The effect of ICSI, maternal age, and embryonic stage on early clinical loss rate of twin versus singleton pregnancies

OBJECTIVES: To compare early loss rates between twin and singleton pregnancies following ART. STUDY DESIGN: First-trimester sonography counted the number of embryos with positive heartbeat in women undergoing IVF/ICSI and transfer of one to three embryos. The number of lost pregnancies was calculated from a second-trimester sonogram. Loss rates of the entire pregnancy were related to maternal age <38 or > or = 38 years, IVF or ICSI, and cleavage or blastocyst stage embryo transfers (in ICSI cases). RESULTS: Patients underwent IVF with (n = 672) and without (n = 189) ICSI. The overall odds of miscarrying the entire singleton pregnancy were 2.6 times that of a twin gestation (95% CI 1.5, 4.5). The disadvantage for singletons compared to twins seems more apparent in pregnancy after ICSI in the subgroup of patients <38 years (OR 2.9, 95% CI 1.5, 5.8). In this subgroup, the disadvantage conferred to singletons appeared only among days 2-3 embryo transfers (OR 3.0, 95% CI 1.3, 7.2). CONCLUSION: A significantly lower early spontaneous loss rate of twin pregnancies seems related to ICSI followed by cleavage stage embryo transfer in patients <38 years.     

Lower embryonic loss rates among twin gestations following assisted reproduction

Purpose: To determine whether maternal age and number of transferred embryos influence early pregnancy losses in twin pregnancies compared to singletons following IVF/ICSI.Methods: We compared the pregnancy loss rates in singleton (n = 549) and twin (n = 252) gestations, stratified by maternal age (≤35 and > 35 years) and the number of transferred embryos (1–3 and 4–9).Results: Loss rates of singleton pregnancies were significantly higher than that in twins (OR 3.0, 95% CI 1.9, 4.9), especially among singletons conceived after transfer of 4–9 embryos (OR 5.0, 95% CI 2.2, 11.9). Younger mothers of twins had lower loss rates (OR 0.3, 95% CI 0.1, 0.9).Conclusion: Twins have a significantly reduced spontaneous miscarriage rate compared with singletons following IVF/ICSI. Higher implantation rates per cycle (i.e., development of twins rather than one live embryo) may represent a better capacity of the uterus for early embryonic development.     

Obstetric and perinatal outcome of 1655 ICSI and 3974 IVF singleton and 1102 ICSI and 2901 IVF twin births: a comparative analysis

A total of 3974 IVF and 1655 ICSI singleton births and 2901 IVF and 1102 ICSI twin births were evaluated. Pregnancies after both fresh and frozen transfers were included. IVF and ICSI singleton pregnancies were very similar for most obstetric and perinatal variables. The only significant difference was a higher risk for prematurity (< 37 weeks of amenorrhoea) in IVF pregnancies compared with ICSI pregnancies (12.4 versus 9.2%, OR = 1.39, 95% CI = 1.15-1.70). For twin pregnancies, differences were not statistically different except for a higher incidence of stillbirths in the ICSI group (2.08 versus 1.03%, OR = 2.04, 95% CI = 1.14-3.64). Intrauterine growth retardation with or without pregnancy-induced hypertension was observed more often in the ICSI group. Regression analysis of the data with correction for parity and female age showed similar results for twins. For singletons, this analysis showed similar results with the exception of low birth weight babies (< 2500 g), which were also observed more often in IVF pregnancies (9.6 versus 7.9%, OR = 0.79, CI = 0.65-0.98, P = 0.03). This large case-comparative retrospective analysis showed that the obstetric outcome and perinatal health of IVF and ICSI pregnancies is comparable.     

The use of vaginal natural progesterone for prevention of preterm birth in IVF/ICSI pregnancies

