Perinatal outcomes of intrauterine insemination/clomiphene pregnancies represent an intermediate risk group compared with in vitro fertilisation/intracytoplasmic sperm injection and naturally conceived pregnancies

Abstract

To compare the pregnancy outcomes in terms of perinatal morbidities and mortality for different types of assisted reproductive technology (ART). A retrospective cohort study was conducted of all babies born by ART in Singapore General Hospital, between 1 November 2001 and 11 January 2012. Incidence of ART was 3.5% in our birth cohort. Pregnancies conceived by ART were more likely to be multiple pregnancies OR 43.50, and were more likely to be premature OR 5.51. Mortality OR was 3.93. IVF/ICSI contributed to an increased OR for multiple gestation of 48.26, an increased OR for prematurity of 5.95 and increased OR for low birthweight of 5.54. Mortality OR was 4.33. Intrauterine insemination (IUI)/clomiphene may represent a lower risk group compared with in vitro fertilisation/intracytoplasmic sperm injection (IVF/ICSI). Prematurity OR was only 2.35, and low birthweight OR was 2.38. These were less than half of IVF/ICSI. Fewer neonatal morbidities were found. Mortality was insignificant. Multiplicity had significant impact on perinatal outcomes in ART and IVF/ICSI but not in IUI/clomiphene conceptions, demonstrated by singleton subgroup analyses and by logistic regression using prematurity as outcome. IUI/clomiphene represented an intermediate risk group compared with the IVF/ICSI.