Pregnancy Complications And Birth Outcomes After In Vitro Fertilization-embryo Transfer

Objective:In recent years,with the development of assisted reproduction technology (ART) in the world, an increasing number of couples seek fertility enhancement with ART procedures. According to the reports,about 1.1%-2.0% of all births followed the use of ART. The first infant was achieved successfully after in vitro fertilization-embryo transfer(IVF-ET) in 1978. In 1992, intracytoplasmic sperm injection(ICSI) was carried out for male factor infertility. These ART avoided the natural processes of acrosome reaction, penetrating through the zona matrix and membrance of oocytes. The fertilization and early embryo stage of these pregnancies were complished in vitro cultural environment. So it is critical to evaluate the pregnancy complications and birth outcomes of ART, which is benefit to assess the long-term safety of ART. This study analyzed the pregnancy complication and birth outcomes after in vitro fertilization-embryo transfer, compared with that of natural pregnancies.Methods:This retrospective study involved 2044 clinical pregnancies originating from ART procedures between August 2001and April 2009 in Shenyang Eastern Medical Group Jinghua Hospital, comparing with 24560 natural conceptions. The exposed group was ART group, which include 1270 traditional in vitro fertilization (IVF) cycles,689 intracytoplasmic sperm injection(ICSI) cycles and 85 IVF+ICSI cycles. The incidences of miscarriage, ectopic pregnancy, multiple delivery were calculated in ART group. The incidences of preterm birth, low birth weight (LBW) and birth defect were compared among the whole ART group as well as in the different types of ART, IVF and ICSI, with the control group and injusted for maternal age, smoking, infant gender and parity.Results:In ART group, miscarriage rate, ectopic pregnancy rate and multiple birth rate were in turn 22.65%,3.77%,27.53%, which were significant higher than those of natural population. Preterm birth rate and LBW rate in ART group were 18.77%,20.32%, respectively, in natural conception group were 2.04%,10.12%, respectively. The distinction has statistical signification (P<0.05).In a total of 1933 infants,1.09% conceived by ART were diagnosed with birth defect. In comparison, a prevalence of birth defect of 0.89% was found. There was no significant difference. (P>0.05). We also explored differ IVF and ICSI ART technique,we found that the rates of multiple birth, LBW, preterm birth and birth defect were all similar.(P>0.05).Conclusion:The increasing miscarriage rate was correlated with higher multiple gestation in ART pregnancy. Early miscarriage may be caused by the altered maternal endocrine environment due to the hormonal treatment preceding, which may influence the endometrial receptivity and early pregnancy. Multiple gestation was the important cause that resulted in preterm birth and LBW of ART newborn. In ART cycles, more than one embryos were usually chose to transfer, which may result in higher ectopic pregnancy rate and multiple gestation rate. Hence, singleton embryo transfer was the available approach to decrease the rate of latrogenic multiple gestation and improve the inverse pregnancy complications and birth outcomes of ART. This study showed that there is no increased risk of birth defects in ART processing.