Les grossesses issues de l’assistance médicale à la procréation se compliquent-elles plus que les grossesses spontanées ? Étude rétrospective sur six ans

Abstract

Comparison of pregnancy pathologies (diabetes, high blood pressure, preeclampsia), the stages of delivery, the weight at birth, the method of delivery, and the neonatal outcome for spontaneous pregnancies, and pregnancies from assisted reproductive technology (ART) obtained by in vitro fertilization (IVF), by intra cytoplasmic sperm injection (ICSI) or intrauterine insemination (IUI) or ovulation induction. A retrospective study over 6 years from January 1st, 2003 and December 31st, 2008 including all births at Jean-Verdier hospital in Bondy, France (n=14,049) taking into account therapeutic abortions, late miscarriages and intrauterine fetal deaths. The population was divided into four groups: spontaneous pregnancies (SP), pregnancies resulting from IVF, those obtained by ICSI and those obtained by other modes of "simple" ART. The distribution of the four populations is: SP: 96.5%, IVF: 1.20%, ICSI: 0.95% and other modes of "simple" ART: 1.35%. There is no significant difference in rates of high blood pressure, preeclampsia, HELLP syndrome, therapeutic abortions and intrauterine fetal deaths between the four populations studied. In contrast, ICSI has a rate of gestational diabetes significantly lower compared to the other three groups (6.7%). The terms of delivery are later and birth weight heavier for spontaneous pregnancies (P<0.05). For the singletons, the terms of delivery are later for "heavy" ART (IVF/ICSI) than for SP (P<0.05). For twins' birth weights, we notice that they are heavier for ICSI (P<0.05) and the terms of delivery are identical between the SP and heavy ART. Our study showed no obstetrical complications for the heavy ART (IVF/ICSI). Pregnancies resulting from ICSI are more favourable than those from IVF and the most unfavourable are the one obtained by simple ART.