Infertility Treatments Associated with Adverse Pregnancy Outcomes?

Journal Watch. 2005;4(11) 

Infants conceived through assisted reproductive technology (ART; procedures in which both eggs and sperm are manipulated outside the body) represent 1% of U.S. births; this statistic does not include infants who are conceived as a result of ovulation induction with fertility drugs with or without intrauterine insemination. To determine whether ART (in vitro fertilization, gamete or zygote intrafallopian transfer) or ovulation induction increase risks for chromosomal abnormalities, fetal malformations, or other adverse pregnancy outcomes, investigators analyzed data from a large prospective NIH-sponsored study of 36,062 singleton pregnancies from 1999 to 2002; 95% did not involve any infertility treatment, 3% involved ovulation induction, and 2% involved an ART procedure.

Women who underwent infertility treatments were significantly older, more likely to be married, and more educated than women who did not. After adjusting for confounders, women who underwent ovulation induction were more likely than controls to experience placental abruption (odds ratio, 2.4) or fetal loss after 24 weeks' gestation (OR, 2.1). Women who underwent ART were more likely than controls to experience preeclampsia (OR, 2.7), placental abruption (OR, 2.4), or placenta previa (OR, 6.0), and more likely to undergo cesarean section (OR, 2.3). The incidence of congenital malformations or aneuploidy was not higher in the infertility treatment group.

It is important to note, as the authors do, that nearly all women who conceive after using infertility treatments deliver normal infants. However, these results add to existing data that indicate increased risk for adverse outcomes from infertility treatments in infants and pregnant women. Couples should be counseled accordingly before initiating infertility therapy.

— Robert W. Rebar, M.D.

Shevell T et al. Assisted reproductive technology and pregnancy outcome. Obstet Gynecol 2005 Nov; 106:1039-45.

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