Factors influencing adverse perinatal outcomes in pregnancies achieved through use of in vitro fertilization
Presented at the 61st Annual Meeting of the American Society for Reproductive Medicine, Montreal, Canada.
Received 28 September 2005; received in revised form 19 April 2006; accepted 19 April 2006. published online 30 October 2006.
Objective
To determine the associations of specific components of IVF treatment with abnormal perinatal outcomes.
Design
Case-control study.
Setting
University-based and community-based infertility centers.
Patient(s)
All viable pregnancies achieved through IVF procedures performed between January 1999 and March 2004.
Intervention(s)
None.
Main Outcome Measure(s)
Infertility etiology, gonadotropin exposure, embryo manipulation, and quality.
Result(s)
Of 455 viable pregnancies identified during the study period, 435 met inclusion criteria. While adjusting for maternal age, race, parity, body mass index, infertility center, and year of IVF procedure, multiple gestations were associated with a 12-fold increased risk of poor perinatal outcome compared to singletons. Ovarian hyperstimulation syndrome significantly increased the risk more than 3-fold (odds ratio = 3.14; 95% confidence interval, 1.08–9.14), while endometrial thickness was found to have a significant protective effect (odds ratio = 0.89; 95% confidence interval, 0.80–0.99). We found no effect of etiology of infertility, dose or type of medication used for stimulation, use of embryo-manipulation techniques, or quality on perinatal outcome.
Conclusion(s)
These data confirm and quantify the risk of perinatal morbidity associated with multiple births. After adjusting for multiple births, ovarian hyperstimulation syndrome and suboptimal endometrial development are associated with adverse outcomes in pregnancies achieved through IVF. Our findings suggest that it may be the endometrium rather than the embryo that influences fetal growth and perinatal outcomes after IVF.
aDivision of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania
bCenter for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania
cNorthern Fertility and Reproductive Associates, Meadowbrook, Pennsylvania
dDivision of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Temple University, Philadelphia, Pennsylvania
Reprint requests: Karine Chung, M.D., M.S.C.E., LAC-USC Women’s and Children’s Hospital, 1240 N. Mission Road, Room 8K9, Los Angeles, California 90033 (FAX: 323-226-2850).
Supported by National Institutes of Health grant T32 for Reproductive Epidemiology to the University of Pennsylvania.
ABSTRACT