Complications in pregnancies after in vitro fertilization and embryo transfer

Kathpalia SK; Kapoor K; Atul Sharma

doi:10.1016/j.mjafi.2015.11.010

Assisted Reproduction · Safety and Risks

Complications in pregnancies after in vitro fertilization and embryo transfer

Kathpalia SK, Kapoor K, Sharma A

Published July 2016 Medical journal, Armed Forces India, 72(3), 211-4

DOI 10.1016/j.mjafi.2015.11.010 PMID 27546958 PMC PMC4982974

RRM Academy Synopsis

Multiple pregnancy was the commonest complication after IVF

Multiple pregnancy was the most common complication in 130 pregnancies after IVF at one tertiary care hospital in India. This case series had no comparison group. Of the 130 pregnancies, 42 were multiples, 28 ended in early birth and 43 in cesarean section.

Key Findings

Of the 130 pregnancies, 75 followed primary infertility and 55 followed secondary infertility. The women ranged in age from 23 to 41 years.
Ultrasound on day 21 showed 42 multiple pregnancies: 35 twin, 6 triplet and 1 quadruplet. Thirty-five cases delivered as twins, and one underwent fetal reduction.
Twenty-eight pregnancies delivered preterm. Forty-three ended in cesarean section, 19 elective and 24 emergency.
Among 149 babies born, 45 weighed less than 2 kg and 38 went to the NICU. The series recorded 8 perinatal deaths, including stillbirths and neonatal deaths.
Recorded complications included 25 threatened abortions, 17 cases of pregnancy-induced hypertension or pre-eclampsia, 8 of gestational diabetes and 4 ectopic pregnancies.

Interpretation

The study is a prospective observational case series from one hospital's ART center over two years. It enrolled 130 women with a positive pregnancy test after embryo transfer and had no control group. The authors compared their counts with published reports, so the series cannot show how much IVF changed any risk. They list maternal age, infertility itself and its treatment as possible contributors. They conclude these pregnancies can deliver vaginally and need larger studies with controls.

RRM Context

IVF goes around infertility without finding why conception fails. Women in this series reported past treatment for tuberculosis (39), an underactive thyroid (10) and endometriosis (4). Restorative reproductive medicine looks for causes like these in both partners first.

Our editorial summary of this paper, not the article's abstract.

Abstract

Background

Many infertile couples need treatment in different forms including Assisted Reproductive Techniques. In Vitro Fertilization and Embryo Transfer is the most advanced method of infertility treatment. Management of these pregnancies is difficult as the couples and treating doctors have undue concern and apprehension and worry about outcome of such pregnancies. This study was undertaken to find out the complications and mode of delivery and if there is a need to manage them at tertiary care centers.

Methods

130 cases were included in the study after pregnancy was confirmed in this prospective study. These cases were followed throughout pregnancy and labour. Pregnancy, labour, and neonatal complications were noted.

Results

Incidence of primary infertility was more common. Mean age of patient was more. All the cases were provided standard routine antenatal care. Multiple pregnancies and preterm labour were more frequent in the study group. A large number of cases delivered vaginally.

Conclusion

A large number of pregnancies terminated in vaginal delivery, thereby indicating that these pregnancies though high risk can have vaginal delivery. They can be managed at any hospital once clinical pregnancy is confirmed.

Topics

Assisted Reproduction › Safety and Risks › Neonatal and Birth Outcomes · Birth and Delivery › Birth Outcomes › Maternal Morbidity · Pregnancy › Pregnancy Complications › Premature Rupture of Membranes

Atul Sharma

A Sharma

PMID 27546958 27546958 DOI 10.1016/j.mjafi.2015.11.010 10.1016/j.mjafi.2015.11.010 Kathpalia et al. 2016, Kathpalia 2016

Keywords

Embryo transfer, In vitro fertilization, Infertility

Complications in pregnancies after in vitro fertilization and embryo transfer

Multiple pregnancy was the commonest complication after IVF

Key Findings

Interpretation

RRM Context

Abstract

Topics

Related research

Complications of pregnancy in infertile couples: routine treatment versus assisted reproduction

An audit of the obstetric outcome of 148 consecutive pregnancies from assisted conception: implications for neonatal services

Maternal morbidity and mortality in in-vitro fertilization

Complications of medically assisted conception in 3,500 cycles

Keywords