Singleton In Vitro Fertilization Research Articles

Preterm birth in young women and singleton pregnancy following IVF in the kingdom of Bahrain

Invitro Fertilization (IVF) rate has been constantly increasing since 1986. Preterm birth is a known complication of IVF pregnancies. Analysis of the risk of preterm birth in young mothers conceived singleton pregnancy through IVF/Intra cytoplasmic sperm injection (ICSI) is an important assessment to counsel young patients contemplating IVF treatment.This is a retrospective analysis of births from young patients of ≤35 years, following natural/ IVF conception between January 2019 and February 2020 at Bahrain Defense Force Hospital. We studied the women who had conceived through ART (Assisted Reproductive Technology) against women conceived naturally. Preterm birth between 24 and 37 weeks of gestation was analyzed. The risk factors for preterm delivery such as multiple pregnancy, placental insufficiency, vaginal infections as well as iatrogenic preterm deliveries were analyzed. P-Value<0.05 is considered statistically significant.The study included 2646 women. IVF conception was reported in 56 patients with rate of 2.1%. Our study showed that gestational age at delivery was earlier for IVF conception at 36.5 weeks compared to 39 weeks for natural conception. Multiple logistic regression analysis after adjusting other risk factors of preterm delivery, confirmed increased risk of delivery before 37 weeks after IVF singleton conception with OR 2.3 and 95% CI(1.1-4.7) P = 0.02. Risk of delivery before 32 weeks not increased with IVF conception OR 2.3 with 95% CI of 0.9-5.9 P=0.09, but the risk significantly increased for delivery before 28 weeks with OR 4.5 with 95% CI(1.2-16.8)P=0.02.Preterm deliveries are significantly increased in women aged less than 35 years old after IVF/ICSI with singleton pregnancies.

The impact of fresh versus frozen-thawed embryos on maternal serum analyte levels in IVF singleton and twin pregnancies.

To determine whether embryo cryopreservation is associated with a difference in maternal serum analyte levels in singleton and twin pregnancies conceived via in vitro fertilization (IVF). This was a retrospective cohort study of singleton and twin pregnancies conceived via IVF from a university health system from 01/2014 to 09/2019. Patients with available first and second trimester serum analyte data were included and analyzed separately. Multiple of the median (MoM) values for free β-human chorionic gonadotropin (β-hCG), pregnancy-associated plasma protein A, alpha-fetoprotein (AFP), Inhibin A, and unconjugated estriol (uE3) were compared between two groups: pregnancies conceived after the transfer of fresh embryos versus pregnancies conceived after the transfer of frozen-thawed embryos. Multiple linear regression of log MoM values with F test was performed to adjust for potential confounders. For singletons, fresh embryos were associated with a lower median first trimester free β-hCG (1.00 MoM vs. 1.14 MoM; parameter estimate [PE] 0.90, 95% CI 0.82-0.99, p = .03) compared to frozen-thawed embryos. Fresh embryos were also associated with a lower median second trimester uE3 (0.93 MoM vs. 1.05 MoM; PE 0.88, CI 0.83-0.95, p = .0004) and AFP (1.02 MoM vs. 1.19 MoM; PE 0.91, CI 0.84-0.99, p = .02) compared to frozen-thawed embryos in singletons. There were no significant differences between median first and second trimester serum analytes in twin pregnancies compared between the two groups. Singleton pregnancies derived from fresh embryos had lower first (free β-hCG) and second (uE3 and AFP) trimester analytes compared to frozen-thawed embryos. Twin pregnancies demonstrated no difference between the groups.

The multiple reference range of mean uterine artery pulsatility index for natural and in vitro fertilization singletons during 11-14 gestational weeks.

