Preterm Birth in Assisted Reproductive Technology: An Analysis of More Than 20,000 Singleton Newborns

Abstract

Background: Several studies have shown that newborns conceived through the ART procedures were associated with an increased incidence of preterm delivery compared to those conceived spontaneously regardless of the type of ART procedure. The aim of the study was to explore risk factors for preterm birth (PTB) in assisted reproductive technology. Method: In this single center retrospective cohort study, a total of 23,111 singleton newborns from January 2010 to December 2018 were included. The primary outcome in this study was preterm birth, defined as live birth before 37 weeks' gestation. Result: In the 23,111 pregnancies, the incidence of PTB was 7.13%. In multivariate logistic regression analysis model, BMI was an independent predictor for PTB (OR = 1.05, 95% CI: 1.03-1.07; P = 0.00 in IVF/ICSI cycles; OR = 1.08, 95% CI: 1.03-1.12; P = 0.00 in IUI cycles). Also, another independent predictor in ART was male newborns (OR = 1.27, 95% CI: 1.14-1.41; P = 0.00 in IVF/ICSI cycles; OR = 1.60, 95% CI: 1.17-2.18; P = 0.00 in IUI cycles). In IVF/ICSI cycles, PTB was significantly higher in patients with advanced age (9.56% in ≥ 38 years old), and in patients with a history of cesarean section (10.39%). In addition, Blastocyst transfer, and frozen thawed transfer were also risk factor for PTB as compared with cleavage transfer, and fresh transfer, respectively. Moreover, in frozen thawed transfer cycles, stimulated protocol (estrogen-progesterone) increased PTB as compared with natural protocol (OR = 1.33, 95% CI: 1.12-1.59; P = 0.00). This situation was similar in IUI cycles as stimulated protocol also increased PTB when compared with natural protocol (OR = 1.72, 95% CI: 1.19-2.48; P = 0.00). Conclusion: Body mass index (BMI), delivery with male newborn, as well as stimulated protocols, were independent risk factors for PTB in both IVF/ICSI and IUI treatment cycles. In IVF/ICSI cycles, independent risk factors also included maternal, history of cesarean section, frozen thawed transfer, and blastocyst transfer.

Effect of artificial cycle with or without GnRH-a pretreatment on pregnancy and neonatal outcomes in women with PCOS after frozen embryo transfer: a propensity score matching study

“…Therefore, considering the adverse effects of PTB on the short- and long-term health of newborns, a timely prediction of the risk of PTB is critical for early clinical intervention. Several studies have shown that both the diagnosis of PCOS and artificial cycle regimens are independent risk factors for PTB in newborns conceived through ART [ 32 – 35 ]. Christ et al [ 36 ] reported that among the three major characteristics of PCOS, hyperandrogenism, rather than polycystic ovarian morphology or oligo-anovulation, was associated with PTB.…”

Effect of HMG on Pregnancy Outcomes in Patients undergoing IUI Cycle -An Analysis of 1230 IUI Cycles

“…Exogenous hormone experiment also showed that a gradual and constant augmentation, instead of a rapid increase, in the thickness of the endometrium stimulated by circulating estrogen was more likely to induce vasodilation and endometrial blood ow and increase the endometrial size during periovulatory periods, explaining why longer days of HMG were related to a better pregnancy outcome [23]. However, supraphysiologic estradiol levels are deemed to adversely affect endometrial receptivity and thereby implantation, resulting in an increased perinatal risk [24]. Consequently, physiologic estradiol level is required in IUI cycles.…”

“…According to European Society of Human Reproduction and Embryology (ESHRE), nearly 776,000 assisted reproductive technology (ART) cycles and 175,000 intrauterine insemination (IUI) cycles were performed in Europe each year [2]. The higher incidence of cancer and congenital disability observed during the in vitro fertilization (IVF) cycles reminds us of careful consideration [3][4][5]. IUI, a safe and relatively low-cost procedure, is often the rst-line in infertility treatment for couples with unexplained infertility, low-grade endometriosis, sexual function disorders, and low-grade male subfertility [6].…”

Impact of paternal body mass index on assisted reproduction treatment outcomes: An updated systematic review and meta‐analysis

“…21,22 Recent reviews indicate that excess maternal weight is linked to suboptimal follicle maturation, lower oocyte retrieval rates, higher need for gonadotropins as well as decreased clinical pregnancy rate, lower birth rate and higher rates of adverse birth outcomes such as miscarriage. [23][24][25][26][27] There is an increasing interest in understanding the role of paternal BMI in influencing the outcomes of ART. However, only two reviews evaluate this factor with controversial conclusions.…”