Developmental outcome of very low birth weight twins conceived by assisted reproduction techniques.

OBJECTIVE: To evaluate the differences in developmental outcomes between very low birth weight twins conceived by assisted reproduction techniques and those conceived spontaneously. STUDY DESIGN: Twenty-two sets of very low birth weight twins were evaluated by the Kyoto Scale for Psychological Development at 36 months of corrected age. Total developmental quotient and developmental quotient (DQ) for three subscales, posture-motor, cognition-adaptation and language-social, were evaluated. RESULTS: Twins conceived with medical assistance demonstrated a higher incidence of total DQ below 85 with lower DQ for cognition-adaptation and language-social skills than spontaneously conceived twins, whereas the quotient for posture-motor skills in medically assisted twins was comparable to that of spontaneously conceived twins. CONCLUSION: At 3 years of age very low birth weight twins conceived by assisted reproduction techniques demonstrated lower cognitive and language skills than twins conceived naturally.     

辅助生育技术受孕双胎与自然受孕双胎妊娠结局的分析

目的　探讨辅助生育技术受孕 (助孕 )双胎与自然受孕双胎围产期的结局。方法　选择 10 4例助孕双胎孕妇 (助孕组 )和 173例自然受孕双胎孕妇 (自然受孕组 ) ,比较两组孕妇一般情况、妊娠合并症、分娩情况和新生儿预后等方面的差异。结果　 (1)助孕组孕妇平均年龄 (31 2± 3 7)岁 ,自然受孕组孕妇为 (2 7 8± 3 5 )岁 ,两组比较 ,差异有显著性 (P <0 0 5 )。 (2 )助孕组孕妇早产 70例(6 7 3% ) ,自然受孕组孕妇早产 78例 (45 1% ) ,两组比较 ,差异有极显著性 (P <0 0 1)。助孕组孕妇患妊娠期糖尿病或糖耐量异常 16例 (15 4 % ) ,自然受孕组孕妇仅 4例 (2 3% ) ,两组比较 ,差异有极显著性 (P <0 0 1)。(3)助孕组孕妇剖宫产率为 76 0 % (79/10 4 ) ,明显高于自然受孕组的 6 5 3% (113/173)。(4)两组围产儿死亡率、畸形发生率和新生儿窒息率等比较 ,差异无显著性 (P <0 0 5 )。结论　助孕双胎孕妇年龄较大 ,早产率及妊娠期糖尿病或糖耐量异常发生率高 ;分娩方式以剖宫产为主。助孕双胎孕妇的围产儿结局与自然受孕双胎相似     

Nuchal translucency in dichorionic twins conceived after assisted reproduction

OBJECTIVES: As opposed to biochemical markers of Down syndrome, nuchal translucency (NT) was once thought to be a more reliable screening marker for high order multiple pregnancies and pregnancies conceived after assisted conception. Recent data suggested that NT in singleton fetuses from assisted reproduction technology (ART) was thicker than those from singleton pregnancies. The present study compared the thickness of NT in dichorionic twins from natural conception and assisted reproduction. METHODS: A retrospective analysis for comparison of NT thickness on 3319 spontaneous singletons, 19 pairs of spontaneous twins and 27 pairs of assisted reproduction twins was performed. RESULTS: The median NT multiple of median (MoM) of spontaneous singletons was 1.00. For twins, the median NT MoM for pregnancies after assisted reproduction and natural conception were 1.02 and 1.07 respectively. There was no statistical difference in the NT thickness among the three pregnancy groups. CONCLUSION: Contrary to the observed increase in NT in singleton pregnancies from assisted reproduction, the NT in dichorionic twins was comparable to the spontaneous ones. The mode of conception appears to impose differential influence on singletons and twins. Copyright (c) 2006 John Wiley & Sons, Ltd.     

