Preimplantation genetic diagnosis: a national multicenter obstetric and neonatal follow-up study

Bay, Bjørn; Ingerslev, Hans Jakob; Lemmen, Josephine G.; Degn, Birte; Rasmussen, I.A.; Kesmodel, Ulrik Schiøler

doi:10.1016/j.fertnstert.2016.07.1092

Cited by 64 publications

(62 citation statements)

References 24 publications

(22 reference statements)

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“…Additionally, the study did not account for variations in obstetrical management. Compared with spontaneously conceived pregnancies, labour following ART pregnancies is more frequently induced, which again may be explained by increased prevalence of obstetrical risk factors or complications, or as a consequence of anxiety or maternal request. However, if unaccounted for, it may introduce survivorship bias and underestimation of the true risk of stillbirth, as it may lead to comparison of pregnancies following spontaneous conception with the remaining ongoing uncomplicated IVF pregnancies.…”

Section: Discussionmentioning

confidence: 94%

“…Correspondingly, IVF has been associated with increased risk of induction of labour. 2,8 When evaluating the risk of stillbirth at a given gestational age associated with IVF, failure to account for induction of labour, or the reason hereof, may lead to underestimation of the true association, as it may give rise to comparison of pregnancies following spontaneous conception with the remaining on-going uncomplicated IVF pregnancies. Thus, for the uncomplicated majority of IVF pregnancies, the risk of stillbirth at term is still controversial.…”

Section: Introductionmentioning

confidence: 99%

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Risk of stillbirth in low‐risk singleton term pregnancies following fertility treatment: a national cohort study

Bay

Boie

Kesmodel

2018

BJOG

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Objective To assess the risk of stillbirth in low‐risk in vitro fertilisation (IVF) pregnancies. Design Register‐based national cohort study. Setting Denmark 2003–2013. Population Cohort of 425 732 singleton pregnancies including 10 235 conceived following IVF/intracytoplasmic sperm injection (ICSI), 4521 conceived following intrauterine insemination (IUI), and 410 976 spontaneously conceived. Methods Information on pregnancy, obstetrical risk factors, stillbirth, and fertility treatment was obtained from the Danish national health registers for all pregnancies after gestational week 21+6. We estimated the overall and gestational age‐specific risk of stillbirth in low‐risk term pregnancies following IVF, ICSI, and IUI. Further, we estimated the association between stillbirth and IVF and ICSI respectively as well as fresh or frozen‐thawed embryo transfer. Main outcome measures Risk of stillbirth. Results The number of stillbirths in spontaneously conceived and IVF/ICSI low‐risk term pregnancies was 525 (0.1%) and 35 (0.3%), respectively. In multivariate analysis, the risk of stillbirth in pregnancies following IVF/ICSI was increased (odds ratio 2.1, 95% CI 1.4–3.1). The risk of stillbirth was correspondingly increased in time‐to‐event analyses taking risk time for each fetus into account from gestational week 37 and onwards (hazard ratio 2.4, 95% CI 1.6–3.6). In sub‐analyses, the risk of stillbirth was increased for pregnancies following ICSI (odds ratio 2.2, 95% CI 1.2–3.1), but not IVF (odds ratio 1.7, 95% CI 0.9–3.1). Conclusion We found a systematically increased risk of stillbirth in low‐risk term pregnancies following IVF/ICSI. Whether the risk was related to the treatment or to underlying subfertility is uncertain. The results may indicate a need for obstetrical surveillance for these pregnancies when reaching term. Tweetable abstract Increased risk of stillbirth in low‐risk term pregnancies following fresh cycle IVF/ICSI.

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Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Risk of stillbirth in low‐risk singleton term pregnancies following fertility treatment: a national cohort study

Bay

Boie

Kesmodel

2018

BJOG

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“…On the other hand, no difference in any perinatal outcome was observed in women aged more than 35 years according to PGD indication [134]. Another recent multicenter-cohort study confirmed that the risk of adverse perinatal outcomes was mainly related to the underlying parental conditions rather than the PGD procedure [135]. In fact, after stratification of data for PGD indication, adverse obstetric and neonatal outcomes were only present in children conceived by PGD due to parental monogenetic disorder but not in children conceived after PGD due to parental chromosomal aberrations [135].…”

