Live birth rates and birth outcomes by diagnosis using linked cycles from the SART CORS database

Stern²,

Kotelchuck³

et al. 2014

Objective To evaluate ART pregnancy outcomes by infertility diagnosis. Study Design ART data on women who were treated and gave birth in Massachusetts were linked to vital records and hospital utilization data. Live births were categorized by eight mutually-exclusive ART diagnoses. Risks of prematurity, low birthweight (LBW), small-for-gestation (SGA), large-for-gestation (LGA), pregnancy hypertension, gestational diabetes, prenatal hospitalizations, and primary cesarean delivery were modeled using logistic regression, adjusted for parental characteristics, treatment parameters, and plurality (adjusted odds ratios, AORs, and 95% confidence intervals); the reference group were pregnancies with the diagnosis of male factor. Results Among the 7,354 singleton and twin pregnancies, there were nonsignificant differences in the risks for LBW, SGA, or LGA. Significantly increased risks included gestational diabetes (ovulation disorders, AOR 1.80, 1.35–2.41); prematurity (ovulation disorders, AOR 1.36, 1.08–1.71; other factors, AOR 1.33, 1.05, 1.67); prenatal hospital admissions (endometriosis, tubal and other factors, ovulation disorders, and uterine factors, AORs ranging from 1.66 to 2.68); primary cesarean section (uterine factors, AOR 1.96, 1.15, 3.36). Conclusions Although the infant outcomes of LBW, SGA, and LGA were generally similar across diagnosis groups, specific diagnoses had greater risks for prematurity, gestational diabetes, prenatal hospital utilization, and primary cesarean delivery.

Section: Discussionsupporting

confidence: 87%

“…Women with uterine factors were more likely to have bleeding diagnoses and to deliver by primary cesarean. The characteristics and outcomes by diagnosis groups confirmed prior reports 14, 15–19, 22 .…”

Section: Discussionsupporting

confidence: 82%

Birth outcomes by infertility diagnosis: analyses of the massachusetts outcomes study of assisted reproductive technologies (MOSART)

Stern²,

Kotelchuck³

et al. 2014

“…This analysis, developing a model predictive of live birth and multiple births based on U.S. national data, extends our prior studies of cumulative live-birth rates with ART treatment (12, 13, 16–18). The prediction model presented here is intended for an individual considering ART and provides the probability of success over the course of the first three fresh autologous cycles and the first fresh donor cycle, as well as the effect of transferring one versus two embryos on the live-birth rate and the multiple birth rate.…”

Section: Discussionsupporting

confidence: 53%

A prediction model for live birth and multiple births within the first three cycles of assisted reproductive technology

Brown

Wantman³

et al. 2014

Self Cite

Objective To develop a model predictive of live-birth rates (LBR) and multiple birth rates (MBR) for an individual considering assisted reproduction technology (ART) using linked cycles from Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) for 2004–2011. Design Longitudinal cohort. Setting Clinic-based data. Patient(s) 288,161 women with an initial autologous cycle, of whom 89,855 did not become pregnant and had a second autologous cycle and 39,334 did not become pregnant in the first and second cycles and had a third autologous cycle, with an additional 33,598 women who had a cycle using donor oocytes (first donor cycle). Intervention(s) None. Main Outcome Measure(s) LBRs and MBRs modeled by woman’s age, body mass index, gravidity, prior full-term births, infertility diagnoses by oocyte source, fresh embryos transferred, and cycle, using backward-stepping logistic regression with results presented as adjusted odds ratios (AORs) and 95% confidence intervals. Result(s) The LBRs increased in all models with prior full-term births, number of embryos transferred; in autologous cycles also with gravidity, diagnoses of male factor, and ovulation disorders; and in donor cycles also with the diagnosis of diminished ovarian reserve. The MBR increased in all models with number of embryos transferred and in donor cycles also with prior full-term births. For both autologous and donor cycles, transferring two versus one embryo greatly increased the probability of a multiple birth (AOR 27.25 and 38.90, respectively). Conclusion(s) This validated predictive model will be implemented on the Society for Assisted Reproductive Technology Web site (www.sart.org) so that patients considering initiating a course of ART can input their data on the Web site to generate their expected outcomes.

“…In another study we compared diagnosis categories within the ART population using male factor pregnancies as the reference group and found elevated risks for gestational diabetes and preterm delivery in women with ovulation disorders as well as an increased risk of prenatal hospital admissions for women with endometriosis (5). Diagnoses have also been shown to affect outcome in other studies (12, 13). The current study adds to these prior studies by providing a direct diagnosis-specific comparison between ART and non-ART pregnancies as compared to fertile pregnancies.…”

Section: Discussionmentioning

confidence: 80%

Adverse pregnancy and birth outcomes associated with underlying diagnosis with and without assisted reproductive technology treatment

Stern

Tobias

et al. 2015

Self Cite

121

116

Objective To compare the risks for adverse pregnancy and birth outcomes by diagnoses with and without ART treatment to non-ART pregnancies in fertile women. Design Historical cohort Setting Massachusetts vital records linked to ART clinic data from SART CORS Patients Diagnoses included male factor (ART only), endometriosis, ovulation disorders, tubal (ART only) and reproductive inflammatory disorders (non-ART only). Pregnancies resulting in singleton and twin live births from 2004–08 were linked to hospital discharges in women who had ART treatment (N=3,689), women with no ART treatment in the current pregnancy (N=4,098) and non-ART pregnancies to fertile women (N= 297,987). Interventions None Main Outcome Measures Risks of gestational diabetes, prenatal hospitalizations, prematurity, low birth weight, and small-for-gestation were modeled using multivariate logistic regression with fertile deliveries as the reference group adjusted for maternal age, race/ethnicity, education, chronic hypertension, diabetes mellitus, and plurality (adjusted odds ratios, AORs, and 95% confidence intervals, CI). Results Risk of prenatal hospital admissions was increased for endometriosis (ART 1.97, 1.38–2.80; non-ART 3.34, 2.59–4.31), ovulation disorders (ART 2.31, 1.81–2.96; non-ART 2.56, 2.05–3.21), tubal (ART 1.51, 1.14–2.01), and reproductive inflammation (non-ART 2.79, 2.47–3.15). Gestational diabetes was increased for women with ovulation disorders (ART 2.17, 1.72–2.73; non-ART 1.94, 1.52–2.48). Preterm delivery (AORs 1.24–1.93) and low birthweight (AORs 1.27–1.60) were increased in all groups except endometriosis with ART. Conclusions The findings indicate substantial excess perinatal morbidities associated with underlying infertility-related diagnoses in both ART-treated and non-ART-treated women.