The aim of this study was to evaluate the effect of vaginal natural progesterone on the prevention of preterm birth in IVF/intracytoplasmic sperm injection (ICSI) pregnancies. A single-centre prospective placebo-controlled randomized study was performed. A total of 313 IVF/ICSI pregnant patients were randomized into two groups for either treatment with daily 400 mg vaginal natural progesterone or placebo, starting from mid-trimester up to 37 weeks or delivery. Amongst the patients, there were 215 singleton and 91 twin pregnancies. There was no significant difference in risk of preterm birth among all patients (OR 0.672, 95% CI 0.42–1.0. There was a significantly lower preterm birth rate in singleton pregnancies in the natural progesterone arm (OR 0.53, 95% CI 0.28–0.97) and no significant difference between both arms in twin pregnancies (OR 0.735, 95% CI 0.36–2). In conclusion, the administration of 400 mg vaginal natural progesterone from mid trimester reduced the incidence of preterm birth in singleton, but not in twin, IVF/ICSI pregnancies.Preterm labour is a major cause of perinatal and neonatal mortality and morbidity. It is defined as birth occurring prior to 37 weeks’ gestation; however, most damage occurs in infants born before 34 weeks. It was reported that pregnancies achieved by IVF or intracytoplasmic sperm injection (ICSI) are more liable to preterm labour. The objective of this study was to evaluate the effect of progesterone (given to the patient vaginally) on the prevention of preterm labour in IVF/ICSI pregnancies. Patients who became pregnant after IVF or ICSI were randomized into two groups. The first group was given 400 mg of vaginal progesterone starting from mid trimester until 37 weeks of pregnancy, and the second group received no treatment. The results showed that administration of 400 mg vaginal progesterone from mid trimester reduces the incidence of preterm labour in singleton, but not in twin, IVF/ICSI pregnancies.     

First trimester screening with free beta-hCG,PAPP-A and nuchal translucency in pregnancies conceived with assisted reproduction

OBJECTIVE: To evaluate the effect of in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) on free beta-human chorionic gonadotrophin (beta-hCG), pregnancy-associated plasma protein A (PAPP-A) and nuchal translucency (NT). METHODS: First trimester maternal dried whole blood specimens from 74 singleton pregnancies (32 by IVF and 42 by ICSI) and 30 twin pregnancies (16 by IVF and 14 by ICSI) in which conception was achieved with assisted reproduction techniques were matched with five controls resulting in 370 singleton controls and 150 twin controls. NT was measured using the Fetal Medicine Foundation protocol. Free beta-hCG, PAPP-A and NT levels were compared between the IVF and control groups and between the ICSI and control groups using the Mann-Whitney U test. RESULTS: In singleton pregnancies, the only significant difference was a 21% (95% CI: -35%--7%) reduction in PAPP-A in IVF cases. In twin pregnancies, the only significant difference was a 12% (95% CI: -34%--3%) reduction in NT in IVF cases. In singleton pregnancies, the false-positive rate for Down syndrome screening was 1.4% and 1.9% greater for the IVF and ICSI groups, respectively, compared to controls for a general screening population. CONCLUSIONS: Patients undergoing assisted reproduction techniques should be counseled about the possibility of increased false-positive rates. Larger studies are needed to confirm this observation and to develop appropriate adjustment factors to reduce false-positive rates.     

Spontaneous embryonic loss after in vitro fertilization with and without intracytoplasmic sperm injection

OBJECTIVE: To determine whether pregnancies after IVF, with and without intracytoplasmic sperm injection (ICSI), have different early spontaneous loss rates. DESIGN: Retrospective analysis of IVF/ICSI dataset. SETTING: The Center of Reproductive Medicine, Arcispedale Santa Maria Nuova, Reggio Emilia, Italy. PATIENT(S): Women undergoing IVF with or without ICSI. INTERVENTION(S): First-trimester sonography at 6-7 weeks to count the number of embryos with positive heartbeat. The number of embryos lost was calculated from a second-trimester sonogram. MAIN OUTCOME MEASURE(S): Embryonic loss rates related to the initial number of embryos, maternal age <35 or > or =35 years, and IVF procedure. RESULT(S): In vitro fertilization and ICSI had similar embryonic loss rates (odds ratio [OR] 1.2, 95% confidence interval [CI] 0.9-1.7, and OR 1.3, 95% CI 0.9-1.8 for women aged <35 years and > or =35 years, respectively). Younger women had fewer losses after IVF (OR 0.7, 95% CI 0.5-0.9). Multiples had lower loss rates compared with singleton pregnancies. CONCLUSION(S): In vitro fertilization and ICSI have similar spontaneous embryonic loss rates. Factors other than the initial number of embryos, maternal age, and IVF technique, such as embryo quality or uterine environment, might be involved in the outcome of multiple pregnancies in assisted reproductive technology procedures.     

