Standard In Vitro Fertilization Research Articles

A giant oocyte in a cohort of retrieved oocytes: does it have any effect on the in vitro fertilization cycle outcome?

To investigate an association between the presence of a giant oocyte and outcome for the cohort in in vitro fertilization (IVF). Retrospective study. Hospital-based academic medical center. IVF and IVF/intracytoplasmic sperm injection (ICSI) cycles having at least one giant oocyte (study group; n = 105), matched with cycles without a giant oocyte (external control group). A further subanalysis compared giant oocyte cycles with the next closest cycles within patients (internal control group; n = 65). Standard IVF protocols. Incidence of giant oocytes, fertilization rate, quality of cohort embryos, and pregnancy outcome. Out of 97,556 oocytes, 117 (0.12%) were giant. Compared with the external control group, cleavage in the study group was abnormal (increased percentage of 1-cell and 10-cell embryos and decreased percentage of 6-cell and 7-cell embryos), although there was no difference for percentage of embryos with perfect symmetry, fragmentation, or implantation, clinical pregnancy, or ongoing/delivered rate. The study group had two cases of pregnancy termination due to chromosomal abnormalities (4.4%) versus none in external controls. No striking differences in embryo quality existed between the study and internal control groups. A giant oocyte is associated with abnormal cleavage in cohort embryos, but not with implantation or pregnancy rates. Giant oocytes occur sporadically and appear not to reflect quality of remaining oocytes in the ovary.

Advances in Swine In Vitro Embryo Production Technologies

Recent advances in new technologies to produce cloned and genetically modified pigs involve manipulating oocytes and/or embryos in vitro. Although a great deal of progress has been made, the current IVM-IVF systems still result in major problems: a high rate of polyspermy; and a low development rate and low quality of blastocysts for in vitro compared with the in vivo-produced embryos. This study summarizes recent advancements in IVM-IVF-IVC porcine systems. Recent methods to select monospermic embryos are also discussed. Finally, achievements in vitrification and in somatic cell nuclear transfer are discussed.

Congenital malformations after assisted reproduction: risks and implications for prenatal diagnosis and fetal medicine

Congenital malformations after assisted reproduction: risks and implications for prenatal diagnosis and fetal medicine

ICSI: Where We Have Been and Where We Are Going

Notwithstanding the broad success of in vitro fertilization (IVF), a failure to achieve fertilization still plagues a substantial group of patients, with sperm abnormalities the main culprit. In the 1980s, several micromanipulation procedures were adopted from animal husbandry to facilitate gamete interaction, and this resulted in the development of intracytoplasmic sperm injection (ICSI), a procedure through which an oocyte can be fertilized independently of the morphology and/or motility of the single spermatozoon injected. The procedure was first used in cases of fertilization failure after standard IVF or when an inadequate number of sperm cells were available. The consistency of fertilization independent of the functional quality of the spermatozoon has extended the application of ICSI to immature spermatozoa retrieved surgically from the epididymis and testis. Moreover, the need to denude the oocyte has allowed assessment of the nuclear maturity of the oocyte. ICSI is also preferred in conjunction with preimplantation genetic diagnosis and recently has been used to treat HIV discordant couples, where there is a pressing need to minimize the exposure of the oocyte to a large number of spermatozoa. For all ages and with all the different sperm types used, fertilization after ICSI is at approximately 70 to 80% and it ensures a clinical pregnancy rate of up to 45%. These results have made ICSI a procedure comparable in popularity with IVF and have minimized the need for couples suffering from all forms of male infertility to resort to adoption or the use of donor sperm.

