In Vitro Fertilization Infants Research Articles

Respiratory pathology in late preterm infants conceived by in vitro fertilization.

This study aimed to identify the incidence of in vitro fertilization (IVF) in late preterm infants and the presence of respiratory pathology in this premature category compared with those conceived naturally. This retrospective study was performed over 6 months, including newborns with a gestational age between 34–36 weeks and 6 days in the Department of Obstetrics, Gynecology and Neonatology, Alessandrescu-Rusescu National Institute of Mother and Child Health. The following variables were assessed: infants' gestational age, delivery mode, respiratory morbidity, and the need for respiratory support. During the mentioned period, 112 late preterm infants were born, out of whom 9.8% represented late preterm infants conceived by in vitro fertilization. The delivery mode of late preterm infants conceived by in vitro fertilization was exclusively by C-section (100%) compared to those conceived spontaneously (44.5%). 18.1% of IVF late preterm infants developed transient tachypnea of the newborn. In the non-IVF group, respiratory distress syndrome was present in 5.9% and transient tachypnea in 33.6% of cases. No IVF late preterm infant required hospitalization in neonatal intensive care for more than 3 days, compared to 19.8% of naturally conceived late preterm infants. Respiratory distress syndrome very seldom occurs in late preterm IVF infants due to prenatal prophylactic treatment with corticosteroids. Respiratory pathology is rarely present due to very careful monitoring during pregnancy, the presence of a neonatal team in the delivery room for possible resuscitation, and providing proper care according to the good state of health during the short, one-week hospitalization.

Association of adverse birth outcomes with in vitro fertilization after controlling infertility factors based on a singleton live birth cohort

Infants conceived with in vitro fertilization (IVF) are exposed to underlying infertility and the IVF process. High risks of adverse birth outcomes (ABOs) were observed among these infants, including preterm birth, low birth weight, macrosomia, being large/small for gestational age (LGA/SGA). It is unclear whether the specific etiology of the rise of ABOs among IVF infants is IVF technology itself or underlying infertility. A total of 9,480 singletons conceived with IVF and 1,952,419 singletons from the general population were obtained in this study. Multivariable logistic regression model was used to assess variations in risk of ABOs according to causes of infertility. Poisson distributions were applied to calculate standardized risk ratios of IVF infants vs. general population after controlling the causes of infertility. Higher risk of preterm birth and low birth weight were observed among parents with polycystic ovary syndrome, endometriosis, uterine and semen abnormalities. Compared to the general population, after excluding the influence of infertility causes, singletons conceived with IVF were at higher risk of macrosomia (SRR = 1.28, 95% CI 1.14–1.44) and LGA (SRR = 1.25, 95% CI 1.15–1.35). The higher risk of ABOs in IVF was driven by both IVF treatments and infertility, which is important for improving IVF treatments and the managing pregnancies and child development.

P–766 Neurodevelopment in fetuses conceived by assisted reproductive technologies following fresh and frozen embryo transfer