Perinatal outcome of ICSI pregnancies compared with a matched group of natural conception pregnancies in Flanders (Belgium): a cohort study

A retrospective cohort study was conducted with an intracytoplasmic sperm injection (ICSI) group and a naturally conceived comparison group. A total of 1655 singleton and 1102 twin ICSI births were studied with regard to perinatal outcome. Control subjects (naturally conceived pregnancies) were selected from a regional registry and were matched for maternal age, parity, place of delivery, year of birth and fetal sex. The main outcome measures were duration of pregnancy, birth weight, Apgar score <5 after 5 min, neonatal complications, perinatal death and congenital malformations. Twin births, when compared with singletons, carry a much higher risk of poor perinatal outcome. For both ICSI singletons and ICSI twins, no significant difference was found between ICSI and naturally conceived pregnancies for all investigated parameters. After excluding like-sex twin pairs, ICSI twin pregnancies were at increased risk for perinatal mortality (OR = 2.74, CI = 1.26-5.98), prematurity (OR = 1.38, CI = 1.10-1.75) and low birth weight (OR = 1.34, CI = 1.06-1.69) compared with spontaneously conceived different-sex twin pairs. In conclusion, the perinatal outcome of ICSI singleton and twin pregnancies was very similar to that of spontaneously conceived pregnancies in this large cohort study. After excluding like-sex twin pairs, ICSI twins were at increased risk for prematurity, low birth weight and higher perinatal mortality compared with the natural conception comparison group.     

Compartment syndrome after gynecologic laparoscopy: systematic review of the literature and establishment of normal values for postoperative serum creatine kinase and myoglobin levels

Purpose

The worldwide prevalence of adverse pregnancy outcomes (APOs) in singleton pregnancies after in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) is suggested to vary; however, a complete overview is missing. The aim of this review is to estimate the worldwide prevalence of APOs associated with IVF/ICSI singleton pregnancies.

Methods

PubMed, Google Scholar, Cochrane Libraries, and Chinese databases were searched for studies assessing APOs among IVF/ICSI singleton births through March 2016. The prevalence estimates were summarized and analyzed by meta-analysis.

Results

Fifty-two cohort studies, with 181,741 IVF/ICSI singleton births and 4,636,508 spontaneously conceived singleton births, were selected for analysis. Among IVF/ICSI singleton pregnancies, pooled estimates were 10.9% [95% confidence interval (CI) 10.0–11.8] for preterm birth, 2.4% (95% CI 1.9–3.0) for very preterm birth, 8.7% (95% CI 7.4–10.2) for low birth weight, 2.0% (95% CI 1.5–2.6) for very low birth weight, 7.1% (95% CI 5.5–9.2) for small for gestational age, 1.1% (95% CI 0.9–1.3) for perinatal mortality, and 5.7% (95% CI 4.7–6.9) for congenital malformations. The IVF/ICSI singleton pregnancies have higher prevalence of APOs compared with those conceived naturally (all P = 0.000). Significant differences in different continents, countries, income groups, and type of assisted conception were found.

Conclusions

The IVF/ICSI singleton pregnancies are at a higher prevalence of adverse perinatal outcomes compared with those conceived naturally. Important geographical differences were found. Yet, population-wide prospective APO registries covering the entire world population for IVF/ICSI pregnancies are needed to determine the exact perinatal prevalence.

     

单、双胎妊娠并发子痫前期不良妊娠结局的荟萃分析

目的探讨单、双胎妊娠并发子痫前期的孕妇与围产儿不良结局发病率差异。 方法检索PubMed、Web of Science、中国生物医学文献数据库、中国学术文献总库、万方和维普中文数据库中2000年1月至2017年12月国内外发表的关于单、双胎妊娠并发子痫前期妊娠结局的研究。采用RevMan 5.3与Stata 12.0软件对资料进行荟萃分析,采用OR值及相应的95%CI评价不良结局与双胎妊娠并发子痫前期的相关性。 结果纳入10篇文献,共692例双胎妊娠合并子痫前期,3101例单胎妊娠合并子痫前期。双胎妊娠合并子痫前期组发病率高于单胎妊娠合并子痫前期：胎盘早剥OR＝2.16,95%CI为1.40～3.36;产后出血OR＝2.90, 95%CI为2.03～4.15;心功能衰竭OR＝3.73, 95%CI为2.10～6.63 ;肺水肿OR＝2.76, 95%CI为1.04～7.27;剖宫产OR＝2.27, 95%CI为1.58～3.26;胎膜早破OR＝2.99, 95%CI为1.64～5.47;早产OR＝6.24,95%CI为4.16～9.38,新生儿重症监护病房转入率OR＝2.33, 95%CI为1.66～3.26。 结论双胎妊娠合并子痫前期的不良妊娠结局包括胎盘早剥、产后出血、心功能衰竭、肺水肿、剖宫产、胎膜早破、早产和新生儿重症监护病房转入的发病率比单胎妊娠合并子痫前期高。     

Maternal serum unconjugated oestriol and human chorionic gonadotrophin levels in twin pregnancies: implications for screening for Down's syndrome.