Day 3 embryo morphology is a predictor of live birth but not miscarriage after in vitro fertilization treatment

OBJECTIVE: Despite the common practice of assessing embryo morphology before transferring day 3 embryos after in vitro fertilization (IVF), little data exists on embryo characteristics as they relate to cycle outcome.DESIGN: Retrospective cohort study.MATERIALS AND METHODS: All women who underwent standard protocol IVF and transfer of a single embryo (non-elective) on day 3 from 2000 through 2005 were included. Pregnancy was documented by beta-human chorionic gonadotropin level and pregnancy outcome was obtained. Miscarriage includes both biochemical and clinical losses. Multivariate regression controlling for patient age was used to calculate risk ratios (RR) and 95% confidence intervals (CI).Table 1Risk of live birth and miscarraige relative to embryo morphologyMorphologyNLive Birth (RR)Live Birth (95% CI)Miscarriage (RR)Miscarriage (95% CI)6 cell, grade 2910.40.18-0.961.10.48-2.516 cell, grade 31480.70.38-1.200.60.23-1.567 cell, grade 2630.10.01-0.742.01.14-3.597 cell, grade 31331.00.50-1.641.20.67-1.968 cell, grade 2610.50.21-1.261.30.57-2.838 cell, grade 3230RefRefRefRef Open table in a new tab CONCLUSIONS: This study shows a benefit to the transfer of 8-cell grade 3 embryos on day 3 over other grades and cell numbers. However, once pregnancy is established, we did not detect a statistically significant difference in the risk of loss based on embryo morphology. OBJECTIVE: Despite the common practice of assessing embryo morphology before transferring day 3 embryos after in vitro fertilization (IVF), little data exists on embryo characteristics as they relate to cycle outcome. DESIGN: Retrospective cohort study. MATERIALS AND METHODS: All women who underwent standard protocol IVF and transfer of a single embryo (non-elective) on day 3 from 2000 through 2005 were included. Pregnancy was documented by beta-human chorionic gonadotropin level and pregnancy outcome was obtained. Miscarriage includes both biochemical and clinical losses. Multivariate regression controlling for patient age was used to calculate risk ratios (RR) and 95% confidence intervals (CI). CONCLUSIONS: This study shows a benefit to the transfer of 8-cell grade 3 embryos on day 3 over other grades and cell numbers. However, once pregnancy is established, we did not detect a statistically significant difference in the risk of loss based on embryo morphology.

Is aneuploidy a recurrent phenomenon in high risk (HR) patients undergoing in vitro fertilization (IVF)?

OBJECTIVE: To determine if aneuploidy rates are similar in patients undergoing 2 IVF cycles with Preimplantation Genetic Diagnosis (PGD). DESIGN: We retrospectively reviewed a total of 463 embryos from 27 patients who had 2 IVF cycles with embryo biopsy from 1/01 through 12/06. Only patients that had at least four embryos biopsied in each cycle were included in the analysis. Patients fell into at least one of four HR groups; Advanced Maternal Age, Recurrent Pregnancy Loss, Repeat IVF Failure, Severe Male Factor. MATERIALS AND METHODS: All patients underwent standard IVF stimulation protocols with embryos biopsied on day 3, between 72 to 78 hours post egg retrieval. Fisher's exact test was used to determine if the population's aneuploidy rate was statistically different from cycle 1 to cycle 2. RESULTS: Shown in Table 1, Table 2 below.Table 1#Pts#EmbryosNormal (%)Abnormal (%)Cycle 12722972 (31.4)157 (68.6)Cycle 22723468 (29.1)166 (70.9)∗∗ P-value cycle 1 vs. cycle 2= 0.6134. Open table in a new tab Table 2% Aneuploidy difference from Cycle1 to Cycle 2Total # Patients# Embryos Cycle 1# Normal Cycle 1 (%)# Embryos Cycle 2# Normal Cycle 2 (%)0 - 10 % difference14 (51.9)12443 (34.8)12140 (33.1)11-25 % difference11 (40.7)9123 (25.3)10227 (26.5)> 25 % difference2 (7.4)146 (42.9)111 (9.1)Total2722972 (31.4)23468 (29.1) Open table in a new tab ∗∗ P-value cycle 1 vs. cycle 2= 0.6134. CONCLUSIONS: In conclusion, we can say the following: (1) The percentage of chromosomally abnormal embryos is similar in subsequent cycles. (2) The majority of patients showed <10% difference in the aneuploidy rate for cycle 1 vs. cycle 2. Furthermore, 92% of patients had <25% difference in aneuploidy rates between cycles. (3) In both cycles, 2/3 or more of the embryos were chromosomally abnormal. Knowing this information may help patients consider other alternatives.