Ultrasonography of the uterine artery (UtA) in the first and second trimesters of pregnancy can assess uterine-placental blood perfusion and guide early clinical prevention. Establishing normal ranges of the UtA pulsatility index (UtA-PI) at 11-14 weeks of pregnancy is helpful for the early identification of high-risk pregnant women and improving the prognosis. This study aimed to establish a reference range of UtA-PI based on crown-rump length (CRL) for spontaneous and in vitro fertilization (IVF) singleton pregnancy during 11-14 weeks, respectively. A prospective study was performed at Peking Union Medical College Hospital. Healthy, low-risk women with a singleton pregnancy at 11-14 gestational weeks were consecutively recruited for this study from December 2017 to December 2020. All participants underwent routine prenatal ultrasound examination. The CRL of the fetus and the UtA-PI were measured in both uterine arteries, and average values were calculated. The LMS method was used to fit the percentile (P)5, P10, P25, P50, P75, P90, and P95 curves of the UtA-PI value of spontaneous and IVF singleton pregnancy with CRL changes, respectively. A total of 1,962 pregnant women with normal fetuses were included in this study, including 1,792 pregnancies conceived naturally and 170 IVF fetuses. The UtA-PI reference range in the spontaneous pregnancy group was consistently higher than that in the IVF group during 11-14 weeks, and showed a statistically significant difference in UtA-PI for spontaneous and IVF pregnancies (P<0.001). According to the LMS method, each percentile curve of UtA-PI decreased with the increase of CRL in both the natural pregnancy group and the IVF group. The P95 range of UtA-PI for pregnant women with naturally conceived and IVF pregnancy was 2.74 to 2.11 and 2.50 to 1.94, respectively. The overall change of UtA-PI differentials of the two groups showed a downward trend and decreased slightly with the increase of CRL. This study provided a single-center, large sample of data and constructed a CRL-based reference value of UtA-PI for spontaneous and IVF singleton pregnancy, which provides a reliable basis for early UtA evaluation and early clinical decision-making during 11-14 gestational weeks.

The impact of preimplantation genetic testing on first- and second-trimester maternal serum analyte levels

Objective To determine whether preimplantation genetic testing (PGT) is associated with a change in maternal serum analyte levels in pregnancies conceived via in vitro fertilization (IVF). Methods Retrospective cohort of singleton and twin IVF pregnancies with available first- or second-trimester serum analyte data from 01/2014 to 09/2019. Multiple of the median (MoM) values for free β-human chorionic gonadotropin (β-hCG), pregnancy-associated plasma protein A (PAPP-A), alpha-fetoprotein (AFP), inhibin A, and unconjugated estriol, were compared between two groups: pregnancies conceived after transfer of PGT screened euploid embryos vs. those conceived after transfer of untested embryos. Multiple linear regression of log MoM values with F test was performed to adjust for potential confounders. Results Nine hundred and sixty-two singleton and 165 twin IVF pregnancies with serum analyte data available for analysis were included. PGT was associated with a higher median first- and second-trimester AFP compared to no PGT in singletons (1.23 MoM vs. 1.13 MoM; parameter estimate [PE] 1.08, 95% CI 1.00–1.17, p= .04, and 1.21 MoM vs. 1.07 MoM; PE 1.07, 95% CI 1.01–1.13, p= .01, respectively). PGT was also associated with a lower median PAPP-A compared to no PGT in twins (0.75 MoM vs. 1.18 MoM, PE 0.74, 95% CI 0.60–0.92, p= .006). Conclusions Our data suggest that PGT is associated with higher maternal serum levels of second-trimester AFP in singleton and lower levels of first-trimester PAPP-A in twin pregnancies conceived via IVF.

P-356 Clinical implications of first-trimester ultrasound dating in singleton pregnancies obtained through in vitro fertilization