OBJECTIVE--To investigate maternal serum unconjugated oestriol (uE3) and human chorionic gonadotrophin (hCG) levels in twin pregnancies and to consider the implications of the results for antenatal screening for Down's syndrome. DESIGN--Measurement of maternal serum uE3 and hCG levels from 15-22 weeks of gestation in twin and singleton pregnancies. Previously available maternal serum alpha-fetoprotein (AFP) levels were also presented. SETTING--Stored serum samples collected from women receiving routine antenatal care in Oxford were used. SUBJECTS--200 women with a twin pregnancy and, for each, three singleton control pregnancies matched for gestational age (same completed week of pregnancy) and duration of storage of the serum sample (same calendar quarter). RESULTS--The median uE3, hCG and AFP levels in the twin pregnancies were respectively, 1.67 (95% CI 1.56-1.79), 1.84 (95% CI 1.64-2.07) and 2.13 (95% CI 1.97-2.31) multiples of the median (MoM) for singleton pregnancies at the same gestational age. The variance of values for the three serum markers (expressed in logarithms), and the correlation coefficients between any two, were similar in the twin and singleton pregnancies. CONCLUSION--In maternal serum screening programmes for Down's syndrome dividing uE3, hCG and AFP MoM values in twin pregnancies by the corresponding medians for twin pregnancies will, in expectation, yield a similar false-positive rate in twin pregnancies as in singleton pregnancies.     

Obstetric outcomes and congenital abnormalities after in vitro maturation, in vitro fertilization, and intracytoplasmic sperm injection

OBJECTIVE: To compare obstetric outcome and congenital abnormalities in pregnancies conceived after in vitro maturation (IVM), in vitro fertilization (IVF), and intracytoplasmic sperm injection (ICSI) with those in spontaneously conceived controls. METHODS: Data were collected from the McGill Obstetrics and Neonatal Database (MOND). All children were examined and classified in a standard manner. Final data were reviewed 12 months after delivery. Pregnancies by IVM, IVF, and ICSI were compared with those of age- and parity-matched controls. Congenital abnormality, gestational age, birth weight, Apgar scores, cord pH, growth restriction, pregnancy complications, mode of delivery, and multiple pregnancy were compared. RESULTS: A total of 432 children were born from 344 pregnancies after assisted reproductive technology (ART) during the study period (IVM 55, IVF 217, ICSI 160). The observed odds ratios (ORs) for any congenital abnormality were 1.42 (95% confidence interval [CI] 0.52-3.91) for IVM, 1.21 (95% CI 0.63-2.62) for IVF, and 1.69 (95% CI 0.88-3.26) for ICSI. Twin pregnancy (IVM 21%, IVF 20%, ICSI 17%) and triplet pregnancy (IVM 5%, IVF 3%, ICSI 3%) were higher than those in controls (1.7% twins and 0% triplets) (P<.001). Cesarean delivery rates were higher after ART, even in singleton pregnancies (IVM 39%, IVF 36%, ICSI 36%; controls: 26.3%) (P<.05). Apgar scores, cord pH, growth restriction, and pregnancy complications were comparable in all groups. CONCLUSION: All ART pregnancies are associated with an increased risk of multiple pregnancy, cesarean delivery, and congenital abnormality. Compared with IVF and ICSI, IVM is not associated with any additional risk.     

