Assisted Reproductive Technology Pregnancies Research Articles

The influence of obesity on perinatal outcomes in pregnancies achieved with assisted reproductive technology: A population-based retrospective cohort study.

To determine the influence of obesity on neonatal outcomes of pregnancies resulting from assisted reproductive technology. Population-based retrospective cohort study of all non-anomalous, live births in Ohio from 2007 to 2011, comparing differences in the frequency of adverse neonatal outcomes of women who conceived with assisted reproductive technology versus spontaneously conceived pregnancies and stratified by obesity status. Primary outcome was a composite of neonatal morbidities defined as ≥1 of the following: neonatal death, Apgar score of <7 at 5 min, assisted ventilation, neonatal intensive care unit admission, or transport to a tertiary care facility. Rates of adverse neonatal outcomes were significantly higher for assisted reproductive technology pregnancies than spontaneously conceived neonates; non-obese 25% versus 8% and obese 27% versus 10%, p < 0.001. Assisted reproductive technology was associated with a similar increased risk for adverse outcomes in both obese (adjusted odds ratio (aOR): 1.33, 95% confidence interval (CI): 1.11-1.59) and non-obese women (aOR: 1.34, 95% CI: 1.18-1.51) even after adjustment for coexisting risk factors. This increased risk was driven by higher preterm births in assisted reproductive technology pregnancies; obese (aOR: 1.06, 95% CI: 0.86-1.31) and non-obese (aOR: 1.15, 95% CI: 1.00-1.32). Assisted reproductive technology is associated with a higher risk of adverse neonatal outcomes. Obesity does not appear to adversely modify perinatal risks associated with assisted reproductive technology.

The meaning of anti-Müllerian hormone levels in patients at a high risk of poor ovarian response

Measurements of ovarian reserve play an important role in predicting the clinical results of assisted reproductive technology (ART). The ideal markers of ovarian reserve for clinical applications should have high specificity in order to determine genuine poor responders. Basal follicle-stimulating hormone levels, antral follicle count, and serum anti-Müllerian hormone (AMH) levels have been suggested as ovarian reserve tests that may fulfill this requirement, with serum AMH levels being the most promising parameter. Serum AMH levels have been suggested to be a predictor of clinical pregnancy in ART for older women, who are at a high risk for decreased ovarian response. We reviewed the prognostic significance of ovarian reserve tests for patients undergoing ART treatment, with a particular focus on the significance of serum AMH levels in patients at a high risk of poor ovarian response.

Prognostic factors for a favorable outcome after varicocele repair in adolescents and adults.

The effect of varicocele repair on male fertility remains controversial. It would be helpful to determined which men would benefit most from varicocele repair, and target repair efforts at those individuals. A detailed review of the literature on prognostic factors for varicocele repair was performed using the PubMed NLM database. We found that the best predictor of postvaricocelectomy semen parameters is the preoperative semen parameters. The greatest improvements in semen parameters were found in men with larger varicoceles. While there is controversy, higher testosterone, younger age and larger testis size, in some studies predict for improvements in semen parameters postvaricocelectomy. A nomogram has been developed to predict the postvaricocelectomy semen parameters based on the preoperative semen parameters, varicocele grade and the age of the man (www.fertilitytreatmentresults.com). Limited data consistently demonstrates the greatest improvements in DNA fragmentation rates in men with higher baseline DNA fragmentation rates. With respect to reproductive outcomes, higher baseline sperm density consistently predicts for natural pregnancy or assisted reproductive technology (ART) pregnancy rates. In addition, varicocele repair does seem to reduce the need for more invasive modalities of ART. In conclusion, we can now start to use specific parameters such as baseline semen quality, varicocele grade and patient age to predict post-repair semen quality and fertility potential following varicocelectomy.