Abstract Study question Is there a correspondence between ultrasound estimation of gestational age (GAUS) and its calculation based on embryo transfer date (GAIVF), in in-vitro fertilization (IVF) pregnancies? Summary answer GAUS and GAIVF are not overlapping, being the first mildly greater than the latter, maybe due to anticipated ovulation and fertilization or accelerated embryo development. What is known already In IVF pregnancies the precise date of conception is known. However, it is possible that some factors (such as a time delay between conception and implantation, an early in-vitro embryo development, and the maternal environment itself with its altered hormonal milieu) may influence the early stages of embryonic development. Data regarding first-trimester fetal development in IVF pregnancies are in fact conflicting and both underestimation and overestimation of the true GA were reported when traditional charts were used for ultrasound pregnancy dating. Study design, size, duration A retrospective study was performed, including all singleton IVF pregnancies who underwent the first-trimester ultrasound scan for the screening of aneuploidies between January 2014 and June 2019. For each pregnancy GA was determined using two alternative methods: one based on the date of embryo transfer (GAIVF), and one based on ultrasound measurement of crown-rump length (CRL) (GAUS). GA were compared to search for any discrepancy. The impact of pregnancy dating on obstetric outcome was evaluated. Participants/materials, setting, methods All women with singleton pregnancies conceived by conventional IVF or intracytoplasmic sperm injection (ICSI), who performed first-trimester ultrasound scan for the screening of aneuploidies at the Department of Obstetrics and Gynecology ‘L. Mangiagalli', Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, were included. Exclusion criteria were as follows: multiple pregnancy (i.e., the evidence of more than one gestational sac at the first ultrasound scan), abnormal karyotype and/or congenital malformations detected either in pre- or postnatal period. Main results and the role of chance Overall, 249 women were selected: 111 pregnancies (45%) by conventional IVF, and 138 (55%) by ICSI. Among the included women, 127 (51%) pregnancies resulted from frozen-thawed embryo transfer. At first trimester ultrasound scan, the discrepancy in days between GAUS and GAIVF was ≥ 4 days in 32 cases (13%, 95%CI: 9-18%). It ranged within 2 and 3 days in 100 cases (40%, 95%CI: 34-47%). In 117 cases (47%, 95%CI: 41-53%) GAUS and GAIVF overlapped or showed a discrepancy of ± 1 day. Comparing GAUS and GAIVF at first trimester ultrasound scan, the median values of GA were 88 [86 - 91] days and 87 [85 - 90] days, respectively (p &amp;lt; 0.001). The median difference was 1 [0 - 2] days, with GAUS systematically higher than GAIVF. This discrepancy persisted when subgroups were analyzed comparing different IVF procedures (conventional IVF versus ICSI, cleavage versus blastocyst transfer, frozen versus fresh transfer). The overall duration of pregnancy differed, with median values of 274 [269 - 281] days in GAUS group and 273 [268 - 280] days in GAIVF group, (p &amp;gt; 0.001). No impact of the dating method on obstetric outcomes was observed, being no differences in the rate of preterm birth or abnormal fetal growth. Limitations, reasons for caution This is a retrospective study and thus exposed to the inaccuracies of this study design. Moreover, being a single-centre study, the sample size is relatively small. Finally, ultrasound evaluations were performed by multiple operators: although they are all certified, there is some inter-individual variability that may impact on the results. Wider implications of the findings Despite a known date of conception, it is difficult to assume that the oocyte retrieval date precisely resembles the date of natural ovulation and conception. IVF seems to anticipate fertilization. On these bases, it would be advisable to date IVF pregnancies using GAUS to realign them to natural pregnancies. Trial registration number Not Applicable

Pregnancy outcomes after in vitro fertilization for moderate and severe endometriosis. A case-control study

IntroductionPrevious international studies showed that endometriosis could have a link with obstetrical complications, as an increased risk of preterm birth, gestational diabetes mellitus, and cesarean section. However, the results are difficult to interpret because biases are common, such as heterogeneity in the severity of the endometriosis cases included. That's why some complications as risk of miscarriage and post-partum hemorrhage are still debated. Our objective was to study pregnancy outcome after In Vitro Fertilization (IVF) in women suffering from rAFS stage III and IV endometriosis. MethodsWe conducted a case-control study between 2009 and 2019. We compared pregnancy outcomes after IVF in two groups of women matched by age, body mass index and smoking in two hospital centers. Group A was constituted by singleton pregnancies following ART for moderate and severe endometriosis (rAFS stage III and IV endometriosis). Group B was composed of singleton pregnancies in women with no endometriosis following ART for another reproductive disease. All women achieved pregnancy after 22 weeks. ResultsA total of 240 pregnant women were included: 80 singleton IVF pregnancies (group A) were compared with 160 singleton IVF pregnancies (group B). We observed an increased risk of placenta previa (12.5% Vs 1.9%; p = 0,001), and cesarean section (49.4% (n = 39) Vs 29.6% (n = 47) p = 0,004). Rate of postpartum hemorrhage was not significantly different in endometriosis group (11.2% Vs 7.5% p = 0.47). ConclusionDespite conflicting results in literature due to a lot of confounding variables, the impact of endometriosis on pregnancy is still debated in women suffering from rAFS III and IV endometriosis. In our study, we observed statistically higher rates of placenta previa and cesarean section but not an increased risk of postpartum hemorrhage. Further larger series are needed to confirm our findings and a possible link with other obstetrical complications. However, we think that an ART pregnancy in a context of severe endometriosis should be considered at risk of adverse obstetrical outcomes.

The impact of preimplantation genetic testing for aneuploidy on prenatal screening.

