Barnhart, K. T. (2013). Assisted reproductive technologies and perinatal morbidity: interrogating the association. Fertility and Sterility, 99(2), 299-302. https://doi.org/10.1016/j.fertnstert.2012.12.032
Barnhart KT. Assisted reproductive technologies and perinatal morbidity: interrogating the association. Fertility and Sterility. 2013;99(2):299-302. doi:10.1016/j.fertnstert.2012.12.032
Barnhart, Kurt T. "Assisted reproductive technologies and perinatal morbidity: interrogating the association." Fertility and Sterility, vol. 99, no. 2, 2013, pp. 299-302.
IVF is associated with preterm birth and low birth weight in babies
A 2013 review that opens a journal series concludes that the link between IVF and complications around birth appears real in many studies. In 2009 CDC data on US births, 33 out of 100 ART infants were born preterm, against 12 out of 100 in the general US birth population.
Key Findings
The CDC counted 146,244 ART procedures in 2009. They led to 60,190 infants born in 45,870 live-birth deliveries, which was 1.4% of U.S. births.
Preterm birth affected 33.4% of US infants conceived with ART and 12.2% of the general birth population. Very preterm birth was 6.1% for ART infants and 2% for the general population.
Multiple births made up 47% of infants conceived with ART and 3% of the general birth population. The review says most of this preterm risk is due to multiple births.
A cited meta-analysis of singleton births found elective cesarean twice as likely after IVF. The infants were 60% more likely to receive overnight NICU observation.
In the studies the review cites, babies from fresh embryo transfer most consistently had more perinatal morbidity, especially low birth weight, than babies from frozen transfer.
Interpretation
The article introduces a series of journal articles and presents no new data. The CDC figures are national counts from 2009. The author lists ways the link could be distorted: infertility itself, time to conceive, ovulation induction, extra monitoring of IVF pregnancies, and differences between the groups compared. A randomized trial would be impractical and may be unethical, the author writes, so the evidence is observational. Effects on childhood development and metabolism have not been established. The size of the risk has not been precisely identified for women overall or for specific subgroups.
RRM Context
A Finnish study cited in the review linked a time to conceive beyond 6 months without medical help to more preterm birth. An Australian study linked infertility to low birth weight and perinatal mortality in women who conceived without IVF. The author ends by saying that improving the environment at conception will likely affect gestation and children's health. Restorative reproductive medicine evaluates why conception is not occurring and treats that cause.
Our editorial summary of this paper, not the article's abstract.
Abstract
Interrogating the association between assisted reproductive technologies (ART) and perinatal outcome is complicated but very important. This is an introduction to a series of articles that review this potential association with an eye toward etiology of risk, and what aspects of in vitro fertilization (IVF) can be modified to reduce this risk. When an association is not due to chance (i.e., statistically significant), one must also consider how the association may be affected due to bias or confounding. Despite lack of the perfect study, perinatal consequences of ART are apparent, even though the vast majority of children conceived with ART are healthy. Pregnancy after IVF is altered as evidenced by risk of preterm delivery, low birth weight among infants, and an alerted prevalence of preeclampsia. The long-term clinical implications of ART, such as childhood development and metabolism, have not been established and ongoing study is proceeding. The risk attributed to multiple births is iatrogenic and needs to be minimized. Optimizing the environment at the time a woman conceives will likely have an effect on gestation as well as the health of children. Reproduction effects health and health effects reproduction.
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