Abstract Study question Do in vitro fertilization (IVF) offspring present different neurodevelopment assessed by fetal neurosonography and infant neurobehavioral tests as compared to those spontaneously conceived (SC)? Summary answer IVF offspring, especially those obtained after fresh embryo-transfer (ET), showed subtle structural differences in fetal neurosonography and poorer neurobehavioral scores at twelve months of age. What is known already The number of pregnancies following assisted reproductive technologies (ART) is currently increasing worldwide. Concerns about the neurodevelopment of subjects conceived by IVF have been rising and mostly studied in children and adolescents with inconsistent results. Many of the identified risk associations were only observed in subgroups or disappeared after adjustment for covariates, mainly multiple pregnancy and gestational age at birth. It is unknown whether fetal brain development and cortical folding differ prenatally in IVF fetuses as compared to SC. Study design, size, duration This is the first study examining fetal neurodevelopment by neurosonography in IVF fetuses. A prospective cohort study of 210 singleton pregnancies recruited from 2017 to 2020, including 70 SC gestations, 70 conceived by IVF following frozen ET (FET) and 70 IVF after fresh ET. Fetal neurosonography was performed in all pregnancies. Additionally, Ages & Stages Questionnaires (ASQ) were obtained at 12 months of corrected age. Participants/materials, setting, methods IVF pregnancies were recruited from a single Assisted Reproduction Center, ensuring homogeneity in IVF stimulation protocols, endometrial preparation, laboratory procedures and embryo culture conditions. SC pregnancies were randomly selected from low-risk fertile couples and paired to IVF by maternal age. Fetal neurosonography including transvaginal approach was performed at 32±2 weeks of gestation, measured off-line by a single investigator and normalized by biparietal or occipitofrontal diameter. ASQ were obtained postnatally, at 12 months of corrected age. Main results and the role of chance Study groups were similar and comparable regarding maternal age, body mass index, study level and employment rate together with exposure to smoke, alcohol, aspirin and corticoids during pregnancy, gestational age (32±2 weeks) and estimated fetal weight (1700±400g) at neurosonography. As compared to SC pregnancies, both IVF populations showed differences in cortical development with reduced parieto-occipital (fresh ET 12.5mm [SD 2.5] vs FET 13.4 [2.6] vs SC 13.4 [2.6]), cingulate (fresh ET 5.8 [IQR 4.2–7.4] vs FET 5.8 [4.1–7.5] vs SC 6.5 [4.8–7.8]) and calcarine (fresh ET 13.5 [IQR 10.1–16.1] vs FET 14.5 [12.1–15.8] vs SC 16.4 [14.3–17.9]) sulci depth together with lower Sylvian fissure grading. Cortical development changes were more pronounced in the fresh ET group as compared to FET. Corpus callosum length and insula depth were lower in FET and fresh ET groups, respectively. Neurosonographic changes remained statistically significant after adjustment by ethnicity, gender, gestational age and weight centile at scan. IVF infants showed worse ASQ scores, especially in fresh ET for communication, personal-social, fine-motor and problem-solving skills. Gross-motor scores were significantly lower in FET as compared to SC and fresh ET. Differences were statistically significant after adjustment by maternal ethnicity, study level, employment status, breastfeeding, gender and corrected age. Limitations, reasons for caution The reported neurodevelopmental differences are subtle, with most neurosonographic findings lying within normal ranges. Infertility factors contribution to the outcome cannot be unraveled from the ART procedure itself. The milder features found in FET individuals cannot condition the techniqués choice and must be considered together with their global perinatal results. Wider implications of the findings: Neurosonography is an appropriate tool to identify subtle brain differences between fetuses exposed and not exposed to ART. Prenatal features were consistent with postnatal neurobehavioral findings. These results support the relevance of a neurodevelopmental follow-up in IVF patients. Further studies are warranted to assess the long-term performance in these subjects. Trial registration number Not applicable

P-766 Neurodevelopment in fetuses conceived by assisted reproductive technologies following fresh and frozen embryo transfer