To determine whether preimplantation genetic testing for aneuploidy (PGT-A) is associated with a reduced risk of abnormal conventional prenatal screening results in singleton pregnancies conceived using in vitro fertilization (IVF). This was a retrospective cohort study of singleton IVF pregnancies conceived from a single tertiary care center between January 2014 and September 2019. Exclusion criteria included mosaic embryo transfers, vanishing twin pregnancies, and cycles with missing outcome data. Two cases of prenatally diagnosed aneuploidy that resulted in early voluntary terminations were also excluded. The primary outcome of abnormal first or second-trimester combined screening results was compared between two groups: pregnancy conceived after transfer of a euploid embryo by PGT-A vs. transfer of an untested embryo. Multivariable backwards-stepwise logistic regression with Firth method was used to adjust for potential confounders. Of the 419 pregnancies included, 208 (49.6%) were conceived after transfer of a euploid embryo by PGT-A, and 211 (50.4%) were conceived after transfer of an untested embryo. PGT-A was not associated with a lower likelihood of abnormal first-trimester (adjusted OR 1.64, 95% CI 0.82-3.39) or second-trimester screening results (adjusted OR 0.96, 95% CI 0.56-1.64). The incidences of cell-free DNA testing, fetal sonographic abnormalities, genetic counseling, and invasive prenatal diagnostic testing were similar between the two groups. Our data suggest that PGT-A is not associated with a change in the likelihood of abnormal prenatal screening results or utilization of invasive prenatal diagnostic testing. Counseling this patient population regarding the importance of prenatal screening and prenatal diagnostic testing, where appropriate, remains essential.

PRETERM BIRTH AND LOW BIRTH WEIGHT IN SINGLETON PREGNANCIES AFTER IN VITRO FERTILIZATION- INFLUENCE OF INFERTILITY AND METHOD OF FERTILIZATION

The aim of our study was to determine the effect of infertility and the method of fertilization on the frequency of preterm birth and low birth weight in singleton pregnancies achieved by in vitro fertilization (IVF). The study was conducted in the period 01.2013 - 12.2017 and included 286 patients with births from singleton IVF pregnancies. Classical IVF received 107 patients (group A1) and ICSI fertilization - 148 (group A2). Cases with tubal infertility were 81 (group B1), and 85 were with male infertility (group B2). In group A1, birth prior to 37 weeks of gestation (w.g.) was found in 33 (30.8%) cases, compared to 26 (17.6%) in group A2 (p=0.029).In group A1, birth weight &lt;2500 g was observed in 27 (25.3%) of cases, and in group A2 - in 17 (11.5%) of cases (p=0.015). In group B1, birth prior to 37 w.g. was established in 26 (32.1%) of the cases, compared to 9 (10.6%) in group B2 (p=0.003). In group B1 there was birth weight &lt;2500 g in 19 (23.5%) of patients, compared to 6 (7.1%) in group B2 (p = 0.009). The average weight of the newborn and average duration of pregnancy was lower in groups with IVF fertilization and tubal infertility compared to ICSI fertilization and male infertility. Tubal infertility and classical IVF fertilization are independent risk factors that increase the frequency of preterm birth and low birth weight in IVF singleton pregnancies.

FIGO good practice recommendations on reduction of preterm birth in pregnancies conceived by assisted reproductive technologies.

FIGO (the International Federation of Gynecology and Obstetrics) supports assisted reproductive technologies (ART) to achieve pregnancy and supports their availability in all nations. However, the increased frequency of preterm birth must be taken into account. Therefore, before in vitro fertilization (IVF) is started, other approaches, including expectant management, should be considered. Single embryo transfer is the best approach to ensure a live, healthy child. However, increased risks for preterm birth are also associated with a singleton IVF pregnancy and should be discussed and contrasted with spontaneous conception. Increased preterm birth and other adverse pregnancy outcomes in singleton IVF cycles warrant investigations to elucidate and mitigate. Minimizing embryo manipulation during cell culture is recommended. Increased risk of preterm birth and other pregnancy complications in ART could reflect the underlying reasons for infertility. This information should be discussed and further explored.

Does the etiology of infertility have any effect on perinatal outcomes?

Objective Pregnancies after in vitro fertilization (IVF) are associated with a less favorable outcome compared to natural conception as consistently shown in various studies. However, etiologic factors behind this issue remain to be elucidated. We aimed to demonstrate whether the etiology of infertility has a role on poor pregnancy outcomes in IVF pregnancies. Methods In this retrospective case control study; IVF and spontaneous singleton pregnancies were investigated. The infertile patients were divided into six groups according to the etiology of their infertility (anovulation, male factor, tubal factor, endometriosis, unexplained infertility and poor ovarian reserve). The incidence of preeclampsia, gestational diabetes mellitus, intrahepatic cholestasis of pregnancy, preterm birth and birth weight discrepancies was examined between the groups and subgroups. After adjusting the confounding variables for each infertility subgroup such as demographic data, embryo stage in transfer (blastocyst against cleavage stage) and fresh and frozen embryo transfer status, the effect on pregnancy outcomes was investigated using multinomial logistic regression analysis. Results The study included 934 patients in the IVF group and 1009 patients in the control group. While adverse pregnancy outcomes were more frequent in the general infertility group in comparison to the control group, after elimination of the confounding variables, the direct effect of the etiology of infertility on these outcomes could not be shown. Conclusion In the IVF pregnancies, most of the increased risk of poor pregnancy outcomes appeared to be explained by maternal characteristics (such as age, body mass index) and by treatment protocols rather than infertility etiology. Physicians should consider these risks while counselling patients.

