Obstetric outcomes in pregnancies resulting from in vitro fertilization (IVF) are not different in fertile, sterilized patients compared to infertile women: a society for assisted reproductive technology (SART) database analysis

Abstract

This study aims to compare obstetric outcomes resulting from assisted reproductive technology (ART) in couples with a history of female sterilization compared to those with other infertility diagnoses. Retrospective Cohort Study. All 760,705 fresh, autologous embryo transfer cycles with partner ejaculated sperm from 2004 to 2013 in the SART database were reviewed. Cycles in women with prior female sterilization were compared to cycles with other infertility diagnoses. After excluding cycles with male sterilization, day of transfer >7, prior sterilization with an additional infertility diagnosis, and unknown method of ICSI or IVF, 4,174 cycles in patients with history of female sterilization were compared to 179,605 cycles in patients with other causes of infertility. Multiple linear regression analyses and generalized estimating equations were performed to assess whether gestational length and birthweight were significantly different between groups in singleton and twin pregnancies after controlling for BMI, age, parity, and type of ART procedure (traditional IVF vs ICSI). Previously sterilized women were older with significantly higher parity and body mass indices than women in couples with all other causes of infertility. Number of oocytes retrieved, timing of embryo transfer, pregnancy and live birth rates were not significantly different between the two groups. Women with a history of sterilization had significantly shorter gestations and lower birth weights than women with other causes of infertility. However, there was no significant difference between these groups after controlling for singleton and twin gestations except in birth weight for twins.Tabled 1All Women (N=183779)Women with history of female sterilization (N=4174)Women with all other causes of infertility (N=179605)P-ValueAge (years)35.281 ± 4.05934.507 ± 4.604<0.0001Parity2.425 ± 1.1720.469 ± 0.710<0.0001Body Mass Index (BMI) (kg/m2)27.155 ± 5.50225.414 ± 15.321<0.0001Number of oocytes retrieved12.734 ± 7.48612.817 ± 7.6980.4794Day of Embryo Transfer3.712 ± 1.0483.705 ± 1.0440.6583Clinical Pregnancy Rate Per Cycle, n (%)1864 (44.66%)81689 (45.48%)0.2897Live Birth Rate Per Cycle, n (%)1544 (36.99%)67972 (37.85%)0.2605Lengthof Gestation, days250.479 ± 1.046252.667 ± 1.3780.0364Singletons Twins270.220 ± 1.051270.662 ± 1.3420.6739236.024 ± 1.924239.780 ± 2.7820.0509Live Birth Weight, grams2100.348 ± 37.1292275.679 ± 53.150<0.0001Singletons Twins3027.401 ± 139.1713142.228 ± 177.8790.40931978.822 ± 48.0002140.158 ± 73.5060.0008 Open table in a new tab Evidence has linked pregnancies resulting from ART with increased risk of adverse obstetric outcomes, including low birthweight; however, it is unclear if this is due to the ART procedures or to subfertility itself.1 This study provides a rare opportunity to evaluate the effects of ART in a population without an underlying infertility diagnosis. This analysis demonstrates no significant differences in neonatal birthweight or gestational age among ART births from women with infertility and tubal sterilization. The results suggest that differences in outcomes between ART and natural conceptions may be due to the procedures of ART itself.