Obstetric outcome of twin pregnancies conceived by in vitro fertilization and ovulation induction compared with those conceived spontaneously

OBJECTIVE: To compare the obstetric characteristics of twin pregnancies conceived by in vitro fertilization (IVF) and ovulation induction with those conceived spontaneously. DESIGN: Case control study. SETTING: Tertiary Medical Center. PATIENTS: All twin deliveries that were achieved by IVF (n=558) and ovulation induction (n=478) from January 1988 through December 2002 were evaluated. Each group was compared with a control group that conceived spontaneously (n=3694) and was delivered during the same period. INTERVENTIONS: Ovulation induction, IVF-ET. MAIN OUTCOME MEASURES: Obstetrical complications. RESULTS: Multivariate analysis showed that patients who conceived with the assistance of IVF and ovulation induction had a significantly higher risk for gestational diabetes mellitus (odds ratio [OR]=2.41, 95% confidence interval [CI]=1.77-3.29 and OR=1.71, CI=1.2-2.42, respectively), cesarean section (OR=2.17, 95% CI=1.74-2.70 and OR=1.76, CI=1.43-2.16, respectively), and a lower gestational age at birth in the IVF group (OR=0.91, 95% CI=0.88-0.94), compared with their controls. CONCLUSIONS: After controlling for maternal age, and nulliparity we demonstrated that twin pregnancies conceived with the assistance of IVF and ovulation induction are at increased risk for gestational diabetes mellitus, and delivery by cesarean section. In addition, IVF conceived pregnancies have a lower gestational age at birth.     

体外受精-胚胎移植后妊娠早期合并宫腔积血异常产科结局的相关因素分析

目的 探讨经体外受精-胚胎移植（IVF/ICSI/F-ET）治疗后早期妊娠合并宫腔积血时导致异常产科结局的相关因素分析。方法 收集2010年4月至2012年8月在安徽医科大学第一附属医院经IVF/ICSI/F-ET助孕后获得宫内妊娠且合并宫腔积血患者274例的临床资料,分析宫腔积血的面积、诊断宫腔积血时孕龄、妊娠年龄、单双胎妊娠及不孕原因对产科结局的影响。结果 单双胎组及不同积血面积、孕龄、年龄组间的异常产科结局发生率差异无统计学意义,输卵管因素性不孕与男方因素性不孕比较差异有统计学意义（80.77%,126/156 vs.58.06%,36/62,P<0.01）。输卵管疾病是异常产科结局发生的危险因素（OR 3.32,95% CI 1.71～6.44）。结论 IVF/ICSI/F-ET助孕后妊娠早期合并宫腔积血时,宫腔积血的面积、诊断宫腔积血时孕龄、妊娠年龄、单双胎妊娠对产科结局影响不大;仅不孕原因与异常产科结局有良好的相关性,输卵管因素较男方因素致不孕患者更容易合并异常产科结局。     

High placental index and poor pregnancy outcomes: a retrospective study of 18 386 pregnancies

Abstract

Introduction: Our aim was to state the correlation between placental index and pregnancy outcomes or in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) pregnancies.

Materials and methods: We included in this retrospective study all singleton births in a third level clinic during the period 2001–2011 (n?=?18?386). We divided placental index into quartiles and analyzed the differences between the groups in term of pregnancy outcomes. Then, we estimated crude and adjusted odds ratios (ORs) for placental index over the third centile of the distribution to correlate with pregnancy outcomes. We also analyzed the correlation between IVF/ICSI conceived pregnancies and placental index.

Results: Poor pregnancy outcomes were overrepresented in the highest quartile of placental index distribution. Thus, placental index was higher in pregnancies characterized by pregnancy-related hypertensive disorders (PRHDs), small for gestational age infants, newborn needing cardiopulmonary resuscitation or hospitalization in neonatal intensive care unit. These findings were independent of maternal age, length of gestation at delivery, IVF/ICSI conception and ethnicity. For IVF/ICSI pregnancies, the OR for being over the third quartile of placental index distribution was 2.01 (CI.95 1.40–2.90) after adjustment for maternal age, length of gestation, ethnicity, birth weight, parity, fetal sex, alteration of glucose metabolism in pregnancy and PRHDs.

Conclusions: We found a high placental index among pregnancies characterized by poor outcomes and conceived by IVF/ICSI.     

Maternal obesity in singleton versus twin gestations: a population-based matched case–control study

Objective: To examine the impact of pre-pregnancy obesity on adverse outcomes in twin compared to singleton pregnancies.

Methods: Dichorionic twin gestations with maternal body mass index >30 were matched to three singleton controls. Both obese groups were matched (1:3) with non-obese controls. Rates of preeclampsia, gestational diabetes, cesarean section, and preterm birth were compared.