Effect of chronic hypertension on assisted pregnancy outcomes: a population-based study in Ontario, Canada

To evaluate maternal and neonatal outcomes in women with chronic hypertension who conceive using assisted reproductive technologies (ART). Population-based retrospective cohort study. Obstetric hospitals. Singleton pregnancies of at least 20 weeks' gestational age to women 18 years and older who delivered a live or stillborn infant between April 1, 2006, and March 31, 2012, categorized as exposed based on a diagnosis of chronic hypertension in the mother predating the index pregnancy. Medically assisted pregnancy including in vitro fertilization/intracytoplasmic sperm injection (IVF-ICSI), intrauterine insemination, and ovulation induction. placental-mediated complications of pregnancy (preeclampsia/eclampsia, stillbirth, fetal growth restriction/low birthweight [<10th percentile], or clinically significant placental abruption); secondary outcomes: cesarean delivery (planned/unplanned), prematurity (<37 or <32 weeks), and neonatal death. Our cohort included 807,765 singleton pregnancies. We used log binomial regression to compute the adjusted relative risks of the various outcomes in women with hypertension as compared with healthy women in ART and unassisted pregnancies. When we tested an interaction term between hypertension and ART in multivariate models, women with ART pregnancies were at higher risk of placental-mediated complications than were those with unassisted pregnancies (adjusted risk ratio 1.48; 95% confidence interval, 1.35, 1.56). The risk was even greater in hypertensive women who used ART (adjusted risk ratio 6.77; 95% confidence interval, 4.72, 9.72). Our findings persisted when assessing IVF only and when evaluating nulliparas. Hypertension is more frequent in ART-treated women. Hypertension increases the risk of placental complications, which appear to be compounded in ART versus unassisted pregnancies.

Human chorionic gonadotropin cutoff value determined by receiver operating characteristic curve analysis is useful but not absolute for determining pregnancy outcomes

Abstract Objective: To assess the clinical value of a single early human chorionic gonadotropin (HCG) assay (day 14 post embryo transfer) in assisted reproductive technology (ART) pregnancies. Design: Retrospective study. Settings: The Assisted Reproductive Unit at Jordan University Hospital, Amman, Jordan. Patients: During 2009–2011, a total of 248 embryo transfer cycles resulting in pregnancy, defined as serum HCG concentration of ⩾10 IU/l, were included. Interventions: None. Materials and methods: Pregnancies were classified as viable (live fetus at 24 weeks gestation) or non-viable (biochemical pregnancy, miscarriage, ectopic pregnancy). Receiver operating characteristic (ROC) curve analysis was used to evaluate the cutoff value of HCG with maximal sensitivity and specificity to differentiate between viable and non-viable pregnancies. Results: The median HCG concentration was 264 IU/l in viable pregnancies and 120 IU/l in non-viable pregnancies ( p p Conclusion: HCG cutoff values determined by a ROC curve analysis are useful but not absolute for discriminating between viable and non-viable pregnancy outcomes on day 14 after embryo transfer. So it is important to continue routine monitoring of ART pregnancy outcomes.

Outcome of assisted reproductive technology in men with treated and untreated varicocele: systematic review and meta-analysis.

Varicocele affects approximately 35%–40% of men presenting for an infertility evaluation. There is fair evidence indicating that surgical repair of clinical varicocele improves semen parameters, decreases seminal oxidative stress and sperm DNA fragmentation, and increases the chances of natural conception. However, it is unclear whether performing varicocelectomy in men with clinical varicocele prior to assisted reproductive technology (ART) improve treatment outcomes. The objective of this study was to evaluate the role of varicocelectomy on ART pregnancy outcomes in nonazoospermic infertile men with clinical varicocele. An electronic search was performed to collect all evidence that fitted our eligibility criteria using the MEDLINE and EMBASE databases until April 2015. Four retrospective studies were included, all of which involved intracytoplasmic sperm injection (ICSI), and accounted for 870 cycles (438 subjected to ICSI with prior varicocelectomy, and 432 without prior varicocelectomy). There was a significant increase in the clinical pregnancy rates (OR = 1.59, 95% CI: 1.19–2.12, I2 = 25%) and live birth rates (OR = 2.17, 95% CI: 1.55–3.06, I2 = 0%) in the varicocelectomy group compared to the group subjected to ICSI without previous varicocelectomy. Our results indicate that performing varicocelectomy in patients with clinical varicocele prior to ICSI is associated with improved pregnancy outcomes.

