Abstract
BackgroundCouples are considered infertile if they do not conceive over a 12-month period of unprotected intercourse. Studies have shown that female causes accounted for between 25 to 37 percent of infertility worldwide (with larger proportions in sub-Saharan Africa and Southeast Asia) and male causes accounted for between 8 to 22 percent. Both male and female causes accounted for between 21 to 38 percent. Although the majority of ART children are normal, there are concerns about the increased risk for adverse pregnancy outcomes. More than 30 % of ART pregnancies are twins or higher-order multiple gestations (triplets or greater) and more than one half of all ART neonates are the products of multifetal gestations, with an attendant increase in prematurity complications. The aim of this study was to evaiuate the outcome of pregnancies conceived by In-vitro fertilisation compared to those conceived naturally in two hospitals in Douala, Cameroon.MethodsThis was a prospective study carried out from October 1, 2011 to September 30, 2012. Participants were recruited from two hospitals: the Douala General Hospital (DGH) and the Clinique de l’ Aéroport (CDA), also in Douala. A total of 102 women were recruited for study: 51 who conceived by IVF (cases) and 51 who conceived naturally (controls). Of the 102 women, 52.9 % were between 31 – 39 years of age, while 21.6 % were above 40.ResultsParticipants who conceived through IVF-ET were 4.1 times more likely to undergo cesarean delivery than those who conceived naturally [OR 4.10, 95 % CI 1.78–9.42]. Similarly, a higher percentage of patients in the IVF group than those in the control group have never given birth (33.3 % vs 2.0 %) (P < 0.0001). The percentage of multiple pregnancies was 7.5 times higher in the IVF group than in the control group (14.7 % vs.1.96 %) (P = 0.000).The leading indication for cesarean delivery was advanced maternal age (27.3 %) followed by IVF or precious pregnancy (18.2 %).ConclusionsCesarean delivery was more frequent amongst the IVF group than in the control group. The leading indications for cesarean delivery were advanced maternal age and IVF or precious pregnancy.The long-term neonatal outcomes of IVF babies beyond 5-min Apgar scores should be studied in Cameroon and follow-up beyond 1 year encouraged.
Highlights
Couples are considered infertile if they do not conceive over a 12-month period of unprotected intercourse
Controlled Ovarian Hyperstimulation (COH) in all patients was done with human menopausal gonadotropin after desensitization with triptorelin (GnRH-a) initiated in the luteal phase of the cycle
Women who conceived by In-Vitro Fertilization (IVF) were 4 times more likely to have a cesarean delivery than those who conceived normally
Summary
Couples are considered infertile if they do not conceive over a 12-month period of unprotected intercourse. With the introduction of IVF, there has been a higher rate of cesarean delivery among IVF cases than among women who conceived naturally (41.9 versus 15.5) [5]. This trend can be explained, on the one hand, by the excessive cautiousness of the obstetricians, and on the other by stress on the part of the couples caused by such things as birth trauma or fear of losing the baby. A similar trend in cesarean sections has been reported in Europe and the United States This rate has remained high over the years, in keeping with the marked increase in the number of IVF centers worldwide [3]
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