Abstract
Objective:To study which factors affect perinatal outcomes in intracytoplasmic sperm injection (ICSI) cycles.Methods:Data was obtained from 402 live births born to 307 patients undergoing ICSI cycles in a private university-affiliated IVF center between Jan/2014 and Dec/2015. The influences of the cycles' characteristics on the number of gestational weeks to livebirth (GW), baby birth weight (BW), and baby birth length (BL) were evaluated by linear regression models, adjusted for maternal age and body mass index, number of transferred embryos, number of gestational sacs, and number of born infants. In a subsequent analysis, GW, BW and baby sex were utilized for cycle classification into the groups Appropriate for gestational age (AGA n=256) and Small for gestational age (SGA n=146), which were compared by general linear models adjusted for the same confounder variables.Results:The number of follicles (β=-0.069 p=0.018) and retrieved oocytes (β=-0.087 p=0.049) were negatively correlated with BL. The endometrial thickness was positively correlated with GW (β=0.198 p=0.003) and BW (β=28.351 p=0.044). When each baby was classified into AGA and SGA groups, it was observed that SGA babies were derived from cycles with higher estradiol levels at hCG day (SGA: 3897.01±550.35 vs. AGA: 2324.78±101.86 p=0.006) and higher number of retrieved oocytes (SGA: 16.70±1.78 vs. AGA: 12.92±0.42 p=0.042). The endometrial thickness was significantly lower in the SGA group (SGA: 10.2±0.23 vs. AGA: 11.68±0.17 vs. p=0.029).Conclusion:Higher ovarian response to stimulation and suboptimal endometrial development are associated with adverse perinatal outcomes in ICSI cycles.
Highlights
Despite assisted reproduction techniques (ART) have advanced significantly since the first in vitro fertilization baby was born, many issues related to the health of ART babies have been raised
Higher ovarian response to stimulation and suboptimal endometrial development are associated with adverse perinatal outcomes in intracytoplasmic sperm injection (ICSI) cycles
Reports comparing babies born from natural pregnancies and those born from assisted reproduction showed correlations between ART pregnancies and worse perinatal outcomes, for instance, preterm birth, low birth weight, small for gestational age, and perinatal mortality (Fauser et al, 2014; Helmerhorst et al, 2004; Ombelet et al, 2016; Pandey et al, 2012; Sunkara et al, 2015)
Summary
Despite assisted reproduction techniques (ART) have advanced significantly since the first in vitro fertilization baby was born, many issues related to the health of ART babies have been raised. Intrinsic parental characteristics must influence baby birth and health; they are insufficient to explain the differences between babies born from natural or assisted pregnancies, considering that, comparing sons born to the same mother, the ART singleton baby tend to have more perinatal complications than non-ART sibling (Hayashi et al, 2012; Henningsen et al, 2011; Kapiteijn et al, 2006; Pandey et al, 2012; Pinborg et al, 2013). The direct correlation between COS and perinatal outcomes is still characterized by contradictions: when the effects of COS were adjusted for biological and social confounders, such as mother's weight and height, duration of infertility, ethnicity, and level of education, it no longer influenced birth weight and other neonatal characteristics (Griesinger et al, 2008; Pelinck et al, 2010; Sunkara et al, 2016)
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