Biochemical markers of placental dysfunction in assisted conception

A possible mechanism for poor perinatal outcomes in singleton pregnancies conceived following assisted reproductive technologies (ART) and those conceived naturally following a period of infertility (>12 months) is thought to be placental dysfunction. This was investigated by measuring plasma concentrations of biochemical markers: (i) soluble fms-like tyrosine kinase1 (sFlt1); (ii) placental growth factor (PlGF); (iii) leptin; and (iv) plasminogen activator inhibitor 2 (PAI-2), serially at four antenatal time points. Baseline concentrations of each marker after delivery were also measured. The control group was naturally conceived singleton pregnancies with no history of infertility. Non-smoking, age-matched nulliparous women with no significant medical history were recruited to all groups. The ART group had significantly lower mean plasma concentrations of PlGF at all antenatal time points compared to the control group (p < 0.001). The subfertility (SF) group had significantly higher mean serum concentrations of leptin than the other groups at all time points (p < 0.001), even after correction for body mass index. There were no significant differences in sFlt1 and PAI-2 concentrations between the groups. Low plasma PlGF concentrations in the ART group might suggest abnormal placentation and/or abnormal function in ART pregnancies with relevance to pathogenesis of pregnancy complications in these women.

Altered gene expression of H19 and IGF2 in placentas from ART pregnancies

IntroductionThe aim of this study is to determine whether the gene expression and associated DNA methylation regulation of H19 and IGF2 are altered in placentas conceived by assisted reproductive technologies (ART) compared to natural conceptions. Methods113 pregnancies were recruited resulting in 119 placentas (83 singletons and 36 twins), where 56 were conceived via in vitro fertilization (IVF), 41 via intracytoplasmic sperm injection (ICSI), and 22 naturally. Regulation of imprinting of H19 and IGF2 was determined by the DNA methylation status at three CpG sites within the H19 imprinting control region 1 (ICR1) using bisulphite pyrosequencing. Expression of H19 and IGF2 in 45 of these placentas (17 IVF, 14 ICSI, and 14 NC) was measured by determining the relative mRNA transcript levels using RT-qPCR in placental villi. ResultsPlacental weight and birth weight were not significantly different between groups. H19 expression was significantly increased in both IVF and ICSI placentas when compared to controls (1.8 and 1.9 fold higher, respectively). Conversely, IGF2 was significantly decreased in both ART groups (0.8 and 0.7 fold lower, respectively). Mean DNA methylation at ICR1 was found to be similar between all groups. No correlation was found between DNA methylation at ICR1 and expression of either gene. However, a significant inverse relationship was found between H19 and IGF2 expression. ConclusionWe provide evidence of altered H19 and IGF2 expression in ART placentas. The altered expression pattern may suggest a loss of imprinting on the paternal allele. Furthermore, these alterations may not be entirely associated with DNA methylation at ICR1. We show further indirect evidence of the H19-IGF2 inverse expression pattern.

Perinatal outcomes after fresh versus vitrified-warmed blastocyst transfer: retrospective analysis

To investigate the possible effect of controlled ovarian stimulation on the perinatal outcomes of assisted reproductive technology pregnancies, by comparing the outcomes from fresh ET with frozen ET (FET) with blastocysts of similar quality. Retrospective observational study. Private fertility center. Seven hundred eighty-four fresh transfers and 382 vitrified-warmed double blastocyst transfers. None. Miscarriage, perinatal mortality, preterm delivery, live birth, live-birth weights, and gestational age of live births. FET resulted in higher implantation rates (51.5% vs. 40.6%), higher live-birth rates per transfer (56.8% vs. 44.3%), and lower ectopic pregnancy rates (0.32% vs. 1.80%). FET pregnancies also had higher day 14 βhCG levels per implantation (148.2 vs. 176.2 IU/L) and higher infant birth weights (singletons Δ109.4 g, twins Δ124 g). Female infants benefitted the most in terms of birth weight. Miscarriage, premature delivery, perinatal morbidity, and live birth per pregnancy were all nonsignificantly different between fresh ET and FET. Clinically significant differences between the peri-implantation and perinatal outcomes of fresh ET and FET suggest better endometrial receptivity and placentation in FET cycles.