Results: One hunder eighty-nine dichorionic twin pregnancies in obese mothers were matched to 567 twin pregnancies in non-obese mothers, and to 567 singleton pregnancies in obese mothers. The latter were matched to 1701 non-obese mothers with singletons. Preeclampsia was more common in obese mothers with both twins and singletons (odds ratio (OR) 3.95, 95% confidence interval (CI) 2.18–7.16 and OR 6.53, 95% CI 3.75–11.4, respectively) as was gestational diabetes (OR 4.35, 95% CI 2.18–8.69; OR 5.53 95% CI 3.60–8.50). Obese mothers with singletons were more likely to deliver abdominally, but the cesarean rates were obesity independent in twins. Obese mothers were more likely to deliver at <?34 weeks in both twin and singleton groups (OR 1.65, 95% CI 1.10–2.48, and OR 2.41, 95% CI 1.21–4.77, respectively).

Conclusion: Obesity-attributable adverse outcomes are lower in twins compared to singletons. Obesity increases the risk of preterm birth regardless of plurality.     

Predicting Preterm Birth in Twin Pregnancy: Was the Previous Birth Preterm? A Canadian Experience

ObjectiveMost studies determining risk of preterm birth in a twin pregnancy subsequent to a previous preterm birth are based on linkage studies or small sample size. We wished to identify recurrent risk factors in a cohort of mothers with a twin pregnancy, eliminating all known confounders.MethodsWe conducted a retrospective cohort study of twin births at a tertiary care centre in Montreal, Quebec, between 1994 and 2008, extracting information, including chorionicity, from patient charts.To avoid the effect of confounding factors, we included only women with a preceding singleton pregnancy and excluded twin-to-twin transfusion syndrome, fetal chromosomal/structural anomalies, fetal demise, and preterm iatrogenic delivery for reasons not encountered in both pregnancies. We used multiple regression and sensitivity analyses to determine recurrent risk factors.ResultsOf 1474 twin pregnancies, 576 met the inclusion criteria. Of these, 309 (53.6%) delivered before 37 weeks. Preterm birth in twins was strongly associated with preterm birth of the preceding singleton (adjusted OR 3.23; 95% CI 1.75 to 5.98). The only other risk factors were monochorionic twins (adjusted OR 1.82; 95% CI 1.21 to 2.73) and oldest or youngest maternal ages. Chronic or gestational hypertension, preeclampsia, and insulin-dependent diabetes during the singleton pregnancy did not significantly affect risk.ConclusionPreterm birth in a previous singleton pregnancy was confirmed as an independent risk factor for preterm birth in a subsequent twin pregnancy. This three-fold increase in risk remained stable regardless of year of birth, inclusion/exclusion of pregnancies following assisted reproduction, or defining preterm birth as < 34 or < 37 weeks’ gestational age. Until the advent of optimal preventive strategies, close obstetric surveillance of twin pregnancies is warranted.     

Obstetrical outcomes of ART pregnancies in patients with male factor infertility

Purpose

Pregnancies conceived by in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) are associated with an increased incidence of obstetrical and neonatal complications. With the growing rate of male factor infertility, which is unique by not involving the maternal milieu, we aimed to assess whether obstetrical outcomes differed between IVF/ICSI pregnancies due to male factor infertility and those not due to male factor infertility.

Methods

A retrospective cohort study of women receiving IVF/ICSI treatments at a single hospital over a five-year period was involved in the study. Inclusion criteria were women with a viable pregnancy that delivered at the same hospital. Pregnancies were divided into male factor only related and non-male factor–related infertility. The groups were compared for several maternal and neonatal complications.

Results

In total, 225 patients met the study criteria, with 94 and 131 pregnancies belonging to the male factor and non-male factor groups, respectively. Demographic and clinical characteristics were comparable, except for younger maternal age and higher incidence of twin pregnancies in the male factor group. A sub-analysis for singleton pregnancies revealed a less likelihood of cesarean delivery, preterm birth, and male gender offspring in the male factor group (p < 0.05). These differences were not observed in the sub-analysis for twin pregnancies. Other outcome measures were similar in both groups, both for singleton and twin pregnancies.

Conclusion

Singleton IVF pregnancies due to male factor infertility are associated with a reduced incidence of some adverse outcomes, likely due to lack of underlying maternal medical conditions or laboratory conditions related to ICSI. Our findings require validation by further studies on larger samples.

