Singh, N., Malhotra, N., Mahey, R., Patel, G., & Saini, M. (2023). In vitro fertilization as an independent risk factor for perinatal complications: Single-center 10 years cohort study. JBRA assisted reproduction. https://doi.org/10.5935/1518-0557.20220041
Singh N, Malhotra N, Mahey R, Patel G, Saini M. In vitro fertilization as an independent risk factor for perinatal complications: Single-center 10 years cohort study. JBRA assisted reproduction. 2023. doi:10.5935/1518-0557.20220041
Singh, Neeta, et al. "In vitro fertilization as an independent risk factor for perinatal complications: Single-center 10 years cohort study." JBRA assisted reproduction, 2023.
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RRM Academy Synopsis
IVF singleton pregnancies had four times the odds of preterm birth
In a retrospective cohort at one Indian tertiary center, IVF-conceived singleton babies had about four times the odds of preterm birth (aOR 4.004). The study compared 1,125 IVF births with 7,193 conceived without help. Low birth weight, NICU admission and neonatal seizures also had higher adjusted odds.
Key Findings
Low birth weight affected 572 (50.8%) of the IVF babies and 2092 (29.1%) of the spontaneously conceived babies; the adjusted odds ratio was 2.530 (95% CI 2.194-2.917).
Births at 34-37 weeks numbered 558 (49.6%) in the IVF group and 968 (13.5%) in the spontaneous group; births before 34 weeks numbered 202 (18%) and 412 (5.7%).
The adjusted odds ratio for preterm birth was 4.004 (95% CI 3.496-4.587). For NICU admission it was 2.003 (95% CI 1.610-2.492).
Neonatal seizures occurred in 73 (6.5%) of the IVF babies and 33 (0.5%) of the spontaneously conceived babies; the adjusted odds ratio was 9.805 (95% CI 5.755-16.706).
Neonatal death was similar between the groups (2.6% and 1.8%, p 0.079). Small for gestational age was not independently increased after adjustment (aOR 1.298, p 0.058).
Interpretation
The study is a retrospective cohort from one center, using data collected prospectively from 2011 to 2020. The IVF group held only successful fresh-transfer singleton pregnancies. Frozen transfers, donor oocyte cycles and mothers with listed medical disorders were excluded. Complete records existed for 8,318 of 10,360 eligible women. IVF mothers were older, with a mean age of 31 years against 26. The authors adjusted for the risk factors listed in each table and report associations. The authors cite earlier studies that name infertility itself and ovarian stimulation as possible contributors. They advise antenatal counseling and delivery at a tertiary center with NICU support.
RRM Context
IVF bypasses infertility and leaves the cause of it unexamined. The comparison women in this cohort conceived without help, so the infertility behind each IVF pregnancy is part of the exposure. Restorative reproductive medicine looks for that cause in both partners and treats it.
Our editorial summary of this paper, not the article's abstract.
Abstract
Assisted Reproductive Technology (ART) has made great strides in the past forty-years, but no medical treatment comes without side effects. Despite several studies reporting high incidences of perinatal complications, the association is inconclusive. Also, the effect of racially and ethnically distinguished Asian population undergoing ART on perinatal outcomes is not well studied. Therefore, this study attempts to compare various perinatal outcome parameters in ART, and spontaneously conceived singleton pregnancies from a single high-volume tertiary care center. This is a retrospective cohort study from a single tertiary infertility center, carried out from January 2011 to September 2020. The study included 1,125 IVF conceived babies (AB group) and 7,193 spontaneous conceived babies (SB group). The groups were compared using the Pearson Chi-square test and adjusted odds ratio, calculated using the multivariate analysis. Most of the perinatal complications, such as preterm birth (PTB), early preterm birth, low birth weight (LBW), extremely low birth weight, small for gestational age, large for gestational age babies, neonatal intensive care unit (NICU) admission, need for surfactant, meconium aspiration syndrome, neonatal seizures, intraventricular hemorrhage, hypoxic-ischemic encephalopathy, and patent ductus arteriosus was significantly increased in the AB group when compared to the SB group (p<0.05). In-vitro fertilization (IVF) independently increases the risk of LBW (aOR 2.530; 95% CI 2.194-2.917), PTB (aOR 4.004; 95% CI 3.496-4.587), NICU admission (aOR 2.003; 95% CI 1.610-2.492) and neonatal seizures (aOR 9.805; 95% CI 5.755-16.706).
Conclusions
All ART-conceived pregnant patients should receive antenatal counselling regarding perinatal complications and should deliver at a tertiary care center with appropriate NICU support.