Abstract Study question Do in vitro fertilization (IVF) offspring present different neurodevelopment assessed by fetal neurosonography and infant neurobehavioral tests as compared to those spontaneously conceived (SC)? Summary answer IVF offspring, especially those obtained after fresh embryo-transfer (ET), showed subtle structural differences in fetal neurosonography and poorer neurobehavioral scores at twelve months of age. What is known already The number of pregnancies following assisted reproductive technologies (ART) is currently increasing worldwide. Concerns about the neurodevelopment of subjects conceived by IVF have been rising and mostly studied in children and adolescents with inconsistent results. Many of the identified risk associations were only observed in subgroups or disappeared after adjustment for covariates, mainly multiple pregnancy and gestational age at birth. It is unknown whether fetal brain development and cortical folding differ prenatally in IVF fetuses as compared to SC. Study design, size, duration This is the first study examining fetal neurodevelopment by neurosonography in IVF fetuses. A prospective cohort study of 210 singleton pregnancies recruited from 2017 to 2020, including 70 SC gestations, 70 conceived by IVF following frozen ET (FET) and 70 IVF after fresh ET. Fetal neurosonography was performed in all pregnancies. Additionally, Ages & Stages Questionnaires (ASQ) were obtained at 12 months of corrected age. Participants/materials, setting, methods IVF pregnancies were recruited from a single Assisted Reproduction Center, ensuring homogeneity in IVF stimulation protocols, endometrial preparation, laboratory procedures and embryo culture conditions. SC pregnancies were randomly selected from low-risk fertile couples and paired to IVF by maternal age. Fetal neurosonography including transvaginal approach was performed at 32±2 weeks of gestation, measured off-line by a single investigator and normalized by biparietal or occipitofrontal diameter. ASQ were obtained postnatally, at 12 months of corrected age. Main results and the role of chance Study groups were similar and comparable regarding maternal age, body mass index, study level and employment rate together with exposure to smoke, alcohol, aspirin and corticoids during pregnancy, gestational age (32±2 weeks) and estimated fetal weight (1700±400g) at neurosonography. As compared to SC pregnancies, both IVF populations showed differences in cortical development with reduced parieto-occipital (fresh ET 12.5mm [SD 2.5] vs FET 13.4 [2.6] vs SC 13.4 [2.6]), cingulate (fresh ET 5.8 [IQR 4.2-7.4] vs FET 5.8 [4.1-7.5] vs SC 6.5 [4.8-7.8]) and calcarine (fresh ET 13.5 [IQR 10.1-16.1] vs FET 14.5 [12.1-15.8] vs SC 16.4 [14.3-17.9]) sulci depth together with lower Sylvian fissure grading. Cortical development changes were more pronounced in the fresh ET group as compared to FET. Corpus callosum length and insula depth were lower in FET and fresh ET groups, respectively. Neurosonographic changes remained statistically significant after adjustment by ethnicity, gender, gestational age and weight centile at scan. IVF infants showed worse ASQ scores, especially in fresh ET for communication, personal-social, fine-motor and problem-solving skills. Gross-motor scores were significantly lower in FET as compared to SC and fresh ET. Differences were statistically significant after adjustment by maternal ethnicity, study level, employment status, breastfeeding, gender and corrected age. Limitations, reasons for caution The reported neurodevelopmental differences are subtle, with most neurosonographic findings lying within normal ranges. Infertility factors contribution to the outcome cannot be unraveled from the ART procedure itself. The milder features found in FET individuals cannot condition the techniqués choice and must be considered together with their global perinatal results. Wider implications of the findings Neurosonography is an appropriate tool to identify subtle brain differences between fetuses exposed and not exposed to ART. Prenatal features were consistent with postnatal neurobehavioral findings. These results support the relevance of a neurodevelopmental follow-up in IVF patients. Further studies are warranted to assess the long-term performance in these subjects. Trial registration number not applicable

Epigenetically regulated imprinted gene expression associated with IVF and infertility: possible influence of prenatal stress and depression.

Despite the growing body of research implying an impact of in vitro fertilization (IVF) on imprinted genes and epigenetics, few studies have examined the effects of underlying subfertility or prenatal stress on epigenetics, particularly in terms of their role in determining infant birthweights. Both subfertility and prenatal stressors have been found to impact epigenetics and may be confounding the effect of IVF on epigenetics and imprinted genes. Like IVF, both of these exposures-infertility and prenatal stressors-have been associated with lower infant birthweights. The placenta, and specifically epigenetically regulated placental imprinted genes, provides an ideal but understudied mechanism for evaluating the relationship between underlying genetics, environmental exposures, and birthweight. In this review, we discuss the impacts of IVF and infertility on birthweight, epigenetic mechanisms and genomic imprinting, and the role of these mechanisms in the IVF population and discuss the role and importance of the placenta in infant development. We then highlight recent work on the relationships between infertility, IVF, and prenatal stressors in terms of placental imprinting. In combination, the studies discussed, as well as two recent projects of our own on placental imprinted gene expression, suggest that lower birthweights in IVF infants are secondary to a combination of exposures including the infertility and prenatal stress that couples undergoing IVF are experiencing. The work highlighted herein emphasizes the need for appropriate control populations that take infertility into account and also for consideration of prenatal psychosocial stressors as confounders and causes of variation in IVF infant outcomes.