High estradiol levels (over 2000 pg/ml) in the day of hCG administration are associated with lower blastocysts rates but only in own oocytes and not in donated oocytes cycles

OBJECTIVE: High levels of estradiol (HE) after controlled ovarian hyperstimulation (COH) and the consequences on the outcome of in vitro fertilization (IVF) treatments remain controversial, mainly when high numbers are picked-up and the risk of suffering syndrome of ovarian hiperstimulation is present. The current study was conducted in our standard IVF cycles (SC) and the oocyte donation (OD) program, in order to depict if the HE in patients and donors after COH affects blastocyst rate formation (BR).

Removal of ascites up to 7.5 liters on one occasion and 45 liters in total may be safe in patients with severe ovarian hyperstimulation syndrome

Ovarian hyperstimulation syndrome (OHSS) is a serious and potentially lethal complication of ovulation induction. We report herein a case with OHSS treated by serial vaginal paracentesis. A 31-year-old patient was hospitalized due to severe OHSS after in vitro fertilization (IVF)–embryo transfer. Transvaginal drainage was performed with a standard 17-gauge IVF needle connected to a vacuum pump through a drainage set in nine courses. We removed 45 liters of ascitic fluid in total and 7.5 liters of ascitic fluid in one course, leading to improvement of the patient's condition and laboratory parameters. In conclusion, removal of ascites up to 7.5 liters on one occasion and 45 liters in total by serial vaginal paracentesis may be performed in patients with severe OHSS.

Comparison of embryo quality between intracytoplasmic sperm injection and in vitro fertilization in sibling oocytes

The aim of the present study was to compare the quality of embryos derived from sibling oocytes by in vitro fertilization (IVF) or ICSI. Consecutive patients with a less than 40% fertilization rate in a previous standard IVF cycle or with relative male factor infertility were recruited for the study. The oocytes retrieved from each patient were divided into two groups for either conventional insemination (group A) or ICSI (group B). Power analysis showed that to detect a 25% difference in the rate of high-quality embryos between the groups with a power of 0.8, at least 1,200 oocytes were needed in each group. One hundred seventy-seven patients were included in the study. Group A was comprised of 1,526 oocytes and group B of 1,480 sibling oocytes. As expected, the fertilization rate was significantly higher in group B than group A (67.1 vs. 43.6%, p < 0.001). No significant between-group differences were observed in cleavage rate (92.7 and 89.7%, respectively) and the rate of either grade A embryos (22.6 and 23.9%, respectively) or grade A(1) embryos (37.3 and 33.5%, respectively). However, in the subgroup of patients with relative male-factor infertility (n = 36), the rate of grade A(1) embryos was significantly higher in the IVF than the ICSI group (46.4 vs. 29.0%, respectively, p = 0.02). Embryo quality does not seem to be influenced by the mode of fertilization (IVF or ICSI). We assume that embryo quality depends on intrinsic factors of the gametes involved rather than on the fertilization process per se.

A luteal estradiol protocol for expected poor-responders improves embryo number and quality

To compare embryo and oocyte data between a standard protocol and a luteal phase estradiol protocol. Retrospective paired cohort analysis. Private in vitro fertilization (IVF) center. 60 poor-responder patients undergoing 120 IVF cycles. Addition of luteal estradiol to the standard IVF protocol. Number of embryos with > or = 7 cells on day 3 of development. The luteal phase estradiol protocol showed a statistically significantly greater number of embryos with > or = 7 cells, oocytes retrieved, mature oocytes, and embryos than did the standard protocol. There was no difference between the two protocols with respect to basal antral follicle count, days of stimulation, number of follicles > or = 14 mm on day of surge, or endometrial thickness on day of surge. A trend toward improved pregnancy outcomes was found with the luteal estradiol protocol. Giving estradiol in the luteal phase preceding IVF hyperstimulation increases the number and the quality of embryos achieved in patients deemed to have a poor response to IVF. Ultimately, this may translate into improved pregnancy outcomes in these patients.

