Abstract
Research question
What are the risk factors for prematurity other than intrauterine growth restriction
in singletons after IVF?
Design
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.
Results
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.
Conclusion
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.
KEYWORDS
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Reproductive BioMedicine OnlineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The phenotypic diversity in per-follicle anti-Müllerian hormone production in polycystic ovary syndrome.Human Reproduction. 2015; 30: 1927-1933https://doi.org/10.1093/humrep/dev131
- Association of Preterm Birth With Prescription of Psychotropic Drugs in Adolescence and Young Adulthood.JAMA Network Open. 2021; 4e211420https://doi.org/10.1001/jamanetworkopen.2021.1420
- Maternal age and risk of low birth weight and premature birth in children conceived through medically assisted reproduction. Evidence from Finnish population registers.Human Reproduction. 2020; 35: 212-220https://doi.org/10.1093/humrep/dez275
- Neonatal outcome of 937 children born after transfer of cryopreserved embryos obtained by ICSI and IVF and comparison with outcome data of fresh ICSI and IVF cycles.Human Reproduction. 2008; 23: 2227-2238https://doi.org/10.1093/humrep/den254
- Risk of spontaneous preterm birth in singleton pregnancies conceived after IVF/ICSI treatment: meta-analysis of cohort studies.Ultrasound in Obstetrics & Gynecology. 2018; 51: 43-53https://doi.org/10.1002/uog.18930
- Assisted reproductive technology and the risk of preterm birth among primiparas.Fertility and Sterility. 2015; 103 (e1): 974-979https://doi.org/10.1016/j.fertnstert.2015.01.015
- Maternal and neonatal health outcomes following assisted reproduction.Reproductive BioMedicine Online. 2013; 26: 454-461https://doi.org/10.1016/j.rbmo.2013.01.014
- Preterm delivery risk factors in singletons born after in vitro fertilization procedures.European Journal of Obstetrics and Gynecology and Reproductive Biology. 2014; 176: 183-186https://doi.org/10.1016/j.ejogrb.2014.03.002
- Pelvic endometriosis and natural killer cell immunity.American Journal of Reproductive Immunology. 2021; 85: e13342https://doi.org/10.1111/aji.13342
- Toward understanding obstetrical outcome in advanced assisted reproduction: varying sperm, oocyte, and uterine source and diagnosis.Fertility and Sterility. 2011; 95 (e1): 1645-1649https://doi.org/10.1016/j.fertnstert.2010.11.029
- Placental weight in singleton pregnancies with and without assisted reproductive technology: a population study of 536 567 pregnancies.Human Reproduction. 2012; 27: 576-582https://doi.org/10.1093/humrep/der428
- Perinatal outcome of singletons and twins after assisted conception: a systematic review of controlled studies.BMJ. 2004; 328: 261https://doi.org/10.1136/bmj.37957.560278.EE
- High antimüllerian hormone levels are associated with preterm delivery in patients with polycystic ovary syndrome.Fertility and Sterility. 2020; 113 (e1): 444-452https://doi.org/10.1016/j.fertnstert.2019.09.039
- Perinatal Outcomes in Singletons Following In Vitro Fertilization: A Meta-Analysis.Obstetrics & Gynecology. 2004; 103: 551-563https://doi.org/10.1097/01.AOG.0000114989.84822.51
- Is IVF/ICSI an Independent Risk Factor for Spontaneous Preterm Birth in Singletons? A Population-Based Cohort Study.Biomed Res Int. 2018; 20187124362https://doi.org/10.1155/2018/7124362
- In vitro fertilization and adverse childhood outcomes: what we know, where we are going, and how we will get there. A glimpse into what lies behind and beckons ahead.Fertility and Sterility. 2011; 95: 1887-1889https://doi.org/10.1016/j.fertnstert.2011.02.044
- Endometriosis with infertility: A comprehensive review on the role of immune deregulation and immunomodulation therapy.American Journal of Reproductive Immunology. 2021; 85: e13384https://doi.org/10.1111/aji.13384
- Associations of Maternal Diabetes and Body Mass Index With Offspring Birth Weight and Prematurity.JAMA Pediatrics. 2019; 173: 371-378https://doi.org/10.1001/jamapediatrics.2018.5541
- Pregnancy and birth outcomes in couples with infertility with and without assisted reproductive technology: with an emphasis on US population-based studies.American Journal of Obstetrics & Gynecology. 2017; 217: 270-281https://doi.org/10.1016/j.ajog.2017.03.012
- Birth Outcomes by Infertility Treatment: Analyses of the Population-Based Cohort Massachusetts Outcomes Study of Assisted Reproductive Technologies (MOSART).J Reprod Med. 2016; 61: 114-127
- Defining the problem: the epidemiology of preterm birth.British Journal of Obstetrics and Gynaecology. 2003; 110: 3-7https://doi.org/10.1046/j.1471-0528.2003.00011.x