Risk of prematurity and infant morbidity and mortality by maternal fertility status and plurality.

To evaluate the risk of prematurity and infant mortality by maternal fertility status, and for in vitro fertilization (IVF) pregnancies, by oocyte source and embryo state combinations. Women in 14 States who had IVF-conceived live births during 2004-13 were linked to their infant's birth and death certificates; a 10:1 sample of non-IVF births was selected for comparison; those with an indication of infertility treatment on the birth certificate were categorized as subfertile, all others were categorized as fertile. Risks were modeled separately for the fertile/subfertile/IVF (autologous-fresh only) group and for the IVF group by oocyte source-embryo state combinations, using logistic regression, and reported as adjusted odds ratios (AORs) and 95% confidence intervals (CI). The study population included 2,474,195 pregnancies. Placental complications (placenta previa, abruptio placenta, and other excessive bleeding) and prematurity were both increased with pregestational and gestational diabetes and hypertension, among subfertile and IVF groups, and in IVF pregnancies using donor oocytes. Both subfertile and IVF pregnancies were at risk for prematurity and NICU admission; IVF infants were also at risk for small-for-gestation birthweight, and subfertile infants had greater risks for neonatal and infant death. Within the IVF group, pregnancies with donor oocytes and/or thawed embryos were at greater risk of large-for-gestation birthweight, and pregnancies with thawed embryos were at greater risk of neonatal and infant death. Prematurity was associated with placental complications, diabetes and hypertension, subfertility and IVF groups, and in IVF pregnancies, donor oocytes and/or thawed embryos.

Birthweight in infants conceived through in vitro fertilization following blastocyst or cleavage-stage embryo transfer: a national registry study.

In vitro fertilization (IVF) infants have lower birthweights than their peers, predisposing them to long-term health consequences. Blastocyst transfer (BT), at day 5-6 post-fertilization, is increasing in usage, partially due to improved pregnancy outcomes over cleavage-stage transfer (CT, day 2-3). Data to date, however, have been inconclusive regarding BT's effects on birthweight. Participants included all US autologous, single-gestation, fresh embryo transfer cycles initiated from 2007 to 2014 that resulted in a term infant (N = 124,154) from the National Assisted Reproductive Technology Surveillance System. Generalized linear models including obstetric history, maternal demographics, and infant sex and gestational age were used to compare birthweight outcomes for infants born following BT (N = 67,169) with infants born following CT (N = 56,985) and to test for an interaction between transfer stage and single embryo transfer (SET). Infants born following BT were 6g larger than those born following CT (p = 0.04), but rates of macrosomia (RR 1.00, 95% CI 0.96-1.04) and low birthweight (LBW, RR 1.00, 95% CI 0.93-1.06) were not different between the groups. The interaction between SET and transfer stage was significant (p = 0.02). Among SET infants, BT was associated with 19.26g increased birthweight compared to CT (p = 0.008). The increase in birthweights identified following BT is unlikely to be clinically relevant, as there were no differences in rates of macrosomia or LBW. These findings are clinically reassuring and indicate that the increasing use of BT is unlikely to further decrease the on average lower birthweights seen in IVF infants compared to their naturally conceived peers.