Population‐based Swedish studies of outcomes after in vitro fertilisation

Various outcomes have been described during pregnancy and among infants born to women after in vitro fertilisation (IVF) treatments. This mini-review summarises recent population-based Swedish studies about the short- and long-term effects of IVF on the infant and child, and also comments on disturbances of pregnancies and deliveries occurring after IVF. Data on women who had IVF treatments and gave birth in Sweden during the period 1982-2001 were collected from all clinics performing IVF. By linkage with the Swedish Medical Birth Register, the Swedish Register of Congenital Malformations, the Swedish Hospital Discharge Register, the Swedish Cancer Register, and the Swedish Cause of Death Register, data on short- and long-term complications were retrieved. From 1982 to 2001, a total of 13,261 women gave birth to 16,280 infants after IVF treatment. During the final years of the study, nearly half of the pregnancies occurred after intracytoplasmic sperm injection intracytoplasmic sperm injection (ICSI). Characteristics of women who delivered after IVF were analysed. Various anomalies in pregnancy and delivery outcome were found, but few long-term effects. Most deviations, except for multiple pregnancies, could be explained by parents characteristics, notably their subfertility status. Little difference was found between pregnancies after standard IVF and pregnancies after ICSI.

Novel follicular-phase gonadotropin-releasing hormone antagonist stimulation protocol for in vitro fertilization in the poor responder

Poor responders continue to be vexing in infertility therapy. By using GnRH antagonists before ovarian stimulation, we demonstrate an improvement in oocyte, embryo, and zygote yield in patients with a prior poor response.

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 …

Sperm protamine 1/protamine 2 ratios are related to in vitro fertilization pregnancy rates and predictive of fertilization ability

To evaluate whether aberrant sperm P1/P2 ratios are predictive of abnormal fertilizing ability and are related to in vitro fertilization (IVF) outcome. Prospective case-control study. University-based infertility and IVF clinic. Forty-three male infertility patients with an abnormally reduced P1/P2 ratio, 251 patients with a normal P1/P2 ratio, and 121 patients with an abnormally elevated P1/P2 ratio. Human IVF, the sperm penetration assay (SPA), and sperm protamine quantification via nuclear protein extraction, gel electrophoresis, and densitometry analysis. Sperm P1/P2 ratios; P1 and P2 quantities; SPA scores; and IVF-fertilization, embryo-quality, pregnancy, delivery, and spontaneous-abortion rates. Standard IVF fertilization rates and SPA scores were significantly reduced in patients with abnormally low and high P1/P2 ratios. In vitro fertilization embryo quality was comparable between these groups, but pregnancy rates were significantly reduced in patients with abnormally reduced P1/P2 ratios. The P1/P2 ratio has a significant relationship to sperm fertilization ability. The relationship between protamines and fertilization ability is not understood but may be either a reflection of generalized abnormalities during spermiogenesis or an indication of protamine deficiency acting as a regulator or checkpoint of spermatogenesis.

P-996: Relationship among HBA, sperm motility, Kruger morphology with fertilization rate and pregnancy outcome in patients treated with IVF or ICSI

Semen analysis with Kruger morphology is widely used to assess male fertility potential. More recently hyaluronan-binding protein has been established as a biomarker for mature, functional sperm. Consequently the HBA assay (Sperm-Hyaluronan Binding assay) has been developed to differentiate functional integrity and fertilization potential of sperm cells. We investigated the relationships among HBA score, sperm motility, and Kruger morphology with fertilization rate in patients undergoing in vitro fertilization (IVF) with standard insemination or intracytoplasmic sperm injection (ICSI). Prospective comparative data analysis. The Andrology and Embryology laboratories at the Kaiser Permanente Center for Reproductive Health performed HBA assay in conjunction with a standard semen analysis with Kruger morphology for patients undergoing IVF. The decision to perform standard IVF or ICSI was made by the primary physicians and the patients. Sperm HBA score, sperm motility and Kruger morphology before and after density gradient preparation were compared and correlated with fertilization rate of oocytes inseminated with standard insemination or ICSI. Linear regression analysis was performed. We studied prospectively 31 cases in which 20 cases were treated with ICSI, 7 cases were treated with IVF, and 4 cases were performed split IVF/ICSI. In the ICSI treatment group, the fertilization rate had no correlation with sperm motility, Kruger morphology, or HBA score (r = -0.15, -0.14, and 0.07 respectively). We achieved high fertilization rates (50 - 100%) in the ICSI treatment group even when the sperm HBA score was less than 10 either before or after density gradient preparation. In general, density gradient preparation of sperm improved its motility and morphology. However, it did not necessarily improve the HBA score. In fact, some sperm samples after density gradient preparation dropped in HBA score dramatically. In the IVF treatment group, there was a positive trend between fertilization rate and initial sperm motility and HBA score. The fertilization rate, as previously suggested by Kruger et al, showed little correlation (r = -0.15) with Kruger morphology when the later score was greater than or equal to 4. HBA assay, sperm motility and Kruger morphology have all been suggested as indicators for differentiating male fertility potential. Based on our data, we can not recommend any one of them individually as a discriminating factor for IVF or ICSI decision making except when Kruger morphology score is ≤ 4. Our results demonstrate a reduction of HBA score after density gradient sperm preparation of some sperm populations. This observation raises a concern about potential damage of membrane integrity and/or unintended acrosome reaction during sperm preparation, both of which may lead to compromised fertilization potential. Future studies are needed to explore the utility of HBA assay in assessing sperm functional integrity after processing.

