Few Complications With Assisted Reproduction, Study Finds

Laura Putre

January 08, 2015

Women trying to get pregnant through assisted reproduction technology (ART) are at low risk for complications, a new study finds.

Jennifer F. Kawwass, MD, from the Emory University School of Medicine in Atlanta, Georgia, and colleagues analyzed data from 2001 to 2011 for more than 1.1 million autologous cycles included in the Centers for Disease Control and Prevention National ART Surveillance System, a federally mandated reporting database.

They found patients were at highest risk for moderate or severe ovarian hyperstimulation (OHSS), which occurs when fertility medication causes overstimulation of the ovaries. Hospitalization was the second most common complication.

Specifically, OHSS incidence peaked at 153.5 (95% confidence interval, 146.0 - 161.3) per 10,000 autologous cycles (women using their own eggs rather than donor eggs). Hospitalizations peaked at 34.8 (95% confidence interval, 30.9 - 39.3) per 10,000 cycles.

Rates of other complications were lower, at fewer than 10 per 10,000 cycles, including infection, hemorrhage requiring transfusion, medication adverse events, anesthetic complication, and patient death within 12 weeks of stimulation.

The study was published in the January 6 issue of JAMA.

ART procedures have shifted in recent years from laparoscopic to the nonsurgical, less invasive transvaginal retrieval of oocytes (egg cells). Overall pregnancy rates have improved with this shift, earlier studies found.

The new research, however, looks not at pregnancy rates but at the welfare of the patients undergoing fertility treatments. "This study is the first, to our knowledge, to quantify US ART-associated patient risk," the authors note.

The study also examined adverse events for donor-assisted reproduction procedures and found the risk was even lower than for autologous procedures. Donor-assisted cycles had a P value of less .05 for all complications. OHSS (peak of 31/10,000 cycles) and hospitalizations (peak of 10.5/10,000) were the most frequent donor-assisted complications.

Because OHSS is the most common complication in ART, the authors suggest future studies could look at predictors for OHSS.

The authors have disclosed no relevant financial relationships.

JAMA. 2015;313:88-90. Abstract

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