Neonatal outcomes in in vitro fertilization (IVF) pregnancies

small-for-gestational age (SGA), and low birth weight (LBW) rates are approximately twice as high in IVF pregnancies than in natural pregnancies. The IVF procedures have become more routine in recent years in Indonesia, but there have been few assessments of neonatal outcomes. The study aimed to evaluate the risk of preterm birth, SGA, and LBW in IVF infants. This was a retrospective cohort study performed in Dr. Sardjito General Hospital, Yogyakarta from January 2012 to December 2016. Pre-coded questionnaires were used to collect data from medical records. The relative risk of preterm birth, SGA, and LBW among IVF infants were calculated and compared to naturally conceived infants. A total sampling method was used for the IVF infants and a simple random sampling method was used for naturally conceived infants, who were born on the same day as an infant in the IVF group. A total of 108 infants were recruited, consisting of 54 IVF infants and 54 naturally conceived infants. The IVF infants had increased risk of preterm birth (RR = 2.0; 95%CI 0.52 - 7.58) and LBW (RR = 1.25; 95%CI 0.53 - 2.92). However, the IVF infants did not have an increased risk of SGA (RR = 1.0; 95%CI 0.21 - 4.73). In conclusion, the risk of preterm birth and LBW in IVF infants are higher than in naturally conceived infants, but not statistically significant. However, there is no increased risk of SGA in IVF infants.

1758 Neonatal Outcomes of very Premature Infants born after in vitro Fertilization

Advances in assisted reproductive technology such as in vitro fertilization (IVF) is known to be associated with a high rate of multiple pregnancy and prematurity. However reliable data on neonatal...

In vitro fertilization and adverse childhood outcomes: what we know, where we are going, and how we will get there. A glimpse into what lies behind and beckons ahead

The majority of perinatal morbidity after in vitro fertilization (IVF) is due to multiple pregnancy; however, even singleton infants are at an increased risk for adverse outcomes. We have summarized data that evaluates adverse outcomes in IVF infants and recent attempts to delineate the underlying causes of this risk. We submit that practitioners of reproductive medicine should remain at the forefront of this investigation.

Ocular Malformations or Poor Visual Acuity in Children Born After In Vitro Fertilization in Sweden

To follow up children born after in vitro fertilization (IVF) with respect to eye malformations and poor visual acuity. Observational cohort study based on Swedish health registers. Congenital eye malformations were studied in 32 091 children born from 1982 through 2007 and severe visual impairment was studied in 24 628 children born from 1985 through 2005 after IVF in Sweden. Comparisons were made with all children born in Sweden during corresponding periods with adjustment for various confounders. The main outcome measure was the presence of a congenital eye malformation and poor visual acuity. Thirty-six (1.1 per 1000) IVF infants with ocular malformations were identified, and the risk, compared with non-IVF children, was not increased when adjusted for maternal age, parity, smoking, and body mass index (odds ratio, 1.05; 95% confidence interval, 0.75 to 1.47). Severe visual impairment was identified in 25 cases (1.0 per 1000), and the risk increase was statistically significant (odds ratio, 1.65; 95% confidence interval, 1.12 to 2.45) and was only slightly reduced when adjustment as above was made (odds ratio, 1.55; 95% confidence interval, 1.04 to 2.32). When adjustment was made for known length of unwanted childlessness, the OR decreased to 1.15 (95% confidence interval, 0.61 to 2.16). Only 3 of the 25 children with visual impairment had ocular malformations. Although there is an increased risk for visual impairment among children born after IVF, the individual risk is small and may be secondary to parental characteristics. No increased risk for eye malformations was found.

Birth defects of 1,397 newborns conceived by in vitro fertilization/intracytoplasmic sperm injection and embryo transfer

