Perinatal outcome of 12 021 singleton and 3108 twin births after non-IVF-assisted reproduction: a cohort study

Abstract

Perinatal outcome of pregnancies caused by assisted reproduction technique (ART) is substantially worse when compared with pregnancies following natural conception. We investigated the possible risks of non-IVF ART on perinatal health. We conducted a retrospective cohort study with two exposure groups: a study group of pregnancies after controlled ovarian stimulation (COS), with or without artificial insemination (AI), and a naturally conceived comparison group. We used the data from the regional registry of all hospital deliveries in the Dutch-speaking part of Belgium during the period from January 1993 until December 2003 to investigate differences in perinatal outcome of singleton and twin pregnancies. 12 021 singleton and 3108 twin births could be selected. Naturally conceived subjects were matched for maternal age, parity, fetal sex and year of birth. The main outcome measures were duration of pregnancy, birth weight, perinatal morbidity and perinatal mortality. Our overall results showed a significantly higher incidence of prematurity (<32 and <37 weeks), low and very low birth weight, transfer to the neonatal intensive care unit and most neonatal morbidity parameters for COS/AI singletons. Twin pregnancies resulting from COS/AI showed an increased rate of neonatal mortality, assisted ventilation and respiratory distress syndrome. After excluding same-sex twin sets, COS/AI twin pregnancies were at increased risk for extreme prematurity and very low birth weight. In conclusion, COS/AI singleton and twin pregnancies are significantly disadvantaged compared to naturally conceived children.

Pregnancy and perinatal outcomes after assisted reproduction: a comparative study

“…It is hoped that future epidemiologic studies will address this issue. In the meantime, we agree with others [3,4] that in the absence of standardised protocols for the obstetric management of pregnancies conceived with IVF, it is prudent for such gestations to be regarded as high-risk. …”

The impact of ovarian stimulation for IVF on the developing embryo

“…The use of gonadotrophins for ovarian stimulation is the most important cause of multiple pregnancies in ART patients in the United States, with one-third of multiple pregnancies being caused by non-IVF ovarian stimulation (Ombelet et al 2006). Multiple pregnancies are associated with increased risk of miscarriage, growth retardation and preterm delivery (Fauser et al 2005).…”

“…Multiple pregnancies are associated with increased risk of miscarriage, growth retardation and preterm delivery (Fauser et al 2005). However, even singletons are at higher risk of low birthweight, premature birth and perinatal mortality and morbidity in the subfertile population using ART (Schieve et al 2002, Helmerhorst et al 2004, Jackson et al 2004, Kapiteijn et al 2006, Ombelet et al 2006. Mouse studies are concordant, as the mean weight of live foetuses was shown to be significantly lower for foetuses obtained from superovulated recipients, compared to that of those obtained from control recipients (Ertzeid & Storeng 2001).…”

Stillbirth incidence in Spain: A comparison of native and recent immigrant mothers

“…Statistics show that the perinatal outcome of pregnancies after such treatments is substantially less successful in comparison with those following natural conception (Ombelet et al 2006). In Spain delayed childbearing has increased the proportion of births for primiparous women over 35 and the frequency of multiple deliveries, due to the use of assisted reproductive technology (Fuster et al 2008).…”