O-159: Singleton and twin pregnancies after assisted reproduction (IVF And non-IVF): A risk pregnancy is born!

Abstract

To investigate the perinatal morbidity and mortality of singleton and twin babies born after assisted reproduction (ART). Although non-IVF hormonal treatment is the most commonly performed infertility treatment worldwide, the majority of data reported on perinatal health of babies born after ART only include IVF and ICSI-pregnancies. In this cohort study we compared the perinatal outcome of babies born after IVF/ICSI, non-IVF (ovarian stimulation with or without artificial insemination) and natural conception (NC). The main outcome measures were gestational age, birth weight, admission to the neonatal intensive care unit (NICU), perinatal mortality and perinatal morbidity including convulsions, intracranial bleeding and assisted ventilation A retrospective cohort study of nearly all deliveries in Flanders (Belgium) from 1993 until 2004 to compare perinatal parameters of babies born after IVF/ICSI, non-IVF and natural conception. In Flanders, the Study Centre for Perinatal Epidemiology collects data on the obstetric history and perinatal events of each hospital delivery of > 21 weeks of gestational age and ≥ 500 grams at birth. Full cooperation of all 80 departments of Obstetrics in Flanders has been established since 1993. Quality of data is controlled on a full time basis through checking of the incoming records for internal inconsistencies, exactness and completeness. Correction and completion is assured by telephone calls, additional questionnaires and visits to the local departments. The data manager visits ad random the 80 maternity units to operate a double check. A total number of 691,228 births were investigated. We studied the perinatal outcome of 642,613 singletons (8,995 IVF/ICSI, 13,195 non-IVF, 642,613 NC) and 25,313 twins (6,118 IVF/ICSI, 3,349 non-IVF, 15,846 NC). Logistic regression analysis included mode of conception, female age, fetal sex, parity and year of delivery. For the statistical analysis comparing perinatal outcome differences between IVF/ICSI, non-IVF and naturally conceived births after adjustment for the different confounding factors, we used the odds-ratio, 95 % confidence interval and its corresponding p-values. IVF/ICSI singletons had a significantly worse outcome when compared to non-IVF and NC for almost all investigated perinatal parameters. Non-IVF singletons were also significantly disadvantaged for birthweight and prematurity when compared to NC. Non-IVF singletons had a better outcome for most perinatal parameters when compared to IVF/ICSI. The outcome of twin pregnancies was similar for the three groups unless only the unlike-sex twins were studied separately. Among this subgroup, IVF/ICSI carried a higher risk for low birth weight when compared to NC and non-IVF unlike-sex twins were also at increased risk for low birth weight and perinatal mortality if compared to NC. Not only multiple births are responsible for the poor perinatal outcome after assisted reproduction. Singletons born after assisted reproduction are also at increased risk when compared to natural conception babies. Singletons after IVF/ICSI have a worse prognosis compared to non-IVF. Our data also show that non-IVF infertility treatment is also responsible for a large part of the adverse outcome associated with ART-related pregnancies. Unlike-sex ART-twins were at increased risk for low birth weight and perinatal mortality if compared to NC.