Malpresentation of the Fetus in Singleton Pregnancies after In Vitro Fertilization

BACKGROUND: There are some data in the literature that show an increased incidence of breech presentation and other non-cephalic presentations in vitro fertilization (IVF) singleton pregnancies compared to spontaneous ones. AIM: The purpose of our study was to compare IVF and spontaneous singleton pregnancies in terms of frequency of breech presentation and its impact on the mode of delivery. Furthermore, we wanted to study the rate of transverse and oblique lie in both groups. MATERIALS AND METHODS: We conducted a prospective and retrospective study at “Maichin Dom” University Hospital in Sofia, Bulgaria for the period from January 2013 to December 2017 and analyzed 402 singleton IVF pregnancies and compared them with 523 spontaneous singleton pregnancies. The primary outcome was a breech presentation of the fetus. RESULTS: We found a significantly higher rate of breech presentation in IVF compared to spontaneous pregnancies (p &lt; 0.001). According to gestational age, the difference between the groups persisted when the pregnancy was at least the 32nd week of gestation. We found no difference in the frequency of vaginal birth in the two groups when the fetus was in breech presentation CONCLUSION: IVF singleton pregnancies are associated with a higher risk of breech presentation. Further research is needed to determine the factors contributing to the higher incidence of breech presentation among patients undergoing IVF.

Obstetrical outcomes of ART pregnancies in patients with male factor infertility.

Pregnancies conceived by in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) are associated with an increased incidence of obstetrical and neonatal complications. With the growing rate of male factor infertility, which is unique by not involving the maternal milieu, we aimed to assess whether obstetrical outcomes differed between IVF/ICSI pregnancies due to male factor infertility and those not due to male factor infertility. A retrospective cohort study of women receiving IVF/ICSI treatments at a single hospital over a five-year period was involved in the study. Inclusion criteria were women with a viable pregnancy that delivered at the same hospital. Pregnancies were divided into male factor only related and non-male factor-related infertility. The groups were compared for several maternal and neonatal complications. In total, 225 patients met the study criteria, with 94 and 131 pregnancies belonging to the male factor and non-male factor groups, respectively. Demographic and clinical characteristics were comparable, except for younger maternal age and higher incidence of twin pregnancies in the male factor group. A sub-analysis for singleton pregnancies revealed a less likelihood of cesarean delivery, preterm birth, and male gender offspring in the male factor group (p < 0.05). These differences were not observed in the sub-analysis for twin pregnancies. Other outcome measures were similar in both groups, both for singleton and twin pregnancies. Singleton IVF pregnancies due to male factor infertility are associated with a reduced incidence of some adverse outcomes, likely due to lack of underlying maternal medical conditions or laboratory conditions related to ICSI. Our findings require validation by further studies on larger samples.

Sixth grade academic achievement among children conceived with IVF: a population-based study in Texas, USA

To compare academic achievement in reading and mathematics at the end of sixth grade and progress from third to sixth grade by children conceived with in vitro fertilization (IVF) to those conceived naturally. This was a retrospective population-based cohort study of IVF-conceived singleton and twin children who took the 3rd grade and 6th grade public school standardized reading and mathematics testing in Texas. There were 6623 children with reading scores in both the third and sixth grades and 6374 children with mathematics scores in both the third and sixth grades. Mean (± SE) scaled test scores for IVF and control singleton children for reading were 1544.6 ± 3.4 and 1527.7 ± 1.9, respectively, in third grade and 1701.2 ± 3.6 and 1681.0 ± 2.0, respectively, in sixth grade; for mathematics, the scores were 1564.4 ± 3.7 and 1548.9 ± 2.1, respectively, in third grade and 1774.0 ± 4.2 and 1752.0 ± 2.3, respectively, in sixth grade. In multivariate models, singleton IVF children scored significantly higher than control children in reading and mathematics, averaging 17.7 ± 4.0 points and 20.1 ± 4.1 points higher, respectively, in reading in third and sixth grades and 17.8 ± 4.4 points and 25.0 ± 4.8 points higher, respectively, in mathematics in third and sixth grades. Children conceived with IVF and aged 8-9 years and aged 10-12 years performed as well on third and sixth grade reading and mathematics assessments as their counterparts conceived naturally.

