Safety Evaluation Of The Offspring Conceived By Assisted Reproductive Technology

Part ⅠThe Pregnancy Outcome of Artificial Reproductive TechnologyObjective:Pregnancy outcome of patients conceived by assissted reproductive treatments were retrospectively analyzed to evaluate the effect of different assissted reproductive technologies on clinical pregnancy outcome.Methoeds:All clinical pregnancy cycles after assissted reproductive technologies (ART)-including in vitro fertilization fresh embryo transfer (IVF), intracytoplasmic sperm injection fresh embryo transfer (ICSI), frozen-thawed embryo transfer (FET), in the Center of Reproductive Medicine, Tongji Hospital from1st January1997to31th December2011were retrospectively analyzed. The rates of miscarriage, ectopic pregnancy, live birth delivery, disorders in pregnancy, multiple pregnancy, multiple delivery, preterm labor, sex ratio at birth and birth defect in group ICSI and group FET were compared with that in group IVF.Result:1. A total of9360clinical pregnancy cycles were analyzed, and the pregnancy outcome was followed up in9303cycles. There were6307cycles (6260cycles followed up) of fresh embryo transfer, including4527IVF cycles (4496cycles followed up), and1780ICSI cycles (1764cycles followed up). There were3052cycles of frozen-thawed embryo transfer (3043cycles followed up).2. The miscarriage rate in all ART cycles was13.19%(1227/9303), and early miscarriage rate was12.49%(1162/9303). There were no difference in the three groups:IVF13.21%(594/4496), ICSI11.96%(211/1764), FET13.87%(422/3043).3. The rate of ectopic pregnancy in all cycles was3.88%(361/9303), and the rate of heterotopic pregnancy was0.32%(30/9303). Compared with group IVF, the rates of ectopic pregnancy in group ICSI was decreased (ICSI2.49%-44/1764vs. IVF5.27%-237/4496,p<0.05). Compared with group fresh embryo transfer, the rates of ectopic pregnancy in group FET was decreased (FET2.63%-80/3043vs. fresh embryo transfer4.49%-281/6260,p<0.05).4. The rate of live birth delivery was81.23%(7557/9303), that in group ICSI was higher than in group IVF (ICSI84.07%-1483/1764vs. IVF79.78%-3587/4496,p<0.05). The rate of live birth delivery was81.73%(2487/3043) in group FET, and it was80.99%(5070/6260) in group fresh embryo transfer (p>0.05).5. The incidence of pregnancy complication in all clinical pregnancy cycles was6.56% (610/9303), and was no difference between group IVF8.11%(365/4496) and group ICSI7.99%(141/1764). The incidence of pregnancy complication in group FET (3.42%,104/3043) was lower than group fresh embryo transfer (8.08%,506/6260)(p<0.05).6. The multiple pregnancy rate was33.29%(3116/9360), and the multiple delivery rate was28.41%(2147/7557). The multiple delivery rates in group ICSI (27.78%-412/1483) was comparable with that in group IVF (30.28%,1086/3587), p>0.05. The multiple delivery rates in group FET (26.1%,649/2487) was lower than that in group fresh embryo transfer (29.55%,1498/5070), p<0.05.7. In live birth cycles, preterm labor rate was19.96%(1500/7515). This rate in group ICSI (17.91%,265/1480) was lower than in gruop IVF (20.52%,732/3568),P<0.05. The preterm labor rate in FET (20.39%,503/2467) was comparable with that in group fresh embryo transfer (19.75%,997/5048),p>0.05.8. The mean birth weight of live births was3.00±0.72kg. There was no difference between group IVF2.99±0.68kg and group ICSI2.98±0.68kg,p>0.05. The mean birth weight of live births in group FET (3.03±0.72kg) was higher than that in group fresh embryo transfer2.99±0.68kg (p<0.05).9. Birth defect rate in ART live births was1.41%(137/9715). There was no difference between group IVF (1.52%,71/4678) and group ICSI (1.58%,104/6573)(p<0.05). Birth defect rate in group FET (1.05%,33/3142) was lower than that in group fresh embryo transfer (1.58%,104/6573)(p<0.05).10. Sex ratio at birth of ART babies was1.15(male/female,5196/4509), and that was lower in ICSI babies (0.93,911/984), compared with IVF babies (1.22,2565/2110),p<0.05. There was no difference between group FET (1.22,1720/1415) and group fresh embryo transfer (1.12,3476/3094), p>0.05. Conclusion:1. ART may not increase the risk of miscarriage and disorders in pregnancy, and not change the sex ratio at birth, when compared with the pregnancy outcome in population cohort reported. However, the incidence of multiple pregnancy and ectopic pregnancy was increased significantly.2. Compared with conventional IVF, ICSI and FET may not increase the risk of adverse pregnancy outcome and the risk of birth defect. However, the proportion of boy babies born after ICSI was decreased. Part ⅡAnalysis of Birth Defects Among Children Conception Through Assisted Reproductive TechnologyObjective:To comparatively assess the rates of birth defects in children conceived by assisted reproduction technology (ART), especially to compare the congenital malformation at birth and over3-year longitudinal follow-up.Method(s):Live birth infants, conceived by in vitro fertilization fresh embryo transfer (IVF), intracytoplasmic sperm injection fresh embryo transfer (ICSI) or frozen-thawed embryo transfer (FET) in Reproductive Center of Tongji Hospital (Wuhan, China) between1997and2008, were followed up at birth and after2years-old. Congenital malformation were compared.Result(s):1. A total of4236children were born after3278ART cycles (IVF2543, ICSI908, FET785). There were94children with birth defect (birth defect rate2.22%,94/4236). Congenital defects were comparable in all groups at birth (IVF2.28%-58/2543, ICSI2.86%-26/908, FET1.27%-10/785).2. In total,2908children participated in the second follow-up, and the cases of birth defects had doubled (2-years:5.16%-150/2908, birth:2.22%-94/4236). The birth defect rate in boys conceived through ICSI was significantly higher than the IVF group after2-year follow-up (ICSI boys:8.62%-25/290, IVF boys:5.21%-50/959,p<0.05), even though there was no significant difference at birth. Conclusion(s):Compared with IVF, FET may not increase risk of birth defects. Children conceived through ICSI, especially males, had higher rates of congenital malformations that were inapparent at birth. So longitudinal monitoring may provide insights into the risks of ART.