Section: Resultsmentioning

confidence: 99%

“…Another recent multicenter-cohort study confirmed that the risk of adverse perinatal outcomes was mainly related to the underlying parental conditions rather than the PGD procedure [135]. In fact, after stratification of data for PGD indication, adverse obstetric and neonatal outcomes were only present in children conceived by PGD due to parental monogenetic disorder but not in children conceived after PGD due to parental chromosomal aberrations [135]. Nevertheless, there was a consistent risk of placenta previa (aOR 9.1, 95 % CI 3.4 to 24.9) after PGD and IVF/ICSI, suggesting that parental factors cannot explain all adverse outcomes [135].…”

Section: Resultsmentioning

confidence: 99%

Risk of adverse pregnancy and perinatal outcomes after high technology infertility treatment: a comprehensive systematic review

Palomba

Homburg

Santagni

et al. 2016

Reprod Biol Endocrinol

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In the literature, there is growing evidence that subfertile patients who conceived after infertility treatments have an increased risk of pregnancy and perinatal complications and this is particularly true for patients who conceived through use of high technology infertility treatments. Moreover, high technology infertility treatments include many concomitant clinical and biological risk factors. This review aims to summarize in a systematic fashion the current evidence regarding the relative effect of the different procedures for high technology infertility treatments on the risk of adverse pregnancy and perinatal outcome. A literature search up to August 2016 was performed in IBSS, SocINDEX, Institute for Scientific Information, PubMed, Web of Science and Google Scholar and an evidence-based hierarchy was used to determine which articles to include and analyze. Data on prepregnancy maternal factors, low technology interventions, specific procedures for male factor, ovarian tissue/ovary and uterus transplantation, and chromosomal abnormalities and malformations of the offspring were excluded. The available evidences were analyzed assessing the level and the quality of evidence according to the Oxford Centre for Evidence-Based Medicine guidelines and the Grading of Recommendations Assessment, Development, and Evaluation system, respectively. Current review highlights that every single procedure of high technology infertility treatments can play a crucial role in increasing the risk of pregnancy and perinatal complications. Due to the suboptimal level and quality of the current evidence, further well-designed studies are needed.

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“…Reports on neonatal outcomes and obstetrical complications of PGT pregnancies are limited. [76][77][78][79][80][81][82] Some studies have evaluated the effects of embryo biopsy without distinction between PGT-M and PGT-A. 77,80 It is necessary to consider that the technical procedures for PGT-M and PGT-A are similar, while the indication for these techniques is not.…”

Section: Obstetrical and Perinatal Outcomesmentioning

confidence: 99%

Assessment of pre‐implantation genetic testing for embryo aneuploidies: A SWOT analysis

et al. 2019

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The recently re‐named pre‐implantation genetic testing for determining embryo aneuploidies (PGT‐A) is presently very popular although its acceptance by the scientific community is controversial. This approach still encounters drawbacks. This paper uses a SWOT (strengths, weaknesses, opportunities and threats) analysis to discuss salient points to be considered when examining the pre‐implantation genetic testing (PGT‐A) strategy to gather information from a range of perspectives. One of the strengths associated with the procedure is represented by an increase in implantation rate although data from the highest level of evidence do not support an increase in cumulative pregnancy rates. The current difficulty in the management of mosaicisms represents a weakness of PGT‐A. The application of the strategy represents an opportunity to favor the single embryo transfer while other advantages, such as reduction of time to pregnancy and emotional distress are controversial. Potential important threats, at present still undefined, are represented by the biopsy‐related damage to the blastocyst and the impact on neonatal and long‐term outcomes.

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Preimplantation genetic diagnosis: a national multicenter obstetric and neonatal follow-up study

Abstract: In this cohort study, the risk of adverse obstetric and neonatal outcomes was mainly related to the underlying parental condition rather than the PGD procedure.

Cited by 64 publications

References 24 publications

Risk of stillbirth in low‐risk singleton term pregnancies following fertility treatment: a national cohort study

Risk of stillbirth in low‐risk singleton term pregnancies following fertility treatment: a national cohort study

Risk of adverse pregnancy and perinatal outcomes after high technology infertility treatment: a comprehensive systematic review

Assessment of pre‐implantation genetic testing for embryo aneuploidies: A SWOT analysis

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