To evaluate risk of birth defects of in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) treatment and to determine the safety of IVF/ICSI. Retrospective study in academic hospital. To review the 1397 infants (1997–2006) whose mothers underwent IVF/ICSI and embryo transfer at Center for Reproductive Medicine, Nanfang Hospital, Southern Medical University .1076 IVF infants and 321 ICSI infants were born after replacement of fresh embryos. Congenital malformations at birth was evaluated based on IVF or ICSI, sington and multiple pregnancies and infant's sex. ICSI was carried out using ejaculated, epididymal or testicular sperm. There were 18 birth defect in 1379 IVF/ICSI-conceived newborn at birth and total birth defect rates was 1.31%. 10 of 1,076 IVF-conceived children (0.93%) and 8 of 321 ICSI-conceived children (2.49%) had a birth defect at birth. The birth defect rate was increased after ICSI compared with IVF. There was statistical difference in birth defect rates between IVF infants and ICSI infants (P=0.018). 9 of 1,462 sington (1.38%) and 9 of 690 twin and triplet (1.19%) had a birth defect at birth. There was no statistical difference in birth defect rates between these two groups (P<0.05). 12 of 754 male IVF/ICSI-conceived infants (1.59%) and 7 of 643 IVF/ICSI-conceived infants (1.09%) had a birth defect at birth. There was no statistical difference in birth defect rates between male and female babies (P<0.05). 5 of 18 (27.8%) were cardiovascular defects. Infants conceived through ICSI have a higher rate (2.67 times) of birth defects compared with IVF. More birth defects are noted among male babies at birth, although this difference is not statistically significant. The follow-up study included to genetic counseling and eventual prenatal diagnosis, followed by a physical examination of the children after 1 year and after 2 years or longer time needs to be performed.

Developmental and Genetic Outcomes in Children Conceived Through Assisted Reproductive Technologies

After completing this article, readers should be able to: 1. Describe the outcomes of assisted reproductive technologies (ART) for singleton, twin, and other multiple births. 2. Describe the role of fertility in adverse outcomes seen with ART births. 3. Review the association of birth defects with ART. 4. Delineate the association of disease of genomic imprinting with ART. 5. Describe the relationship between ART and the subsequent incidence of neurodevelopmental sequelae. In the 1977 ruling “Carey v. Population Services International,” the United States Supreme Court ruled that the decision to bear children is constitutionally protected. (1) Significant interest already had been shown in the development and improvements of in vitro fertilization (IVF) for infertile couples. The first human pregnancy and human birth using IVF were reported by Steptoe and Edwards in the United Kingdom. (2) Their work resulted in the first baby born via reproductive technologies, Louise Brown, born on July 25, 1978, at Oldham General Hospital in Oldham, United Kingdom. (3) She was born via a planned cesarean section, and her birthweight was 2.61 kg. The first successful viable IVF in the United States was performed by Jones and Seager-Jones in 1981 in Norfolk, Virginia. (4) Assisted reproductive technologies (ART) have seen a recent surge in popularity. The Centers for Disease Control and Prevention (CDC) reported that 122,872 cycles of ART were initiated in 2003, resulting in the delivery of 48,756 neonates, (5) accounting for approximately 1% of all neonates delivered in the United States. The percentage is higher in many countries, including Denmark, where it is estimated that 5% of all deliveries are with the assistance of ART. (6) Couples pursue ART for myriad reasons, including tubal transport factors, ovulatory dysfunction, uterine factors, endometriosis, male- and female-specific factors, and when a cause of infertility is unknown. (5) It would be very …

Consequences of Vanishing Twins in IVF/ICSI Pregnancies

In Denmark, 4% of children at present are born by in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). Singleton IVF/ICSI infants are relatively likely to be preterm and have low birth weight. Spontaneous reductions may increase morbidity in singleton IVF infants. Previous work indicates that “vanishing” twins is not the only factor in adverse outcomes. The authors analyzed data on women with ongoing IVF/ICSI pregnancies that were detected by transvaginal sonography in gestational week 8. The goals were to determine the frequency of spontaneous reductions in IVF/ICSI twin pregnancies and to compare morbidity in survivors of a vanishing cotwin with both singletons and born twins. Included were 642 survivors of a vanishing cotwin, 5237 singletons from single gestations, and 3678 twins from twin gestations. Approximately 10% of all IVF singletons born resulted from a twin gestation in early pregnancy. On multiple logistic regression analysis, adjusting for maternal age, parity, and ICSI, the odds ratio (OR) for birth weight below 2500 g in singleton survivors of a vanishing twin was 11.7 (95% confidence interval [CI], 1.2–2.2), and for birth weight below 1500 g, it was 2.1 (95% CI, 1.3–3.6), compared with singletons resulting from single gestations. Corresponding figures were obtained for preterm births. The increased risk was almost entirely the result of reductions occurring after 8 weeks gestation. No increase in the risk of neurologic sequelae was found in survivors of a vanishing cotwin compared with singletons. The OR for cerebral palsy, however, was 1.9 (95% CI, 0.7–5.2). The later in pregnancy that spontaneous reduction began, the higher the risk of neurologic sequelae. The adjusted OR of child death was 3.6 (95% CI, 1.7–7.6) in survivors compared with the singleton cohort. These findings suggest that outcomes for IVF/ICSI survivors of a vanishing cotwin have poorer outcomes than singletons from single gestations. Because approximately 10% of IVF/ICSI singletons result from a vanishing twin pregnancy, this may explain the relatively adverse outcomes observed in IVF/ICSI singleton infants. These considerations favor elective single embryo transfer, which will reduce the high risk of twins and may also lessen the risk of spontaneous reduction and the poor outcomes associated with it.