Risk of hypertensive disorders in pregnancies following assisted reproductive technology: a cohort study from the CoNARTaS group.

Is the risk of hypertensive disorders in pregnancies conceived following specific assisted reproductive technology (ART) procedures different from the risk in spontaneously conceived (SC) pregnancies? ART pregnancies had a higher risk of hypertensive disorders, in particular following cryopreservation, with the highest risk seen in twin pregnancies following frozen-thawed cycles. The risk of hypertensive disorders is higher in ART pregnancies than in SC pregnancies. The increased risk may be partly explained by multiple pregnancies and underlying infertility, but a contribution from specific ART procedures has not been excluded. Population-based cohort study, including sibling design with nationwide data from health registers in Sweden, Denmark and Norway. All registered ART pregnancies and a sample of SC pregnancies with gestational age ≥22 weeks from 1988 to 2007 were included. ART singleton pregnancies (n = 47 088) were compared with SC singleton pregnancies (n = 268 599), matched on parity and birth year. ART twin pregnancies (n = 10 918) were compared with SC twin pregnancies (46 674). We used logistic regression to estimate adjusted odds ratios and risk differences for hypertensive disorders in pregnancies following IVF, ICSI and fresh or frozen-thawed cycles. We also compared fresh and frozen-thawed cycles within mothers who had conceived following both procedures using conditional logistic regression (sibling analysis). Hypertensive disorders were reported in 5.9% of ART singleton and 12.6% of ART twin pregnancies. Comparing singleton pregnancies, the risk of hypertensive disorders was higher after all ART procedures. The highest risk in singleton pregnancies was seen after frozen-thawed cycles [risk 7.0%, risk difference 1.8%, 95% confidence interval (CI) 1.2-2.8]. Comparing twin pregnancies, the risk was higher after frozen-thawed cycles (risk 19.6%, risk difference 5.1%, 95% CI 3.0-7.1), but not after fresh cycles. In siblings, the risk was higher after frozen-thawed cycles compared with fresh cycles within the same mother (odds ratio 2.63, 95% CI 1.73-3.99). There were no clear differences in risk for IVF and ICSI. The number of ART siblings in the study was limited. Residual confounding cannot be excluded. In addition, we did not have information on all SC pregnancies in each woman's history, and could therefore not compare risk in ART versus SC pregnancies in the same mother. Pregnancies following frozen-thawed cycles have a higher risk of hypertensive disorders, also when compared with fresh cycle pregnancies by the same mother. The safety aspects in frozen-thawed cycles merit further attention. Funding was received from the European Society for Human Reproduction and Embryology, the University of Copenhagen, the Danish Agency for Science, Technology and Innovation, the Nordic Federation of Societies of Obstetrics and Gynecology and the Liaison Committee between the Central Norway Regional Health Authority and the Norwegian University of Science and Technology. None of the authors has any competing interests to declare.

Assisted reproductive technology and risk of congenital malformations: a meta-analysis based on cohort studies.

To assess the association between assisted reproductive technology (ART) and risk of congenital malformations (CM) by conducting a meta-analysis of cohort studies. PubMed, Google Scholar, Cochrane Libraries and Chinese database were searched through August 2014 to identify studies that met pre-stated inclusion criteria. Either a fixed- or a random-effects model was used to calculate the overall combined risk estimates. Subgroup analysis was performed to explore potential heterogeneity moderators. Fifty-seven studies involving 119,874 infants conceived following ART and 1,212,320 infants conceived naturally were included in the analysis. The ART-conceived infants were associated with a higher risk of CM [relative risk (RR)=1.33; 95% confidence interval (CI) 1.24-1.43] when compared with those conceived naturally. When data were restricted to singleton births (RR=1.38; 95% CI 1.30-1.47), major CM (RR=1.47; 95% CI 1.29-1.68), matched/adjusted studies (RR=1.37; 95% CI 1.27-1.47) or high quality studies (RR=1.40; 95% CI 1.27-1.55), the increased risk of CM still existed in ART pregnancies. Additionally, an increased risk of CM was also found when the ART twin (RR=1.18; 95% CI 1.06-1.32) or multiple births (RR=1.16; 95% CI 1.05-1.27) were separately compared with spontaneously conceived twin or multiple births. Substantial heterogeneity was observed across studies (I (2)=68, 44, 39, and 33% for all infants, singletons, twins and multiples, respectively). Whether confounding factors were matched or adjusted, study quality and sample size as the first three of the most relevant heterogeneity moderators have been identified. No evidence of publication bias was observed (P>0.10). The ART-conceived infants have a higher risk of CM compared with those conceived naturally. However, these estimates have to be viewed with caution because of heterogeneity.