     

Hydatid of Morgagni: a possible underestimated cause of unexplained infertility

Objectives

To assess the risk of spontaneous and iatrogenic preterm delivery in singleton pregnancies when comparing in vitro fertilization (IVF) pregnancies with intracytoplasmic sperm injection (ICSI) pregnancies.

Study design

A national population-based cohort study using Norwegian Medical Birth Register data during 1999 through 2006 was designed. The cohort included 5824 singleton pregnancies after IVF and ICSI treatment. Multinomial logistic regression analyses were used to calculate risk estimates.

Results

There were no differences in maternal complicating factors such as pre-eclampsia, hypertension and diabetes between the IVF and ICSI pregnancies. However, IVF pregnancies had a 60% increased risk of moderately (32^+0days-36^+6days gestational weeks) iatrogenic preterm delivery (OR: 1.6, 95%CI: 1.1-2.2) and a 40% increased risk of iatrogenic preterm delivery <37 weeks (OR: 1.4, 95%CI: 1.02-1.9) compared to ICSI pregnancies.

Conclusion

IVF pregnancies were at increased risk of moderately iatrogenic preterm delivery when compared to ICSI pregnancies.     

The parent trap: desire for multifetal gestation among patients treated for infertility

ObjectiveTo evaluate predictors for patient preference regarding multifetal or singleton gestation among women presenting for infertility care.DesignCross-sectional study.SettingAcademic university hospital-based infertility clinic.Patient(s)Five hundred thirty-nine female patients with infertility who presented for their initial visit.Main outcome measure(s)Demographic characteristics, infertility history, insurance coverage, desired treatment outcome, acceptability of multifetal reduction, and knowledge of the risks of multifetal pregnancies were assessed using a previously published 41-question survey. Univariate analysis was performed to assess patient factors associated with the desire for multiple births. Independent factors associated with this desire were subsequently assessed by multivariate logistic regression analysis.Result(s)Nearly a third of women preferred multiples over a singleton gestation. Nulliparity, lower annual household income, older maternal age, marital status, larger ideal family size, openness to multifetal reduction, and lack of knowledge of the maternal/fetal risks of twin pregnancies were associated with pregnancy desire. Older age (OR (95% CI) 1.66 (1.20–2.29)), nulliparity (OR (95% CI) 0.34 (0.20–0.58)), larger ideal family size (OR (95% CI) 2.34 (1.73–3.14)), and lesser knowledge of multifetal pregnancy risk (OR (95% CI) 0.67 (0.55–0.83)) were independently associated with desire.Conclusion(s)A large number of patients undergoing fertility treatment desire multifetal gestation. Although a lack of understanding of the risks associated with higher order pregnancies contributes to this desire, additional individual specific variables also contribute to this trend. Efforts to reduce the incidence of multiples should focus not only on patient education on comparative risks of multiples vs singleton pregnancies but also account for individual specific reservations.     

Differential effect of mode of conception and infertility treatment on fetal growth and prematurity

Objectives To examine perinatal outcomes in pregnancies conceived by different methods: fertile women with spontaneous pregnancies, infertile women who achieved pregnancy without treatment, pregnancies achieved by ovulation induction (OI) and in vitro fertilization or intra-cytoplasmic sperm injection (IVF/ICSI).

Methods Retrospective single-center cohort study including 200 fertile and 748 infertile women stratified according to infertility treatment. The outcome measurements were preterm delivery (PTD), small-for-gestational-age (SGA), gestational diabetes, placenta previa or preeclampsia.

Results The overall rate of pregnancy complications was significantly increased in all infertility groups regardless of the infertility treatment (adjusted odds ratio (OR): infertile without treatment 2.3 versus OI 2.2 versus IVF/ICSI 3.4). While PTD was mainly associated to IVF/ICSI (adjusted OR: infertile without treatment 1.3 versus OI 1.6 versus IVF/ICSI 3.3), SGA was significantly associated to both OI and IVF/ICSI (adjusted OR: infertile without treatment 1.9 versus OI 2.7 versus IVF/ICSI 2.6). All these associations remained statistically significant after adjusting by maternal age and twin pregnancy.

Conclusions This study confirms the higher prevalence of pregnancy complications in infertile women irrespectively of receiving infertility treatment or not, and further describes a preferential association of prematurity with IVF/ICSI, and SGA with treated infertility (OI and IVF/ICSI).