Abstract
OBJECTIVE: The aim was to determine which factors affect adverse birth outcomes of singletons after ART including low birthweight (LBW<2.5kg), preterm birth (PTB<37weeks), and perinatal death (PND, stillbirth or neonatal death <28 days). DESIGN: A record linkage study of birth information in the Victorian Perinatal Data Collection Unit linked to all the Melbourne ART centers' patients between 1991-2004 who delivered singletons of 20 or more weeks gestation. MATERIALS AND METHODS: Data were compared for the first singleton births from IVF or ICSI fresh and frozen (FET) embryo transfers with those of two control groups: 1. women seen for infertility but who conceived without ART (non ART) and 2. fertile controls from the general population matched 3:1 by age and year of parturition. Analysis included logistic regression to adjust for covariates. RESULTS: LBW, PTB and PND were significantly more frequent with fresh embryo transfers than in the control general population (Table 1). The higher LBW and PTB rates with FET and non ART were not significant after covariates such as parity were adjusted for by regression analysis but the results with fresh transfers remained highly significant. CONCLUSIONS: These results suggest the adverse birth outcomes of ART are associated with fresh embryo transfers and therefore embryology laboratory procedures affecting the embryos are not the cause because they are not seen with FET. The adverse effects must operate via the woman. If these involve ovarian stimulation or anesthesia for oocyte collection they may be able to be modified to improve birth outcomes. The other implication is that FET should be more widely used.Table 1Frequencies (number and (%)) of low birthweight (LBW), preterm birth (PTB), and perinatal death (PND) in singleton births after fresh (IVF/ICSI) and frozen embryo transfers (FET), non ART conceptions in women seen for infertility (non ART), and natural conceptions in the general population (Control)GroupLBWPTBPNDTotalIVF/ICSI469 (11.0)a527 (12.3)a80 (1.87)a4279FET163 (6.5)b237 (9.4)b29 (1.16)b2510Non ART149 (6.9)b177 (8.2)b27 (1.24)b2169Control1260 (5.1)c1519 (6.2)c224 (0.81)b24646Percentages with different letters are significantly different (p<0.05). Open table in a new tab Percentages with different letters are significantly different (p<0.05).
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