In vitro fertilization (IVF) in Sweden: infant outcome after different IVF fertilization methods

To compare infant outcome after different IVF techniques. A register study in Sweden of IVF infants compared with all infants born. National health registers. We studied 16,280 IVF infants, 30% of whom were conceived by intracytoplasmic sperm injection (ICSI). None. Multiple births, infant sex, preterm birth, low birth weight, and small for gestational age among singletons, mortality, low Apgar score, neonatal diagnoses. Twinning was less frequent after frozen standard IVF (18.1%) and after ICSI (21.8%) than after fresh standard IVF (24.4%). The male/female ratio was significantly increased in infants conceived after standard IVF. No significant differences were seen between singleton infants conceived after different IVF methods with respect to preterm birth, low birth weight, or infant mortality, with the possible exception of frozen standard IVF, for which some of these rates were lower than after fresh standard IVF. Infants born after ICSI had an indicated lower risk of respiratory problems than infants born after standard IVF. Little difference in outcome was seen after different IVF methods. The differences observed might be due to dissimilar characteristics of the treated women (e.g., because ICSI was mainly used in connection with male infertility).

The prevalence of major congenital malformations during two periods of time, 1986–1994 and 1995–2002 in newborns conceived by assisted reproduction technology

Evidence has emerged that assisted reproduction technology (ART) may be associated with an increased risk of congenital malformations, low birth weight, and genetic imprinting disorders. The aim of the study was to determine, the prevalence of major malformations in newborns conceived by standard in vitro fertilization (IVF) in 1986–1994 and newborns conceived by different types of ART procedures in 1995–2002. Data were collected from the IVF Registry and Israel Birth Defects Monitoring System for all infants (live births, stillbirths and terminations of pregnancy) delivered after 20 weeks’ gestation who achieved a fetal weight of at least 500 g. The control groups consisted of all spontaneously conceived babies (live births, stillbirths and terminations of pregnancy) born in our center during the same time periods. During the first period, a total of 31,007 babies were born at our center, of whom 278 were conceived by standard IVF. Twenty-six of the IVF infants had major malformations, for a prevalence rate of 9.35%, which was 2.3-fold higher than that in the general population (4.05%). During the second period, 53,208 infants were born, of whom 1632 were conceived by ART. Major malformations were found in 147 ART infants, for a prevalence rate of 9.0%, which was 1.75-fold higher than in the general population (5.18%). Analysis of the clinical characteristics of the ART infants with major malformations showed that 70.3% were born preterm, 76.5% had low birth weight, 58.6 were twins, and 11.7% were triplets. The use of ART procedures increased by a factor of 3.4 in the second period. Two important outcomes of ART were observed: an increased prevalence of major malformations about double the general population in both periods, and a high frequency of adverse clinical characteristics among ART infants with major malformations. Infertile couples should be adequately counseled regarding the real risk of having a child with malformations or a preterm or low birth weight infant.