Comparison of genome-wide and gene-specific DNA methylation between ART and naturally conceived pregnancies

Data linking assisted reproductive technologies (ART) with aberrant DNA methylation is limited and inconclusive. In addition, most studies to date have analyzed only a small number of CpG sites and focused on methylation changes in placentas, while data on cord blood are scarce. Our aim was to compare DNA methylation in cord blood samples from ART (N = 10) and control pregnancies (N = 8) using a genome-wide approach with the Illumina® Infinium Human Methylation27 array, which interrogates 27,578 CpG sites. A total of 733 (2.7%) of the CpG sites were significantly differentially methylated between the 2 groups (P < 0.05), with an overall relative hypomethylation in the ART group (P < 0.001). Differences in DNA methylation were more pronounced for CpG sites in certain types of genomic locations and were related to baseline methylation levels and distance from CpG islands and transcription start sites. ART was associated with significantly higher variation in DNA methylation, suggesting that differences in DNA methylation between cases and controls may result from stochastic (or random) genome-wide changes in DNA methylation in ART pregnancies. We identified 24 candidate genes with 2 or more CpG sites that were significantly different between the IVF and control groups. The current study provides support for the hypothesis that ART or associated subfertility may be associated with genome-wide changes in DNA methylation, and these changes appear to be, at least in part, due to epigenetic instability in ART pregnancies. Further studies are required in order to determine the extent to which such ART-related epigenetic instability may have phenotypic consequences.

Demographic and obstetric outcomes of pregnancies conceived by assisted reproductive technology (ART) compared to non-ART pregnancies

Use of assisted reproductive technology has increased steadily, yet multiple socioeconomic and demographic disparities remain between the general population and those with infertility. Additionally, both mothers and infants experience higher rates of adverse outcomes compared to their non-ART counterparts. Using International Classification of Diseases, Ninth Revision (ICD-9) coding, we performed a retrospective review of all ART-conceived deliveries in California in 2009. A total of 551 ART pregnancies were compared to Non-ART pregnancies (n=406,885). The majority of ART deliveries belonged to women of advanced maternal age (AMA) and Caucasian or Asian race. Nearly half of all ART deliveries were multiple gestations. Compared to non-ART deliveries, ART pregnancies were associated with placenta previa, placental abruption, mild preeclampsia, and fetal growth restriction. While not powered to detect all outcomes, our study highlights significant racial and ethnic disparities between ART and Non-ART pregnancies.

