Perinatal outcome of singletons and twins after assisted conception: a systematic review of controlled studies

Purpose Aim of this study was to investigate the association between congenital malformations and type of conception (spontaneous or medically assisted). Methods This is a population based study using data from the regional data base of Lombardy, a Northern Italian Region with a population of about 10 million inhabitants. Included in the study were 277,043 neonates born in Lombardy during the study period 2010-2012. Adjusted and unadjusted odds ratios (OR), and corresponding 95 % confidence intervals (CI), of congenital abnormalities were calculated using unconditional multiple logistic regression. Results A total of 7057 births (2.5 %) were reported after non spontaneous conception. Overall, the frequency of birth defects was 4.4 % among births after spontaneous conception and 6.7 % among births after non spontaneous ones (OR= 1.67, 95%CI=1.5-1.9). The association disappeared after taking into account the confounding effect of maternal age and factors associated with non spontaneous conception. The crude OR of abnormalities was higher than unity for any defect (OR=1.67, 95%CI=1.5-1.9), multiple defects (OR=1.76, 95%CI=1.3-2.3), cardiovascular (OR=2.05, 95%CI=1.8-2.4), musculoskeletal (OR=2.05, 95%CI=1.7-2.5) and metabolic system abnormalities (OR=1.97, 95%CI=1.1-3.5). Almost all these associations, however, disappeared after taking into account potential confounding with the exception of musculoskeletal defects (adjusted OR=1.31, 95%CI=1.1-1.6). In this case also, if adjustment for multiple comparison is taking into account, results did not reach statistical significance. Conclusions The results of this analysis confirm the recently emerging view that the increased frequency of birth defects observed after ART/medically induced ovulation only is largely due to confounders.

Section: Discussionmentioning

confidence: 91%

The risk of birth defects after assisted reproduction

Parazzini

Cipriani

Bulfoni

et al. 2015

“…Different studies have shown that children born after assisted reproductive techniques (ART) have poorer outcomes in terms of preterm birth (PTB), low birth weight (LBW), small for gestational age (SGA), and perinatal mortality when compared with newborns of natural conceptions [54][55][56]. Among those undergoing IVF, the results between fresh and frozen embryo transfers (FET) in obstetric perinatal outcome terms are still unclear [57][58][59].…”

Section: Freeze-all-why?mentioning

confidence: 99%

The state of “freeze-for-all” in human ARTs

Basile

Garcia-Velasco

2016

The recent development of vitrification technologies and the good outcomes obtained in assisted reproduction technologies have supported new indications for freezing and segmentation of treatment. Beyond OHSS prevention and avoidance of embryo transfers in the setting of an adverse endocrinological profile or endometrial cavity, we have witnessed a trend to shift fresh embryo transfers to frozen embryo transfers in many programs. We critically review the available evidence and suggest that freeze-all is not Bfor all,b ut should be individualized.

“…This approach, however, is associated with a number of risks including ovarian hyperstimulation syndrome and increased cost due to the high doses of medications used. Furthermore, the practice of transferring more embryos carries the risk of multiple gestations, which is associated with increased maternal and perinatal morbidity and mortality [30][31][32][33].…”

Section: Introductionmentioning

confidence: 99%

Embryo wastage rates remain high in assisted reproductive technology (ART): a look at the trends from 2004–2013 in the USA

Ghazal¹,

Patrizio²

2016

This work examined the trend in Bembryo wastager ates after ART in USA and its relationship to the number of embryos transferred, live born infants delivered across patient age, and the yearly percentage of embryos wasted. The data were obtained from the US-clinics SART databank for the years 2004-2013. A total of 1,808,082 non-donor embryos were transferred in 748,394 fresh cycles resulting in 358,214 liveborn. During the years of analysis, the mean number of embryos transferred has progressively decreased leading to an overall significant decrease in Embryo Wastage rates (83.2 to 76.5%, p < 0.001) while the percentage of transfers leading to a live born increased (24.8 to 27.8%, p = 0.002). Embryo Wastage negatively correlated with percentage of transfers resulting in live birth (p = 0.001), and the average number of embryos transferred positively correlated with the percentage of embryos wasted (p < 0.001). The overwhelming majority of embryos transferred still do not result into a live birth confirming that only few embryos per ART cycle are competent. The overall BEmbryo Wastage^rates have consistently decreased from a high of 90% in 1995 to a rate of 76.5% in 2013. Transferring fewer embryos particularly at the blastocyst-stage and improved methods of embryo selection may further decrease BEmbryo Wastage^rates.