The diagnosis of Gestational Diabetes Mellitus and its impact on In Vitro Fertilization pregnancies. A pilot study.

In Vitro Fertilization (IVF) is increasingly becoming a necessary mode of reproduction. This high risk group is prone to Gestational Diabetes Mellitus (GDM) which further exposes these pregnancies to an increased risk of adverse outcomes. In light of the limited data in the current literature, further investigation is needed regarding the time of GDM diagnosis in IVF pregnancies as well as the outcome of IVF pregnancies complicated by GDM. In this three center pilot cross sectional study, the data of 101 singleton IVF pregnancies complicated by GDM were analyzed. Prompt GDM diagnosis in IVF pregnancies was accomplished by self-blood glucose monitoring (SMBG) from the first antenatal visit and confirmed by an OGTT. To evaluate pregnancy outcome, maternal and fetal complications in the 101 GDM IVF group was compared to 101 IVF as well as 101 spontaneous conceptions (SC). The three groups were matched by age. The effect of demographic and glycemic parameters on the outcome of GDM IVF pregnancies was investigated. GDM diagnosis was made before the 24th week in 37.6% of the GDM IVF group. The week of delivery was earlier for the GDM IVF group (37 ± 1.7) relative to the IVF (37.9 ± 0.9, p < 0.001) and the SC group (38.1 ± 0.8, p < 0.001). GDM IVF pregnancies exhibited greater preeclampsia rates and 84.8% underwent caesarian section. No significant difference regarding LGA and SGA birth weights was found. Complications of GDM IVF pregnancies were associated with the 1-h postprandial BG (r = 0.267, p = 0.007). GDM screening in IVF pregnancies may be considered earlier than the 24th week. IVF pregnancies affected by GDM are prone to increased maternal and fetal complications which are associated with 1-h postprandial BG.

885 Maternal and neonatal outcomes associated with preimplantation genetic testing in IVF singleton live births

Despite its widespread use, data regarding the impact of preimplantation genetic testing (PGT) on pregnancy outcomes are limited. We set out to determine whether PGT is associated with adverse maternal or neonatal outcomes in singleton in vitro fertilization (IVF) pregnancies. Retrospective cohort of singleton live births conceived by IVF within a university health system and delivered between January 2014 and August 2019. Patients with missing outcome data were excluded. Adverse maternal outcomes, i.e. hypertensive disorders of pregnancy, abnormal placentation, preterm birth, and adverse neonatal outcomes were compared between two groups: patients who had a transfer of a PGT screened euploid embryo versus transfer of an untested embryo. Statistical analysis included use of Chi-square and Wilcoxon rank sum tests, as well as multivariate backwards-stepwise logistic regression, with significance defined as P value < 0.05. Data was presented as adjusted Odds Ratios (OR) with 95% confidence intervals (CI). Of the 1,015 live births, 496 (48.9%) underwent PGT prior to conception and 519 (51.1%) did not. A subset of baseline characteristics, such as race or ethnic group, infertility diagnosis, egg source, and cycle type, were significantly different between the two groups (Table 1). After adjusting for potential confounders, there was no significant difference between the two groups with respect to adverse maternal or neonatal outcomes (Table 2). Our data suggest that IVF with PGT is not associated with an increased risk of adverse maternal or neonatal outcomes compared to IVF without PGT. Specifically, the rates of placental disorders such as hypertensive disorders of pregnancy, fetal growth restriction and abnormal placentation were similar between the two groups. Such data may provide reassurance to couples when planning fertility treatments.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