İkiz gebeliklerde koryon ve amniyon tiplerinin dağılımı

Objective: Our aim was to determine the distribution of chorion and amnion sac types in twin pregnancies during the routine screening procedures during the first trimester, and to investigate their relevance with pregnancy being natural or by assisted reproductive technology. Methods: Twin pregnancies analyzed during routine first trimester screening were evaluated retrospectively. The twins were grouped according to their conception types which are natural birth and by assisted reproductive technologies (ART). The cases which have missing or suspicious information about chorion-amnion types and with unknown conditions for pregnancies whether they were by ART or naturally were excluded from the study. In the sonographic chorionicity distinction, the presence of classic lambda and T signs was considered. The unavailability of amniotic membrane among fetuses was defined as monoamniotic twin. Results: During 14 years, 286 twin pregnancies were considered as appropriate cases to analyze. Mean maternal age was 30.47±5.07 years, and mean week of gestation during sonography was 12.23±0.70. Double placentas were found in 83.2% of all pregnant women, and single placenta in 16.7% of all pregnant women. While 54.5% (n=156) of twin pregnancies were ART pregnancies, 45.5% of them were natural pregnancies. It was determined that 67.7% of natural twins were diamniotic dichorionic, 27.7% of them were diamniotic monochorionic and 4.6% of them were monoamniotic monochorionic while 96.2% of ART pregnancies were diamniotic dichorionic, 3.2% of them were diamniotic monochorionic and 0.6% of them were monoamniotic monochorionic. There was statistically significant difference between ART twins and natural twins in terms of chorionicity distributions (p<0.05). Conclusion: Monochorionic structure is observed more frequently in natural twins. In the follow-up of these pregnancies, early and accurate diagnosis may be the basis of early and accurate approach for the issues related with monochorionic placentation.

Cervical conization doubles the risk of preterm and very preterm birth in assisted reproductive technology twin pregnancies

Does cervical conization add an additional risk of preterm birth (PTB) in assisted reproduction technology (ART) singleton and twin pregnancies? Cervical conization doubles the risk of preterm and very PTB in ART twin pregnancies. ART and cervical conization are both risk factors for PTB. In this national population-based controlled cohort study, we included all ART singletons and twin deliveries from 1995 to 2009 in Denmark by cross-linkage of maternal and child data from the National IVF register and the Medical Birth register. Furthermore, control groups of naturally conceived (NC) singletons and twins were extracted. Cervical diagnoses were obtained from the Danish Pathology register. Cervical conization included both cold knife cone and LEEP (loop electrosurgical excision procedure) but not cervical biopsies. The main outcomes measures were PTB (PTB ≤ 37 + 0 gestational weeks), very preterm birth (VPTB ≤ 32 + 0 gestational weeks) and preterm premature rupture of membranes (PPROM). In all 16 923 ART singletons and 4829 ART twin deliveries were included. A random sample of NC singletons, 2-fold the size of the ART singleton group matched by date and year of birth (n = 33 835) and all NC twin deliveries (n = 15 112), was also extracted. Multiple logistic regression analyses were performed to adjust for the following confounders: maternal age, parity, year of child birth and sex of child. Cervical morbidity (dysplasia and conization) was more often observed in ART pregnancies (6.2% of ART singletons and 5.4% ART twins) than in NC pregnancies (4.2% for NC singletons and 4.5% for NC twins), both for singletons and twins. In ART singleton deliveries, the PTB rate was 13.1 versus 8.2% in women with and without conization, respectively, with an adjusted odds ratio (aOR) of 1.56 [95% confidence interval (CI) 1.21-2.01]. In ART twin deliveries, the prevalence of PTB was 58.2 versus 41.3% in women with and without conization, respectively, with an aOR 1.94 (95% CI 1.36-2.77), and the risk of VPTB was also doubled. Furthermore, previous dysplasia (without conization) increased the risk of VPTB in ART twins (aOR 1.74, 95% CI 1.04-2.94). Cervical dysplasia did not increase the risk of any of the other adverse outcomes in ART singletons or twins. The risk of PPROM was increased in both in ART and NC singleton deliveries with conization versus no conization; however, this increased risk of PPROM after conization was not observed in either ART or NC twin pregnancies. We were not able to adjust for the height of the cervical cone or the severity of the cervical intraepithelial neoplasia (CIN) or the time window between diagnosis of CIN and ART treatment. The finding on an increased risk of VPTB in ART twin pregnancies after dysplasia without conization may be random as we found no other increased risk after dysplasia alone either in singletons or in twins. After ART and prior conization, 58% of twin pregnancies versus 13% of ART singleton pregnancies result in PTB. There is a doubled risk of preterm delivery in ART twins with conization versus ART twins with no prior conization. Single-embryo transfer should always be recommended in women with prior conization irrespective of female age, embryo quality and prior number of ART attempts. No external funding was achieved for this project.

