Abstract
BackgroundSeveral studies have shown that newborns conceived through the ART procedures were associated with an increased incidence of preterm delivery compared to those conceived spontaneously regardless of the type of ART procedure. The aim of the study was to explore risk factors for preterm birth (PTB) in assisted reproductive technology.MethodIn this single center retrospective cohort study, a total of 23,111 singleton newborns from January 2010 to December 2018 were included. The primary outcome in this study was preterm birth, defined as live birth before 37 weeks’ gestation.ResultIn the 23,111 pregnancies, the incidence of PTB was 7.13%. In multivariate logistic regression analysis model, BMI was an independent predictor for PTB (OR = 1.05, 95% CI: 1.03–1.07; P = 0.00 in IVF/ICSI cycles; OR = 1.08, 95% CI: 1.03–1.12; P = 0.00 in IUI cycles). Also, another independent predictor in ART was male newborns (OR = 1.27, 95% CI: 1.14–1.41; P = 0.00 in IVF/ICSI cycles; OR = 1.60, 95% CI: 1.17–2.18; P = 0.00 in IUI cycles). In IVF/ICSI cycles, PTB was significantly higher in patients with advanced age (9.56% in ≥ 38 years old), and in patients with a history of cesarean section (10.39%). In addition, Blastocyst transfer, and frozen thawed transfer were also risk factor for PTB as compared with cleavage transfer, and fresh transfer, respectively. Moreover, in frozen thawed transfer cycles, stimulated protocol (estrogen-progesterone) increased PTB as compared with natural protocol (OR = 1.33, 95% CI: 1.12–1.59; P = 0.00). This situation was similar in IUI cycles as stimulated protocol also increased PTB when compared with natural protocol (OR = 1.72, 95% CI: 1.19–2.48; P = 0.00).ConclusionBody mass index (BMI), delivery with male newborn, as well as stimulated protocols, were independent risk factors for PTB in both IVF/ICSI and IUI treatment cycles. In IVF/ICSI cycles, independent risk factors also included maternal, history of cesarean section, frozen thawed transfer, and blastocyst transfer.
Highlights
There are more and more infertile couples getting their own babies by assisted reproductive technology (ART)
Several other reports are not in line with this study [3, 6, 7]. Another large sample retrospective analysis involved 67,147 in vitro fertilization/ intracytoplasmic sperm injection (IVF/ICSI) cycles reporting there was no significant difference in the risk of Preterm birth (PTB) after blastocyst stage embryo transfer compared with cleavage stage group [8]
PTB was different in patients according to Maternal age, Body mass index (BMI), Infertility diagnosis, History of cesarean section, Type of embryo transfer, Stage of embryo, Number of embryos transferred (Table 1)
Summary
There are more and more infertile couples getting their own babies by assisted reproductive technology (ART). Several possible factors such as embryo culture medium, in vitro culture to blastocyst stage, as well as embryo cryopreservation, might be related to PTB in couples treating with ART. Several other reports are not in line with this study [3, 6, 7] Another large sample retrospective analysis involved 67,147 in vitro fertilization/ intracytoplasmic sperm injection (IVF/ICSI) cycles reporting there was no significant difference in the risk of PTB after blastocyst stage embryo transfer compared with cleavage stage group [8]. The aim of the study was to explore risk factors for preterm birth (PTB) in assisted reproductive technology
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