The prevalence of major congenital malformations during two periods of time, 1986?1994 and 1995?2002 in newborns conceived by assisted reproduction technology

Evidence has emerged that assisted reproduction technology (ART) may be associated with an increased risk of congenital malformations, low birth weight, and genetic imprinting disorders. The aim of the study was to determine, the prevalence of major malformations in newborns conceived by standard in vitro fertilization (IVF) in 1986-1994 and newborns conceived by different types of ART procedures in 1995-2002. Data were collected from the IVF Registry and Israel Birth Defects Monitoring System for all infants (live births, stillbirths and terminations of pregnancy) delivered after 20 weeks' gestation who achieved a fetal weight of at least 500 g. The control groups consisted of all spontaneously conceived babies (live births, stillbirths and terminations of pregnancy) born in our center during the same time periods. During the first period, a total of 31,007 babies were born at our center, of whom 278 were conceived by standard IVF. Twenty-six of the IVF infants had major malformations, for a prevalence rate of 9.35%, which was 2.3-fold higher than that in the general population (4.05%). During the second period, 53,208 infants were born, of whom 1632 were conceived by ART. Major malformations were found in 147 ART infants, for a prevalence rate of 9.0%, which was 1.75-fold higher than in the general population (5.18%). Analysis of the clinical characteristics of the ART infants with major malformations showed that 70.3% were born preterm, 76.5% had low birth weight, 58.6 were twins, and 11.7% were triplets. The use of ART procedures increased by a factor of 3.4 in the second period. Two important outcomes of ART were observed: an increased prevalence of major malformations about double the general population in both periods, and a high frequency of adverse clinical characteristics among ART infants with major malformations. Infertile couples should be adequately counseled regarding the real risk of having a child with malformations or a preterm or low birth weight infant.

Neonatal Outcome and Congenital Malformations in Children Born After In-Vitro Fertilization

Koivurova, Sari; Hartikainen, Anna-Liisa; Gissler, Mika; Hemminki, Elina; Sovio, Ulla; Järvelin, Marjo-Riitta

Characteristics and Outcomes of Low Birth Weight Infants from In Vitro Fertilization and Natural Conceptions

Objective: To compare characteristics and outcomes (0–18 months) between surviving low birth weight (< 1250 g) in vitro fertilization (IVF) infants, and low birth non-IVF infants born between 1991 and 1997.Design: Retrospective case-controlled study.Setting: The Regional Fertility Program (RFP) and Southern Alberta Perinatal Follow-up Program (PNFU) in Calgary, Alberta.Participants: Fifteen infants born with birth weight less than 1250 g after IVF at the RFP and seen at the PNFU. Three controls per case were matched for year of birth, birth weight, and gender.Main Outcome Measures: Neonatal intensive care unit data, hospitalizations, medications, disabilities, developmental outcomes, and parental demographics.Results: IVF infants were significantly more likely to have older mothers (mean 31.80 vs. 28.00 years, p = 0.005), ventriculomegaly (26.7% vs. 4.4%, p = 0.030), been given non-prescription medications (91.7% vs. 52.6%, p = 0.018), a non-vertex presentation at delivery (72.7% vs. 45.2%, p = 0.027), and to be of multiple birth (80.0% vs. 26.7%, p < 0.0005). A significantly higher percentage of IVF infants had one minute Apgar scores over 6 (66.7% vs. 40.0%; p trend = 0.031 ). Non-IVF infants were significantly more likely to have one or more ear infections (71.4% vs. 33.3%, p = 0.037) and smaller head circumferences at eight month visit (mean 44.19 cm vs. 44.98 cm, p = 0.053). Their mothers were significantly more likely to have had a previous preterm birth (24.4% vs. 0%, p = 0.05). Cognitive scores were similar between cases and controls.Conclusions: Eighteen month outcomes of IVF and non-IVF infants less than 1250 g did not differ dramatically. Long-term comparisons of extremely low birth weight IVF and non-IVF infants with regard to mental and physical development are essential. IVF pregnancies are known to increase the risk of low birth weight, preterm delivery, multiple birth, and coexistent morbidities. These risk factors are of social and economic importance to parents and health care providers.

Oocyte donation in infertility treatment

Oocyte donation in infertility treatment