The possible association between exposure to air pollution and the risk for congenital malformations

BackgroundOver the last decade, there is growing evidence that exposure to air pollution may be associated with increased risk for congenital malformations. ObjectivesTo evaluate the possible association between exposures to air pollution during pregnancy and congenital malformations among infants born following spontaneously conceived (SC) pregnancies and assisted reproductive technology (ART) pregnancies. MethodsThis is an historical cohort study comprising 216,730 infants: 207,825 SC infants and 8905 ART conceived infants, during the periods 1997–2004. Air pollution data including sulfur dioxide (SO2), particulate matter <10µm (PM10), nitrogen oxides (NOx) and ozone (O3) were obtained from air monitoring stations database for the study period. Using a geographic information system (GIS) and the Kriging procedure, exposure to air pollution during the first trimester and the entire pregnancy was assessed for each woman according to her residential location. Logistic regression models with generalized estimating equation (GEE) approach were used to evaluate the adjusted risk for congenital malformations. ResultsIn the study cohort increased concentrations of PM10 and NOx pollutants in the entire pregnancy were associated with slightly increased risk for congenital malformations: OR 1.06(95% CI, 1.01–1.11) for 10µg/m3 increase in PM10 and OR 1.03(95% CI, 1.01–1.04) for 10ppb increase in NOx. Specific malformations were evident in the circulatory system (for PM10 and NOx exposure) and genital organs (for NOx exposure). SO2 and O3 pollutants were not significantly associated with increased risk for congenital malformations. In the ART group higher concentrations of SO2 and O3 in entire pregnancy were associated (although not significantly) with an increased risk for congenital malformations: OR 1.06(95% CI, 0.96–1.17) for 1ppb increase in SO2 and OR 1.15(95% CI, 0.69–1.91) for 10ppb increase in O3. ConclusionsExposure to higher levels of PM10 and NOx during pregnancy was associated with an increased risk for congenital malformations. Specific malformations were evident in the circulatory system and genital organs. Among ART pregnancies possible adverse association of SO2 and O3 exposure was also observed. Further studies are warranted, including more accurate exposure assessment and a larger sample size for ART pregnancies, in order to confirm these findings.

Intrapartum Interventions for Singleton Pregnancies Arising From Assisted Reproductive Technologies

Objective: To assess whether singleton pregnancies conceived by assisted reproductive technology (ART) are associated with an increased use of intrapartum interventions when compared with spontaneous singleton pregnancies. MethodsIn total, 1327 ART pregnancies and 5222 spontaneous pregnancies during the period 2004 to 2008 were extracted from BORN (Better Outcomes Registry & Network) Ontario’s information system. The incidences of common intrapartum interventions were compared, and different classification systems for Caesarean section were used to compare the indications for these between singleton pregnancies following ART with or without intracytoplasmic sperm injection and singleton spontaneously conceived pregnancies. ResultsCompared with spontaneous singleton pregnancies, the ART group had increased incidences of internal electronic fetal monitoring (OR 1.60; 95% CI 1.37 to 1.87), artificial rupture of membranes (OR 1.39; 95% CI 1.17 to 1.66), oxytocin augmentation of labour (OR 1.51; 95% CI 1.28 to 1.77), induction of labour (OR 1.31; 95% CI 1.14 to 1.50), and Caesarean section (OR 1.40; 95% CI 1.24 to 1.60). ConclusionSingleton pregnancies resulting from ART were associated with more frequent use of several intrapartum interventions, including Caesarean section.

Prevalence of velamentous and marginal umbilical cord insertions; a comparison of term singleton ART and non-ART pregnancies

