Assisted reproductive technology and pregnancy outcome.
OBJECTIVE
To determine whether the use of assisted reproductive technology (ART) is associated with an increase in chromosomal abnormalities, fetal malformations, or adverse pregnancy outcomes.


METHODS
A prospective database from a large multicenter investigation of singleton pregnancies, the First And Second Trimester Evaluation of Risk trial, was examined. Subjects were divided into 3 groups: no ART use, use of ovulation induction (with or without intrauterine insemination), and use of in vitro fertilization (IVF). Multivariate logistic regression analysis was used to assess association between ART and adverse pregnancy outcomes (significance of differences was accepted at P < .05).


RESULTS
A total of 36,062 pregnancies were analyzed: 34,286 (95.1%) were spontaneously conceived, 1,222 (3.4%) used ovulation induction, and 554 (1.5%) used IVF. There was no association between ART and fetal growth restriction, aneuploidy, or fetal anomalies after adjustment for age, race, marital status, years of education, prior preterm delivery, prior fetal anomaly, body mass index, smoking history, and bleeding in the current pregnancy. Ovulation induction was associated with a statistically significant increase in placental abruption, fetal loss after 24 weeks, and gestational diabetes after adjustment. Use of IVF was associated with a statistically significant increase in preeclampsia, gestational hypertension, placental abruption, placenta previa, and risk of cesarean delivery.


CONCLUSIONS
Patients who undergo IVF are at increased risk for several adverse pregnancy outcomes. Although many of these risks are not seen in patients undergoing ovulation induction, several adverse pregnancy outcomes are still increased in this group. There was no increased incidence of fetal chromosomal or structural abnormalities in the women who used any type of ART compared with the women who conceived spontaneously.


METHODS
II-2.
Shevell
Tracy
T
Division of Maternal-Fetal Medicine, Whittingham Pavilion, Stamford Hospital, 30 Shelburne Road, Stamford, CT 06904, USA. tshevell@stamhealth.org
Malone
Fergal D
FD
Vidaver
John
J
Porter
T Flint
TF
Luthy
David A
DA
Comstock
Christine H
CH
Hankins
Gary D
GD
Eddleman
Keith
K
Dolan
Siobhan
S
Dugoff
Lorraine
L
Craigo
Sabrina
S
Timor
Ilan E
IE
Carr
Stephen R
SR
Wolfe
Honor M
HM
Bianchi
Diana W
DW
D'Alton
Mary E
ME
D000328:Adult; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011256:Pregnancy Outcome; D011446:Prospective Studies; D027724:Reproductive Techniques, Assisted; D018570:Risk Assessment