1121 Comprehensive appraisal of outcomes in singleton pregnancies conceived via in vitro fertilization: US 2016-2018

We set out to better define pregnancy and neonatal outcomes in singleton gestations conceived via in vitro fertilization (IVF). Retrospective analysis of the Centers for Disease Control and Prevention, Natality Live Birth database (2016-2018). All singleton births conceived via IVF comprised the study group while those conceived spontaneously served as controls. Pearson’s chi-square test with Bonferroni adjustment were used to compare baseline characteristics as well as several pregnancy and neonatal outcomes. Multivariate logistic regression was used to adjust outcomes for potential confounders such as maternal age, race/ethnicity, body mass index (BMI), chronic hypertension, pregestational diabetes, and prior preterm birth. Results were presented as adjusted odds ratios (aOR) with 95% confidence intervals (CI), and statistical significance was set as P value < 0.05. IVF singleton births comprised 0.84% of the study cohort (83,624 of 9,936,721). Baseline characteristics such as maternal age, BMI, race/ethnicity, pre-gestational diabetes, and smoking varied significantly between the groups (Table 1). IVF pregnancies were associated with several adverse pregnancy and neonatal outcomes including hypertension disorders of pregnancy (aOR 1.73, CI 1.64-1.77), maternal transfusion (aOR 3.12, CI 2.91-3.35), gravid hysterectomy (aOR 2.92, CI 2.47-3.44), maternal ICU admissions (aOR 2.28, CI 2.02-2.56) and preterm deliveries (aOR 1.47, CI 1.44-1.50), as well as adverse neonatal outcomes including low Apgar score (aOR 1.40, CI 1.34-1.47), NICU admission (aOR 1.65, CI 1.61-1.68), prolonged ventilation (aOR 2.18, CI 2.09-2.27), and neonatal seizures (aOR 1.85, CI 1.41-2.42) amongst others (Table 2). We report a significant increase in several adverse pregnancy and neonatal outcomes in singleton pregnancies conceived via IVF compared to those conceived spontaneously. Our data add to the clinical information available regarding pregnancy risks in this population, suggesting that Maternal Fetal Medicine specialist should be involved in the care of patients conceived via IVF.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

918 The impact of preimplantation genetic testing for aneuploidy on prenatal screening

The clinical utility of preimplantation genetic testing for aneuploidy (PGT-A) is well established. However, data is limited on the residual risk for abnormal prenatal screening in PGT-A screened embryos. We investigated whether PGT-A is associated with a reduced risk of abnormal prenatal screening in singleton pregnancies conceived using in vitro fertilization (IVF). Retrospective cohort of singleton IVF pregnancies conceived from a single center from 01/2014 to 09/2019. Exclusion criteria included transfer of mosaic embryos, vanishing twins, and missing data. Two cases of prenatally diagnosed aneuploidy that resulted in early voluntary terminations were also excluded. Maternal age was adjusted for donor egg age where indicated. The primary outcome of abnormal first or second trimester serum screening was compared between two groups: pregnancy after transfer of a euploid embryo by PGT-A (n = 208) versus transfer of an untested embryo (n = 211). Secondary outcomes included other prenatal screening modalities and rate of invasive prenatal diagnostic testing. Multivariate backwards-stepwise logistic regression with Firth method was used to adjust for potential confounders. Baseline characteristics compared between the two groups are displayed in Table 1. PGT-A was not associated with a reduced risk of abnormal first-trimester (adjusted OR 1.64, 95% CI 0.82-3.39) or second-trimester screening (adjusted OR 0.96, 95% CI 0.56-1.64) (Table 2). The likelihood of cell free DNA testing, soft sonographic markers, major fetal structural malformations, genetic counseling and invasive prenatal diagnostic testing were also similar between the two groups (Table 2). Our data illustrate that PGT-A is not associated with a reduced rate of abnormal prenatal screening, or likelihood of invasive prenatal diagnostic testing. Nevertheless, counseling this patient population regarding the importance of prenatal screening and prenatal diagnostic testing where appropriate remains essential.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Single Embryo Transfer Versus Double Embryo Transfer: A Cost-Effectiveness Analysis in a Non-IVF Insurance Mandated System.

Because of increased morbidity seen in multiple gestations, the American Society of Reproductive Medicine recommends transfer of blastocysts one at a time for most patients. While cost-effectiveness models have compared single embryo transfer (SET) versus double embryo transfer (DET), few incorporate maternal and neonatal morbidity, and none have been performed in U.S. Military facilities. The purpose of this study was to determine the cost effectiveness of sequential SET versus DET in a U.S. Military treatment facility. A cost-effectiveness model was created based on 250 patients between the ages of 20-44 who previously underwent in vitro fertilization (IVF) at our facility. The model consisted of patients pursuing either SET or DET with two total embryos. Cycle outcomes were determined using the published SARTCORS success calculator. Neonatal and obstetrical outcomes were simulated based on singleton and twin IVF pregnancies. Neonatal and obstetrical cost estimates were based on internal data as well. If 250 model patients pursue SET, 140 live births would occur, with total cost of $5.7 million, and cost per delivery of $40,500. If the model patients pursued DET, 117 live births would occur, with total cost of $9.2 million and a cost per delivery of $77.700. DET would lead to more total infants (207 vs. 143 in SET cohort). Personal costs are higher in SET versus DET cohorts ($23,036 vs. $20,535). SET in a system with no infertility coverage saves approximately $3.5 million per 250 patients. Higher personal costs as seen with SET may incentivize patients to seek DET. The total savings should encourage alteration to practice patterns with the U.S Military Healthcare System.

