In-vitro fertilization pregnancies and perinatal health in Finland 1991–1993

Abstract

In 1993, in Finland at least 0.7% of all pregnancies ending in birth were assisted by in-vitro fertilization (IVF). The purpose of this study was to compare IVF mothers with other mothers, and the perinatal health and health care costs of IVF infants to those of other infants. The main source of information was the Medical Birth Register for 1991-1993 (n = 19,1712 pregnancies, of which 1015 were started by IVF). IVF mothers were more often older, married and primiparas. They started antenatal care earlier, had more visits than other mothers and more than 50% were hospitalized during their pregnancy. Every fourth IVF pregnancy was a multiple one. Both IVF singletons and multiples had poorer health than other infants. The new practice of implanting fewer embryos than before was introduced in 1992-1993, and a 50% decrease in triplet rate was found. At the same time, a somewhat better outcome for IVF newborns was found. However, every fourth child was still preterm or weighed < 2500 g. The health care costs for one IVF newborn from induction of pregnancy until the age of 7 days was 5.4-fold compared to other newborns. The subsequent health of IVF children has to be further studied to more fully assess the health impact of IVF.

Prevention of multiple pregnancies in assisted reproduction

“…Corresponding results are reported in a recent Finnish study, which showed that 13.4% of IVF singletons and 38.2% of IVF twins required hospitalisation during the neonatal period [6]. Perinatal mortality is fourto fivefold higher in twins than in singletons [8].…”

Public Financing of IVF: A Review of Policy Rationales

“…The evidence on the economics of IVF predominately falls under two broad domains-the costs of IVF and the cost-effectiveness or, less frequently, cost-utility of IVF. The estimates generated by these studies vary widely, ranging from £4,202 to £90,112 (€6,186 to €132,657), depending on the age of the woman, number of cycles and embryo transfers, use of combination regimens, comparator treatments (if included), and inclusion of the costs of complications (e.g., multiple births), obstetrics, and neonatal care [16,18,21,23,39,47,50,64]. Based on the available evidence, the cost-effectiveness of IVF depends on four primary factors: (1) experienced or estimated treatment success rates, (2) the age of the woman, (3) multiple pregnancy, and (4) cost(s) of treatment.…”

Off to a good start: the influence of pre- and periconceptional exposures, parental fertility, and nutrition on children's health.

“…ART is recognized as an important contributor to the U.S. low birth weight rate because of the known associations between ART and multiple birth (CDC 2002a(CDC , 2002b and between multiple birth and low birth weight (Martin and Park 1999). Additionally, studies have suggested that low birth weight rates are increased among singleton infants conceived with ART compared with naturally conceived infants or population-based rates (Bergh et al 1999;Dhont et al 1999;FIVNAT 1995;Friedler et al 1992;Gissler et al 1995;MRC Working Party 1990;Schieve et al 2002;Verlaenen et al 1995;Westergaard et al 1999). Additional analysis suggests that the increased risk for term low birth weight may be related to the ART procedure itself rather than the underlying infertility.…”