[Artificial insemination by donor/in vitro fertilization by donor and quality of the embryo. Federation of CECOS].
OBJECTIVE
To assess pregnancies and conceptus after artificial insemination (IAD) or IVF with frozen semen donor (IVFD) on sufficiently large study population in order to distinguished minor variations.


METHODS
From 1987 to 1994 all pregnancies obtained after AID or IVFD where registered prospectively in the French CECOS Federation data base. Different factors were recorded for this study: first menarch age of the recipient women, cycle length, insemination date in the conception cycle, maternal age at delivery, hormonal treatments, donor age, sperm conservation length and follow up of the pregnancy: miscarriage, tubal pregnancy, time at delivery, sex of the fetus, weight, malformation.


RESULTS
21,597 pregnancies obtained after AID and 3381 after IVFD were registered. 2% where lost of follow up. Fetal loss rate is 18% after AID and 21.5% after AID and 1.7% after IVFD (p < 0.0001). 18,128 children were born after AID and 3,313 after IVFD. After AID the twin pregnancy rate is 6.9% and the multiple pregnancy (> or = 3 fetus) rate is 0.7%. After IVDF these rates are respectively 24.8% and 4.2% (p < 0.0001). After AID the mean weight at delivery, sex ratio, premature rate, intra uterine growth retardation rate are not different from national rates published in 1995. The fetus malformation rate (including medical abortions) is 1.9% after AID and 2.7% after IVFD (p < 0.009). After AID the trisomy 21 rate increase with the mother age but also with the donors age if the maternal age is equal. The birth defects rate is not different from those registered in Paris, Strasbourg and Marseille. The birth defects rate observed after IVDF is not different from the rate observed after IVF with husband semen (2.74% versus 2.99%, p = 0.16).


CONCLUSIONS
After AID the miscarriage and tubal pregnancy rate, the children weight, the premature rate is not different from the general French, population. Sex ratio is normal as the global malformation rate. The multiple pregnancy rate (x 7 for twin and by 10 for multiple pregnancies more than 3 fetus) is high showing the influence of ovulation induction treatment. The birth chromosomic abnormalities rate is normal and correlated to the mother age but also to the donor age. This result without clear biological explanation will require further verification in a greater population. Practically speaking, this observations encourages lowering the age limit for the semen donors less than 45 years. IVFD practice instead of AID double the tubal pregnancy rate (0.9% versus 1.7% and increase the twin pregnancy rate by 2.5% and the multiple pregnancy (> or = 3 fetus) rate by 3. It is necessary to promote AID from which the pregnancy rate is very different from one center to another with in the centers with AID low results a too high rate of IVFD. Finally we can say that pregnancy from IVFD or IVF with husband semen are not significantly different. In other words pregnancy outcome is not changed after sperm cryopreservation.
D000328:Adult; D000013:Congenital Abnormalities / Q000453:epidemiology; D004622:Embryo, Mammalian; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D007316:Insemination, Artificial, Heterologous; D011247:Pregnancy / Q000706:statistics & numerical data; D011446:Prospective Studies