Vanishing Twins Conceived Through Fresh In Vitro Fertilization: Obstetric Outcomes and Placental Pathology.

To characterize the obstetric outcomes and placental pathology in live births arising from vanishing twin pregnancies compared with nonreduced in vitro fertilization (IVF) pregnancies. This is a retrospective cohort study of live births resulting from fresh embryo transfers after IVF cycles with autologous oocytes from 2004 through 2017 at a large academic fertility center. Clinical information and pathology reports were reviewed. Placental diagnoses were coded using established nosology by expert placental pathologists. Analysis of variance, Kruskal-Wallis, Pearson's χ, and Fisher exact tests were used, as appropriate, to compare pathology categories between pregnancy outcomes. Mixed effects logistic regression models were generated to reveal the association between pregnancy outcome and placenta pathology, controlling for pregnancies arising in the same woman and various suspected confounders. Of 905 fresh autologous IVF cycles with placental pathology available for review, we identified 73 vanishing twin pregnancies (8.1%), 556 singleton pregnancies (61.4%), and 276 twin pregnancies (30.5%). Vanishing twin syndrome was not associated with preterm delivery, route of delivery, growth restriction or other obstetric outcomes as compared with IVF singleton pregnancies. However, vanishing twin syndrome pregnancies showed distinctive placental pathologies including an increased rate of small placentas (less than the 10th percentile by weight), with more anatomical abnormalities than IVF singleton pregnancies (odds ratio 1.73, 95% CI 0.94-3.19; adjusted odds ratio 2.15, 95% CI 1.08-4.28). The frequency of placental vascular and inflammatory pathologies associated with IVF vanishing twin syndrome pregnancies were similar to that of IVF singleton pregnancies. Loss of a twin after 8 weeks of gestation was not associated with greater risks of placental pathologies. In vitro fertilization pregnancies affected by vanishing twin syndrome did not have significant differences in obstetric or perinatal outcomes as compared with twin or singleton gestations. However, early twin loss was potentially associated with differences in placental development associated with a higher rate of small placentas and other anatomic pathologies.

Complications of the third stage of labor are more prevalent in IVF pregnancies

Background Pregnancies conceived by in vitro fertilization (IVF) are associated with a higher prevalence of perinatal complications than pregnancies conceived spontaneously, even after correction of confounding factors. Little is known about the prevalence of complications of the third stage of labor in IVF pregnancies. Objective To compare the prevalence and types of complications of the third stage of labor following vaginal delivery of singleton infants born to matched groups of women who conceived through IVF or spontaneously. Study design A retrospective case-control study design was used. The electronic delivery files of a tertiary medical center were reviewed for all women with a singleton IVF pregnancy who gave birth by vaginal delivery from August 2011 to March 2014. The women were matched 1:2 for age, gravidity, parity, and week of delivery to women with a singleton spontaneously conceived pregnancy who gave birth by vaginal delivery during the same period at the same hospital. The impact of mode of conception on the length and complications of the third stage of labor was evaluated. Results The study group consisted of 242 women with IVF pregnancies (cases), and 484 matched controls with spontaneously conceived pregnancies (controls). The length of the third stage was similar in the cases and controls (14.23 ± 8.89 and 13.69 ± 9.19 min, respectively). IVF pregnancy was associated with a significantly higher rate of postpartum hemorrhage (PPH) (5.79 versus 1.45%, p = .001), manual removal of retained placenta (11.98 versus 7.02%, p = .025), and blood transfusion (2.07 versus 0.41%, p = .032). On multivariate analysis, pregnancy conceived by IVF was an independent risk factor for an adverse outcome of the third stage of labor (OR 2.86, 95% CI 1.53–5.33). Conclusion After correction for confounders, IVF conception proved to be a significant independent risk factor for PPH, manual removal of the placenta, and blood transfusion in the third stage of labor. Therefore, the management of women who give birth vaginally following IVF pregnancy should be designed to anticipate complications in the third stage even in the absence of other risk factors.