Abnormal umbilical cord insertion (i.e., velamentous or marginal insertion) sometimes results in serious obstetric complications. The reported adverse outcomes include placenta previa, fetal growth restriction, non-reassuring fetal status requiring an emergency Cesarean section, and fetal exsanguination due to the rupture of vasa previa. This study was conducted to investigate whether pregnancies obtained by assisted reproductive technologies (ART) influence the prevalence of anomalous cord insertions. Observational study and comparative analysis. We reviewed the records of 6604 consecutive singleton, term labor and delivery cases in our clinic between the study period of January 2010 to April 2014, including personal details, obstetric history, details of infertility treatment, and insertion site of the umbilical cord. They were categorized according to their conception method (Group A: ART pregnancies, n=253, Group B: non-ART pregnancies, n=6351). Abnormal cord insertion was divided into two categories: velamentous insertion(VI) and marginal insertion(MI). Odds ratio, 95% confidence intervals(CI), and significance of the odds ratio were calculated for the conditions of interest. As for maternal age and their parity both in Group A and Group B, there were no statistically significant differences between the presence and the absence of abnormal cord insertion. The prevalence of abnormal cord insertion was 19.3% (VI: 4.3%, MI: 15.0%) in Group A, and 6.4% (VI: 0.6%, MI: 5.8%) in Group B. The odds ratio for delivery with VI in Group A as opposed to Group B was calculated as 7.6 (95% CI: 3.8 - 15.0), P<0.001 (X2=46.4, 1 df). The odds ratio for delivery with MI in Group A as opposed to Group B was 2.9 (95% CI: 2.0 - 4.1), P<0.001 (X2=35.7, 1 df). Tabled 1Prevalence of Abnormal Cord InsertionsGroup A (ART: n=253)Group B (non-ART: n=6351)Total (n=6604)Maternal age (y)35.3 ± 3.631.1 ± 4.431.3 ± 4.5Parity (primipara/multipara)197 / 563390 / 29613587 / 3017Velamentous Insertion(VI)11 (4.3%)38 (0.6%)49 (0.7%)Marginal Insertion (MI)38 (15.0%)369 (5.8%)407 (6.2%)Data are mean±SD or number of subject Open table in a new tab Data are mean±SD or number of subject 1) These findings suggest that the ART procedures have a positive correlation on the incidence of abnormal cord insertion (esp. velamentous insertion). 2) ART-conceived cases should be more proactively screened and assessed for insertion site of the umbilical cord during routine obstetric ultrasound examinations, in addition to other already-known ART-associated risk factor assessments, to improve their perinatal outcomes.

Special research presentation: epigentic profiles in ART pregnancies

Pregnancies conceived using assisted reproductive technologies (ART) are associated with adverse outcomes. As more than 1% of babies born in the U.S. are conceived using ART, it is essential to determine whether these adverse outcomes specifically result from the in vitro fertilization (IVF) used in ART, or are related to the causes of the underlying infertility. We hypothesize that IVF can induce epigenetic changes independent of genetic predisposition to infertility, and that these changes have lasting effects on placental and ultimately fetal development.

Birth outcomes by infertility diagnosis: analyses of the massachusetts outcomes study of assisted reproductive technologies (MOSART)

To evaluate assisted reproductive technology (ART) pregnancy outcomes by infertility diagnosis.ART data on women who were treated and gave birth in Massachusetts were linked to vital records and hospital utilization data. Live births were categorized by 8 mutually exclusive ART diagnoses. Risks of prematurity, low birthweight (LBW), small-for-gestational age (SGA), large-for-gestational age (LGA), pregnancy hypertension, gestational diabetes, prenatal hospitalizations, and primary cesarean delivery were modeled using logistic regression, adjusted for parental characteristics, treatment parameters, and plurality (adjusted odds ratios [AORs] and 95% confidence intervals); the reference group were pregnancies with the diagnosis of malefactor.Among the 7,354 singleton and twin pregnancies, there were nonsignificant differences in the risks for LBW, SGA, or LGA. Significantly increased risks included gestational diabetes (ovulation disorders, AOR 1.80, 1.35-2.41), prematurity (ovulation disorders, AOR 1.36, 1.08-1.71; other factors, AOR 1.33, 1.05-1.67), prenatal hospital admissions (endometriosis, tubal and other factors, ovulation disorders, and uterine factors, AORs ranging from 1.66-2.68), and primary cesarean section (uterine factors, AOR 1.96, 1.15-3.36).Although the infant outcomes of LBW, SGA, and LGA were generally similar across diagnosis groups, specific diagnoses had greater risks for prematurity, gestational diabetes, prenatal hospital utilization, and primary cesarean delivery. (J Reprod Med 2015;