Association between ovarian stimulators with or without intrauterine insemination, and assisted reproductive technologies on multiple births

Chaabane, Sonia; Sheehy, Odile; Monnier, Patricia; Bissonnette, François; Trasler, Jacquetta M.; Fraser, William D.; Bérard, Anick

doi:10.1016/j.ajog.2015.06.028

Cited by 19 publications

(16 citation statements)

References 45 publications

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“…The risk of monozygotic twinning is increased when culture is extended to the blastocyst stage, and in cleavage stage embryos with assisted hatching (62, 66–73). A recent case-control study from Canada reported that the use of ovarian stimulators alone and with intrauterine insemination greatly increased the risk of multiple births (AORs of 4.5 and 9.32, respectively) (74). …”

Section: Discussionmentioning

confidence: 99%

Adverse pregnancy, birth, and infant outcomes in twins: effects of maternal fertility status and infant gender combinations; the Massachusetts Outcomes Study of Assisted Reproductive Technology

Luke

Gopal

Cabral

et al. 2017

American Journal of Obstetrics and Gynecology

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Background It is unknown whether the risk of adverse outcomes in twin pregnancies among subfertile women, conceived with and without in vitro fertilization (IVF), differ from those conceived spontaneously. Objective To evaluate the effects of fertility status on adverse perinatal outcomes in twin pregnancies on a population basis. Study Design All twin live births of ≥22 weeks’ gestation and ≥350 grams birthweight to Massachusetts resident women in 2004–10 were linked to hospital discharge records, vital records, and IVF cycles. Women were categorized by their fertility status as in vitro fertilization (IVF), subfertile, or fertile, and by twin pair genders (all, like, unlike). Women whose births linked to IVF cycles were classified as IVF; those with indicators of subfertility but without IVF treatment were classified as subfertile; all others were classified as fertile. Risks of six adverse pregnancy outcomes (gestational diabetes, pregnancy hypertension, uterine bleeding, placental complications (placenta abruptio, placenta previa, and vasa previa), prenatal hospitalizations, primary cesarean), and nine adverse infant outcomes (very low birthweight, low birthweight, small-for-gestation birthweight, large-for-gestation birthweight, very preterm (<32 weeks), preterm, birth defects, neonatal death, and infant death) were modeled by fertility status with the fertile group as reference, using multivariate log binomial regression and reported as adjusted relative risk ratios (ARRs) and 95% confidence intervals (CI). Results The study population included 10,352 women with twin pregnancies (6,090 fertile, 724 subfertile, and 3,538 IVF). Among all twins, the risks for all six adverse pregnancy outcomes were significantly increased for the subfertile and IVF groups, with highest risks for uterine bleeding (ARR 1.92, 2.58, respectively), and placental complications (ARR 2.07and 1.83, respectively). Among all twins, the risks for those born to subfertile women were significantly increased for very preterm birth, and neonatal and infant death (ARR 1.36, 1.89, and 1.87, respectively); risks were significantly increased among IVF twins for very preterm birth, preterm birth, and birth defects (ARR 1.28, 1.07, and 1.26, respectively). Conclusions Risks of all maternal and most infant adverse outcomes are increased for subfertile and IVF twins. Among all twins, the highest risks were for uterine bleeding and placental complications for the subfertile and IVF groups, and neonatal and infant death in the subfertile group. These findings provide further evidence supporting single embryo transfer and more cautious use of ovulation induction.

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Section: Discussionmentioning

confidence: 99%

Adverse pregnancy, birth, and infant outcomes in twins: effects of maternal fertility status and infant gender combinations; the Massachusetts Outcomes Study of Assisted Reproductive Technology

Luke

Gopal

Cabral

et al. 2017

American Journal of Obstetrics and Gynecology

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“…This can serve as indicator for a similar trend among medically assisted reproduction nonparticipants, which minimize the occurrence of a selection bias. The differences in the education level and socioeconomic status, between participants and nonparticipants, may affect the generalizability of our results (Chaabane et al., ). Nevertheless, this has a minimal effect on internal validity.…”

Section: Discussionmentioning

confidence: 87%

“…). Responders were compared with nonresponders with regards to comorbidity profiles, and were found to be similar (Chaabane et al., ).…”

Section: Resultsmentioning

confidence: 99%

Ovarian Stimulators, Intrauterine Insemination, and Assisted Reproductive Technologies Use and the Risk of Major Congenital Malformations—The AtRISK Study

Chaabane

Sheehy

Monnier

et al. 2016

Birth Defects Research Pt B

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“…Stricter controls and more stringent regulations are being enforced in many countries towards IVF treatments in the hope of stalling the multiple pregnancy rate, however this has not been replicated in the field of ovulation induction, as this is often performed outside of large fertility clinics, or without strict tracking protocols. Hence it is believed that ovulation induction accounts for up to 65% of the world's higher order multiple pregnancies [5].…”

Section: Ovulation Inductionmentioning

confidence: 99%

Judicious Fertility Treatment to Minimise the Risk of Multiple Pregnancy

Langdon

Hart²

2019

Multiple Pregnancy - New Challenges

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Pregnancies resulting from fertility treatment are associated with higher rates of multiple pregnancy and have higher rates of pregnancy complications than spontaneously conceived pregnancies. Methods exist to make fertility treatment safer and less likely to result in multiple pregnancy and practitioners should be practicing fertility treatment with the aim to produce a healthy, term, singleton pregnancy. Approaches to minimising the risk of multiple pregnancy include carefully monitoring ovulation induction (OI) cycles to produce mono-follicular ovulation. Identifying patients at risk of excessive response to ovulation induction and treating them with low dose therapies and close monitoring is a critical step in practicing safe OI treatment. Performing single embryo transfer in all but exceptional cases of in-vitro fertilisation (IVF), and never transferring more than two embryos, is the single, most successful way to reduce the multiple pregnancy rate with IVF. An appreciation of the increased risk of mono-chorionic twinning with IVF is also important. This chapter will explore ways to minimise the risk of multiple pregnancy with a variety of fertility treatments.

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Association between ovarian stimulators with or without intrauterine insemination, and assisted reproductive technologies on multiple births

Abstract: Although the risk of multiple births associated with invasive ART can be decreased by elective implementing of single embryo transfer, special attention should be paid to the greatly increased risk associated with ovarian stimulation used alone or with IUI.

Cited by 19 publications

References 45 publications

Adverse pregnancy, birth, and infant outcomes in twins: effects of maternal fertility status and infant gender combinations; the Massachusetts Outcomes Study of Assisted Reproductive Technology

Adverse pregnancy, birth, and infant outcomes in twins: effects of maternal fertility status and infant gender combinations; the Massachusetts Outcomes Study of Assisted Reproductive Technology

Ovarian Stimulators, Intrauterine Insemination, and Assisted Reproductive Technologies Use and the Risk of Major Congenital Malformations—The AtRISK Study

Judicious Fertility Treatment to Minimise the Risk of Multiple Pregnancy

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