Risk factors associated with preterm birth in singletons born after IVF: a national cohort study

Published:January 17, 2023DOI:


      Research question

      What are the risk factors for prematurity other than intrauterine growth restriction in singletons after IVF?


      Data were collected from a national registry, based on an observational prospective cohort of 30,737 live births after assisted reproductive technology (fresh embryo transfers: n = 20,932 and frozen embryo transfer [FET] n = 9805) between 2014 and 2015. A population of not-small for gestational age singletons conceived after fresh embryo transfers and FET, and their parents, was selected. Data on a number of variables were collected, including type of infertility, number of oocytes retrieved and vanishing twins.


      Preterm birth occurred in 7.7% (n = 1607) of fresh embryo transfers and 6.2% (n = 611) of frozen–thawed embryo transfers (P < 0.0001; adjusted odds ratio [aOR] = 1.34 [1.21–1.49]). Endometriosis and vanishing twin increased the risk of preterm birth after fresh embryo transfer (P < 0.001; aOR 1.32 and 1.78, respectively). Polycystic ovaries or more than 20 oocytes retrieved also increased preterm birth risk (aOR 1.31 and 1.30; P = 0.003 and P = 0.02, respectively); large oocyte cohort (>20) was no longer associated with the risk of prematurity in FET.


      Endometriosis remains a risk for prematurity even in the absence of intrauterine growth retardation, which suggests a dysimmune effect. Large oocyte cohorts obtained by stimulation, without clinical polycystic ovary syndrome diagnosed before attempts, do not affect FET outcomes, reinforcing the idea of a phenotypic difference in the clinical presentation of polycystic ovary syndrome.


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      Dr Marie-Jose Gervoise Boyer is a specialist in reprotoxicity. She has been working since 1984 on the risks associated with pre-conception or in-utero drug exposure, and has extensive experience in paediatric pharmacovigilance. Since 2000, her research has focused on the follow-up of children born after medically assisted procreation.
      Key message
      Endometriosis is associated with preterm birth, regardless of intrauterine growth restriction, suggesting a dysimmune cause. Frozen embryo transfer, compared with fresh embryo transfer, lowers the risk of preterm birth, especially in a large oocyte cohort. This reinforces the idea of a phenotypic difference in clinical presentation of polycystic ovary syndrome.