Tubal factor infertility is associated with an increased risk of preterm birth compared with male factor infertility

Abstract

PRETERM BIRTH COMPARED WITH MALE FACTOR INFERTILITY ALISON STUEBE, MEHMET GENC, THOMAS MCELRATH, Brigham and Women’s Hospital, Harvard Medical School, Department of Obstetrics and Gynecology, Boston, Massachusetts OBJECTIVE: Several studies have documented an association between ART and poor obstetrical outcomes in singleton pregnancies. We hypothesized that the pathophysiology that led to tubal factor infertility (TFI) may increase a woman’s risk of preterm birth compared with women undergoing IVF for male factor infertility (MFI). STUDY DESIGN: We studied singleton IVF pregnancies among women who delivered at Brigham and Women’s Hospital between 1995 and 2000. Univariate analyses were conducted to compare the risk of preterm birth among women diagnosed with TFI vs. MFI. Multivariate logistic regression analysis was performed to control for other confounding factors. RESULTS: Of 495 women who underwent IVF and delivered singleton infants, 111 carried a diagnosis of TFI, and 126, MFI. The risk of birth prior to 37, 32, and 28 weeks of gestation was significantly higher among cases of TFI as compared to those of MFI (Table). We also found a higher rate of spontaneous preterm birth among TFI vs. MFI women at !32 weeks (6.3% vs. 0%, p=0.005) and !28 weeks (4.5% vs. 0%, p=0.02). TFI remained associated with an increased risk of birth at less then 37 (OR 2.16; 95% CI, 1.06-5.44), 32 (OR 5.94; 95% CI, 2.02-17.48), and 28 weeks of gestation (OR 4.81; 95% CI, 1.49-15.49), adjusting for maternal age, parity, ovulation induction, and other concurrent infertility diagnoses. CONCLUSION: Compared with MFI, we observed an increased association between TFI and preterm birth. The higher incidence of spontaneous preterm birth in the TFI group supports our hypothesis that the pathological events that led to TFI may also play a role in the pathogenesis of preterm birth.