Letrozole Reduces Estrogen and Gonadotropin Exposure in Women with Breast Cancer Undergoing Ovarian Stimulation before Chemotherapy

Women with breast cancer are not typically offered embryo or oocyte cryopreservation to preserve their fertility before chemotherapy because of the potential risks associated with high estrogen levels arising from ovarian stimulation. We aimed to determine whether the combination of an aromatase inhibitor with gonadotropin treatment in breast cancer patients produces comparable results to standard in vitro fertilization (IVF), without a significant increase in estradiol levels and delay in the initiation of chemotherapy. Stages I-IIIA breast cancer patients (n = 47) received 5 mg/d letrozole and 150-300 IU FSH to cryopreserve embryos or oocytes. Age-matched retrospective controls (n = 56) were selected from women who underwent IVF for tubal disease. Whereas letrozole and FSH stimulation resulted in significantly lower peak estradiol levels (mean +/- sd 483.4 +/- 278.9 vs. 1464.6 +/- 644.9 pg/ml; P < 0.001) and 44% reduction in gonadotropin requirement, compared with controls, the length of stimulation, number of embryos obtained, and fertilization rates were similar. The human chorionic gonadotropin administration criteria had to be adjusted to 20 mm after letrozole stimulation, compared with 17-18 mm in the controls. The mean delay from surgery to cryopreservation was 38.6 d, with 81% of all patients completing their IVF cycles within 8 wk of surgery. Ovarian stimulation with letrozole and FSH appears to be a cost-effective alternative for fertility preservation in breast cancer patients with reduced estrogen exposure, compared with standard IVF. If patients are referred promptly, they may undergo embryo or oocyte cryopreservation without a delay in chemotherapy.

WITHDRAWN: Recombinant versus urinary follicle stimulating hormone for ovarian stimulation in assisted reproduction cycles.

Until recently, the main source of exogenous follicle stimulating hormone (FSH) for therapeutic use in infertility had been the urine of postmenopausal women. New developments have resulted in the production of FSH in vitro by recombinant DNA technology. The extremely high purity and batch-to-batch consistency of recombinant FSH (rFSH) make it an attractive alternative to urinary FSH (uFSH). To conduct a systematic review and meta-analysis of randomised trials comparing the effectiveness of rFSH with uFSH in ovarian stimulation protocols in in vitro fertilization (IVF) or intra-cytoplasmic sperm injection (ICSI) treatment cycles. Search strategies included on-line searching of the MEDLINE and EMBASE databases from 1985 to 1999, hand searching of bibliographies of relevant publications and reviews and abstracts of scientific meetings, peer consultation and contacting the pharmaceutical companies that manufacture the gonadotropins under consideration. Randomised trials comparing rFSH with uFSH for ovarian stimulation in IVF or ICSI treatment for infertility. The main outcome measure was clinical pregnancy per cycle started. Also considered were clinical pregnancy per cycle reaching oocyte retrieval and per cycle reaching embryo transfer (ET), ongoing pregnancy per cycle started, spontaneous abortion, multiple pregnancy, ovarian hyperstimulation syndrome (OHSS), number of follicles and serum estradiol level on the day of human chorionic gonadotropin administration day, total dose of FSH, and number of oocytes retrieved. Common odds ratios (OR) and risk differences for rFSH relative to uFSH were calculated after testing for homogeneity of treatment effect across all trials. The fixed effects model was used, unless significant heterogeneity was present, in which case the random effects model was used. The overall odds ratio for clinical pregnancy per cycle started was 1.21 (95% confidence limits (CL) 1.04,1.42) for rFSH compared to uFSH. The risk difference was a 3.7% (0.8,6.7) absolute increase in clinical pregnancy rate with rFSH. The OR for ongoing pregnancy per cycle started was 1.29 (1.08,1.54). There was no significant difference between rFSH and uFSH in the rates of spontaneous abortion, multiple pregnancy or OHSS. The total dose of FSH was lower by 406 (185,627) IU with rFSH, but there was no significant difference in the number of follicles or serum estradiol on hCG day or in the number of oocytes retrieved. This review has demonstrated a statistically significant increase in clinical pregnancy rate with rFSH compared to uFSH, when used for ovarian stimulation in assisted reproduction. This benefit was observed only in standard IVF cycles and not in cycles in which ICSI was used.

