Perinatal outcome after in-vitro fertilization-surrogacy

Abstract

The perinatal outcome of pregnancies (both single and multiple) established after in-vitro fertilization (IVF)-surrogacy was evaluated and compared to the outcome of pregnancies that resulted from standard IVF. Analysis of medical records and a telephone interview with physicians, IVF-surrogates, and commissioning mothers were conducted to assess prenatal follow up and delivery care in several hospitals. 95 IVF-surrogates delivered 128 liveborn (65 singletons, 27 sets of twins and two sets of triplets). The commissioning mothers and the IVF-surrogates average ages were 37.7 +/- 5.0 and 30.4 +/- 4.7 years old respectively. IVF-surrogates carrying twin and triplet gestations delivered substantially earlier than those who gestated singleton pregnancies (36.2 +/- 0.4 versus 35.5 versus 38.7 +/- 0.3 weeks gestation respectively; P < 0.001). Twin newborns were significantly lighter than singleton infants born through IVF-surrogacy (2.7 +/- 0.06 versus 3.5 +/- 0.07 kg; P < 0.001). The incidence of low birth weight infants rose from 3.3% in the single births to 29.6% (P < 0.01) in the twins and to 33.3% in the triplets born through IVF-surrogacy. The incidence of prematurity was significantly greater in both twins delivered by IVF-surrogates (20.4%) and infertile IVF patients (58%). The occurrence of pregnancy-induced hypertension and bleeding in the third trimester was four to five times lower in the IVF-surrogates, independently of whether they were carrying multiples. The incidence of Caesarean section was 21.3% for singleton gestations, while two times higher in the IVF-surrogates carrying multiples (56.3%). Postpartum complications occurred in 6.3% of patients and the incidence of malformation was similar to those reported for the general population. The results provide general reassurance regarding perinatal outcome to couples who wish to pursue IVF-surrogacy.

Surrogacy in modern obstetric practice

“…In a study comparing the perinatal outcome of pregnancies (both single and multiple) established after in-vitro fertilisation (IVF)esurrogacy with the outcome of pregnancies resulting from standard IVF [41], there was general reassurance regarding perinatal outcome. The incidence of malformation was similar to those reported for the general population.…”

Surrogate pregnancy: a guide for Canadian prenatal health care providers

“…Most case series report no increase in adverse events related to surrogate pregnancy. 10,[18][19][20][21][22] However, in a recent report, 2 of 9 surrogate mothers underwent postpartum hysterectomy: after a delivery of triplets with placenta accreta and after uterine rupture that occurred during delivery of a macrosomic infant. 23 The limited amount of evidence about the risks associated with surrogate pregnancy has 2 implications: (a) health care providers should have a high index of suspicion for complications and a low threshold for investigations and referral to higher levels of care; and (b) if complications occur, health care providers should report the complications to the centre that initiated the pregnancy so that surrogacy outcomes can be tracked and a better evidence base can be built.…”

“…10,21,22 The evidence is limited, but perhaps these theoretical concerns are not clinically relevant. An alternative explanation for the discrepancy between expert opinion and clinical experience is that thorough counselling before conception reduces psychological risk.…”

Might uterus transplantation be an option for uterine factor infertility?

“…Clues on the transplantation technique and improvements in immunosuppressive agents have enabled progression to the clinical research phase in the last two decades (8,9). Currently, uterine factor infertility patients can conceive through gestational surrogacy (10). Other indications of gestational surrogacy are history of recurrent miscarriage and implantation failure and deteriorating maternal diseases such as severe systemic lupus erythematosus, cardiac disorders, Takayasu's arteritis, history of breast cancer, hematological condition, pulmonary hypertension, residual pituitary macroadenoma, and brain tumor (10,11).…”

“…Currently, uterine factor infertility patients can conceive through gestational surrogacy (10). Other indications of gestational surrogacy are history of recurrent miscarriage and implantation failure and deteriorating maternal diseases such as severe systemic lupus erythematosus, cardiac disorders, Takayasu's arteritis, history of breast cancer, hematological condition, pulmonary hypertension, residual pituitary macroadenoma, and brain tumor (10,11). Results of many studies have shown that children born through vital organ tissue transplantation and immunosuppression or gestational surrogacy are healthy (12)(13)(14).…”