Nuchal translucency in pregnancies conceived after assisted reproduction technology

PURPOSE OF REVIEW: Nuchal translucency is one of the important markers in the first trimester during antenatal screening for fetal Down's syndrome. With the observation of alterations in biochemical markers in pregnancies conceived after assisted reproduction, this review presents current information related to the thickness of nuchal translucency in these pregnancies. RECENT FINDINGS: Early small studies did not demonstrate any discrepancy in the thickness of nuchal translucency in fetuses from assisted reproduction and from spontaneous pregnancies, but there has been recent evidence to suggest an increased level of nuchal translucency in singletons from various modes of assisted-reproduction technology. Nuchal translucency in twins following assisted reproduction did not, however, show a similar increase. Although the effect of chorionicity was not specifically addressed, nuchal translucency thickness in twins born after assisted reproduction was reported to be comparable to that in spontaneous singletons. It is possible that singletons and twins after assisted reproduction exhibit different antenatal behavior and pregnancy courses. SUMMARY: Similar to other biochemical markers of fetal Down's syndrome, nuchal translucency is increased in singletons after assisted-reproduction technology. Further studies on twin pregnancies, in particular dichorionic twins, are necessary before conclusive evidence can be drawn for multiple pregnancies.     

Anthropometric measurements in infants conceived by assisted reproductive techniques versus spontaneous conception

Abstract

Objective: To compare body length and head circumference at birth of neonates conceived after in vitro fertilization/intracytoplasmic injection (IVF/ICSI), ovarian stimulation alone (OSa) or by natural conception (NC).

Methods: A retrospective, cohort study of all singleton neonates conceived after fertility treatment and born at 38–40 gestational weeks in 2011 in a tertiary, university-affiliated hospital. Pregnancy, delivery and neonatal data were obtained from the medical records. NC singleton neonates born at 38–40 weeks were selected to serve as controls.

Results: The sample included 81 IVF/ICSI neonates, 102 OSa neonates and 91 neonates after NC. Mean gestational age (GA) was 38.8 weeks. Gravidity and parity were significantly higher in the NC group. Mean neonatal length was 50.0?±?2.1 cm in the IVF/ICSI group, 49.7?±?2.6?cm in the OSa group and 50.3?±?2?cm in the NC group (p?=?0.123). Corresponding mean head circumference was 34.4?±?1.5, 34.2?±?1.8 and 34.5?±?1.2?cm (p?=?0.287). Neither of these parameters was significantly different even after adjustment for GA at delivery and sex.

Conclusions: Our study showed no significant difference in body length or head circumference at birth related to the mode of conception. Previously reported differences in anthropometric parameters in childhood may be related to other factors.     

Birth defects and congenital health risks in children conceived through assisted reproduction technology (ART): a meeting report

PurposeAssisted Reproduction Treatment (ART) is here to stay. This review addresses the parental background of birth defects, before, during and after conception and focuses both on the underlying subfertility and on the question whether ART as a treatment is an additional contributing factor.MethodsSearches were performed in Medline and other databases. Summaries were discussed in a Delphi panel set-up by the European Society of Human Reproduction and Embryology (ESHRE).ResultsSeveral birth defects and adult diseases arise during the earliest stages of ovarian development and oocyte differentiation: this is the case of cleft palate disorders in offspring from female rat exposed to Dioxin during fetal life or the polycystic ovary diseases in female offspring (primates) exposed to elevated androgen concentration during fetal life. Human oocytes and embryos often fail to stop the propagation of aneuploid cells but maintain their ability to repair DNA damages including those introduced by the fertilizing sperm. There is a 29 % increased risk of birth defects in the newborns spontaneously conceived by subfertile couples and the risk is further increased (34 %) when conception is achieved by treating infertlity with ART (Danish IVF Registry). Periconceptional conditions are critical for ART babies: their birth weight is in general smaller (Norvegian Registry) but a more prolonged culture time doubled the number of large babies (Finnish Registry).ConclusionThe long-term developmental effects of ART on child and subsequent health as an adult remains a subject worthy of futher monitoring and investigation.     

Amniotic fluid human chorionic gonadotrophin and alpha-fetoprotein levels in pregnancies conceived after assisted reproduction

OBJECTIVES: To study the alteration in the second-trimester maternal serum levels of human chorionic gonadotrophin (hCG) and alpha-fetoprotein (AFP) in pregnancies conceived after assisted reproduction. METHODS: We compared the amniotic fluid hCG and AFP concentrations of 45 pregnancies with fresh embryo transfer and 25 pregnancies with frozen-thawed embryo transfer with 269 spontaneous pregnancies. Wilcoxon rank-sum test was used for analysis. RESULTS: The median amniotic fluid hCG MoM in pregnancies conceived after frozen-thawed embryo transfer was significantly increased to 1.41 compared to 1.00 (p = 0.01) in naturally occurring pregnancies and 0.96 (p = 0.049) in pregnancies after fresh embryo transfer. Further analysis showed that this was only observed in frozen embryos fertilized by conventional insemination with MoM of 1.59. The AFP MoMs were similar among the groups. CONCLUSIONS: The observed raised amniotic fluid hCG level in IVF-FET pregnancies may reflect the elevated maternal serum level in these pregnancies. Further studies should be directed towards exploring the underlying pathophysiology.     