In vitro fertilization in Sweden: maternal characteristics

Deliveries among women who had an in vitro fertilization (IVF) are characterized by increased risks for both the mother and the infant/child. Part of these effects may be due to maternal characteristics. Using reports from all clinics performing IVF in Sweden, 12 186 women who gave birth after such procedures were identified (13 261 deliveries, 16 280 infants born). Various social and medical characteristics of the women were studied and compared with all women giving birth. Information was retrieved by interviews in early pregnancy or by linkage with various registers. Women who had IVF were older than other women who gave birth and were older after standard IVF than after intracytoplasmatic sperm injection (ICSI). They were more often of first parity and smoked less than other delivered women. There were more women with high body mass index: they worked outside home less often and were more often of Swedish nationality. Women who had standard IVF had more previous miscarriages than expected, but this was not true for women who had ICSI. Their pattern of drug usage differed from that of other women who had given birth. Women who underwent IVF and gave birth showed marked deviations from other women who gave birth. Some of these characteristics may help to explain the increased risks associated with these procedures. Women who had ICSI were less deviating than women who had standard IVF.

In vitro fertilisation in Sweden: obstetric characteristics, maternal morbidity and mortality

To investigate obstetric characteristics, maternal morbidity and mortality among Swedish women giving birth after in vitro fertilisation (IVF) treatment. Register study. Nationwide study in Sweden. All women known to have had IVF in Sweden 1982-2001. Using Swedish health registers, women who had given birth after IVF were identified from all Swedish IVF clinics and compared with all women who gave birth. Analysis was performed with the Mantel-Haenszel technique. Diagnoses during pregnancy, at delivery and at re-admission within 60 days after delivery and risk of cancer. IVF women had an increased risk of bleeding in early pregnancy [odds ratio (OR) = 4.59, 95% confidence interval (95% CI) 4.08-5.15] and of ovarian torsion during pregnancy (OR = 10.6, 5.69-10.7). They were also more likely to encounter pre-eclampsia (OR = 1.63, 1.53-1.74), placental abruption (2.17, 1.74-2.72), placenta praevia (3.65, 3.15-4.23), bleeding in association with vaginal delivery (1.40, 1.38-1.50) and premature rupture of membranes (PROM) (2.54, 2.34-2.76). Interventions including caesarean sections (1.38, 1.32-1.43) and induction of labour (1.37, 1.29-1.46) in singleton pregnancies was more frequent. The type of IVF method had little effect on these results, but there was a tendency for women who had received intra-cytoplasmatic sperm injection (ICSI) to have slightly fewer complications than women having standard IVF. There was a significant decrease in cancer risk after IVF (0.79, 0.69-0.91) but a suggested increase in the risk of ovarian cancer both before (2.70, 1.49-4.91) and after (2.08, 1.15-3.76) IVF. No change in mortality was observed. Women treated with IVF had an increased obstetric morbidity. This seems to contribute little to the well-known increased risk of preterm delivery.

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).