity [ 37 – 40 ]…”

Increased Risk of Cerebral Palsy in IVF/ICSI Babies: Meta analysis of Current Literature

“…(1-2) However, the topic of concern regarding the prevalence of congenital anomalies in pregnancies resulting from IVF and ICSI has been a topic of ongoing debate within the medical community (1)(2)(3)(4)(5). Potential hypotheses behind this phenomenon include factors such as maternal age at the time of IVF/ICSI, multiparity, and innate susceptibility to natural congenital pathologies (29)(30). Some causes of female infertility can predispose embryos to malformations and increase the risk of prematurity (30)(31).…”

“…Potential hypotheses behind this phenomenon include factors such as maternal age at the time of IVF/ICSI, multiparity, and innate susceptibility to natural congenital pathologies (29)(30). Some causes of female infertility can predispose embryos to malformations and increase the risk of prematurity (30)(31). Moreover, the risk of prematurity is heightened by multiparity, which is more prevalent in IVF/ICSI cases (28-31).…”

Nomogram for predicting the risk of preterm birth in women undergoing in vitro fertilization cycles

“…Previous studies have demonstrated that preterm birth is associated with many factors, such as maternal demographic characteristics, nutritional status, pregnancy history, adverse behaviors, and so on [ 6 ]. It was known that preterm birth was predominantly related to multiple gestation births, regardless of IVF cycles or intrauterine insemination (IUI) cycles [ 7 ]. Some researchers thought that the patient's own infertility factors might contribute to the preterm birth rather than the IVF procedures themselves [ 8 ].…”