Concerns regarding the follow-up of children conceived after assisted reproduction in Latin America

Children born through assisted reproduction are not usually followed up in Latin America. However, in spite of all the social-economic and cultural complexity of this part of the world, professionals involved in assisted reproduction should not relinquish the responsibility of following up these children. In May 2002, the Centre for Human Reproduction Sinhá Junqueira, started a specific project for evaluation and follow-up of its children. It is the first centre in Brazil, and probably in Latin America, with this aim, and this paper reports initial results concerning the intellectual development of these children.     

Results of assisted reproduction techniques in Latin America

The fact that today it is possible to write a comprehensive report on assisted reproduction technologies in Latin America is the result of a serious and systematic effort, accomplished by more than 80 centres, from Mexico to Chile. Over the past 10 years, these centres representing the vast majority of assisted reproductive treatment cycles performed in Latin America, have agreed voluntarily to report their work to our regional registry using a pre-established format. Furthermore, during 1999 and part of 2000, all centres were visited by a team of biologists and clinicians, who evaluated for consistencies in the data reported. This activity also included an evaluation of personnel, facilities, etc. It can be proudly said that the data reported are a true reflection of the actual situation in our region.     

Network support and parenting in mothers and fathers who conceived spontaneously or through assisted reproduction

Background: Little is known about the contribution of other significant relationships beyond the partnership for parental adjustment and care in parents who conceived through Assisted Reproductive Technologies (ART). Objective: This study examined the role of perceived network support on parenting stress and investment in the child in parents who conceived spontaneously or through ART, during their transition to parenthood. Methods: Thirty‐five couples who conceived through ART and 31 couples who conceived spontaneously completed self‐report questionnaires regarding perceived emotional and instrumental support from their social network members (i.e. nuclear and extended family members and friends) during pregnancy (twenty‐fourth week) and regarding parenting stress and investment in the child four months after the partum. Results: Regardless of method‐of‐conception, instrumental support from the nuclear family was positively associated with maternal investment in the child and emotional and instrumental support from the extended family were positively associated with paternal stress while support from friends was negatively associated with it. Conclusion: Results suggest that parents who conceive through ART and spontaneously are alike in that their adjustment to parenthood and the quality of the care they provide to their children depends on perceived support from nuclear and extended family and friends.     

The risk of birth defects after assisted reproduction

PurposeAim of this study was to investigate the association between congenital malformations and type of conception (spontaneous or medically assisted).MethodsThis is a population based study using data from the regional data base of Lombardy, a Northern Italian Region with a population of about 10 million inhabitants. Included in the study were 277,043 neonates born in Lombardy during the study period 2010-2012. Adjusted and unadjusted odds ratios (OR), and corresponding 95 % confidence intervals (CI), of congenital abnormalities were calculated using unconditional multiple logistic regression.ResultsA total of 7057 births (2.5 %) were reported after non spontaneous conception. Overall, the frequency of birth defects was 4.4 % among births after spontaneous conception and 6.7 % among births after non spontaneous ones (OR = 1.67, 95%CI = 1.5–1.9). The association disappeared after taking into account the confounding effect of maternal age and factors associated with non spontaneous conception. The crude OR of abnormalities was higher than unity for any defect (OR = 1.67, 95%CI = 1.5–1.9), multiple defects (OR = 1.76, 95%CI = 1.3–2.3), cardiovascular (OR = 2.05, 95%CI = 1.8–2.4), musculoskeletal (OR = 2.05, 95%CI = 1.7–2.5) and metabolic system abnormalities (OR = 1.97, 95%CI = 1.1–3.5). Almost all these associations, however, disappeared after taking into account potential confounding with the exception of musculoskeletal defects (adjusted OR = 1.31, 95%CI = 1.1–1.6). In this case also, if adjustment for multiple comparison is taking into account, results did not reach statistical significance.ConclusionsThe results of this analysis confirm the recently emerging view that the increased frequency of birth defects observed after ART/medically induced ovulation only is largely due to confounders.