- Role of Relaxin and Estrogen in the Control of Eosinophilic Invasion and Collagen Remodeling in Rat Cervical Tissue at Term1.Biology of Reproduction. 1998; 59: 795-800https://doi.org/10.1095/biolreprod59.4.795
- Hypertension in Polycystic Ovary Syndrome: Novel Insights.Current Hypertension Reviews. 2020; 16: 55-60
- Is frozen embryo transfer better for mothers and babies? Can cumulative meta-analysis provide a definitive answer?.Human Reproduction Update. 2018; 24: 35-58https://doi.org/10.1093/humupd/dmx031
- Preterm birth and low birth weight among in vitro fertilization singletons: A systematic review and meta-analyses.European Journal of Obstetrics and Gynecology and Reproductive Biology. 2009; 146: 138-148https://doi.org/10.1016/j.ejogrb.2009.05.035
- Increased risk of preterm birth in singleton pregnancies resulting from in vitro fertilization–embryo transfer or gamete intrafallopian transfer: A meta-analysis.Fertility and Sterility. 2004; 82: 1514-1520https://doi.org/10.1016/j.fertnstert.2004.06.038
- Elevated Maternal Serum Relaxin Concentrations Throughout Pregnancy in Singleton Gestations After Superovulation.Obstetrics & Gynecology. 1998; 92: 17-20https://doi.org/10.1016/S0029-7844(98)00091-X
- Fetal growth restriction: current knowledge.Arch Gynecol Obstet. 2017; 295: 1061-1077https://doi.org/10.1007/s00404-017-4341-9
- Immunology and the immunological response in pregnancy.Best Practice & Research Clinical Obstetrics & Gynaecology, Immunisation in Pregnancy. 2021; 76: 3-12https://doi.org/10.1016/j.bpobgyn.2020.07.013
- Obstetric and perinatal outcomes in singleton pregnancies resulting from IVF/ICSI: a systematic review and meta-analysis.Human Reproduction Update. 2012; 18: 485-503https://doi.org/10.1093/humupd/dms018
- Risques de morbidité maternelle et périnatale en fécondation in vitro : une étude nationale de cohorte française.Gynécologie Obstétrique Fertilité & Sénologie. 2020; 48: 351-358https://doi.org/10.1016/j.gofs.2020.02.002
- Serum relaxin as a potential marker for preterm labour.British Journal of Obstetrics and Gynaecology. 1992; 99: 292-295https://doi.org/10.1111/j.1471-0528.1992.tb13725.x
- Consequences of vanishing twins in IVF/ICSI pregnancies.Human Reproduction. 2005; 20: 2821-2829https://doi.org/10.1093/humrep/dei142
- Assisted reproductive technology and the risk of pregnancy-related complications and adverse pregnancy outcomes in singleton pregnancies: a meta-analysis of cohort studies.Fertility and Sterility. 2016; 105 (e6): 73-85https://doi.org/10.1016/j.fertnstert.2015.09.007
- Mortality Among Young Adults Born Preterm and Early Term in 4 Nordic Nations.JAMA Network Open. 2021; 4e2032779https://doi.org/10.1001/jamanetworkopen.2020.32779
- Risk of type 2 diabetes is increased in nonobese women with polycystic ovary syndrome: the National Health Insurance Service-National Sample Cohort Study.Fertility and Sterility. 2021; 115: 1569-1575https://doi.org/10.1016/j.fertnstert.2020.12.018
- The risk of preterm birth in vanishing twin: A multicenter prospective cohort study.PLOS ONE. 2020; 15e0233097https://doi.org/10.1371/journal.pone.0233097
- Endometriosis, assisted reproduction technology, and risk of adverse pregnancy outcome.Human Reproduction. 2009; 24: 2341-2347https://doi.org/10.1093/humrep/dep186
- Tabagisme pendant la grossesse : impact sur l'enfant, de la naissance à l’âge adulte — Rapport d'experts et recommandations CNGOF-SFT sur la prise en charge du tabagisme en cours de grossesse.Gynécologie Obstétrique Fertilité & Sénologie, Prise en charge du tabagisme en cours de grossesse. 2020; 48: 567-577https://doi.org/10.1016/j.gofs.2020.03.026
- Preterm birth and low birth weight after assisted reproductive technology-related pregnancy in Australia between 1996 and 2000.Fertility and Sterility. 2005; 83: 1650-1658https://doi.org/10.1016/j.fertnstert.2004.12.033
- Perinatal outcomes of children born after frozen-thawed embryo transfer: a Nordic cohort study from the CoNARTaS group.Human Reproduction. 2013; 28: 2545-2553https://doi.org/10.1093/humrep/det272
- Risk of preterm delivery in singletons conceived by in vitro fertilization.Gynecological Endocrinology. 2019; 35: 661-664https://doi.org/10.1080/09513590.2018.1525702
- Causes and Consequences of Polycystic Ovary Syndrome: Insights From Mendelian Randomization.The Journal of Clinical Endocrinology & Metabolism. 2022; 107: e899-e911https://doi.org/10.1210/clinem/dgab757
Biography
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.
Article info
Publication history
Published online: January 17, 2023
Accepted:
January 10,
2023
Received:
October 18,
2022
Declaration: The authors report no financial or commercial conflicts of interest.Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.
