title: Factors influencing adverse perinatal outcomes in pregnancies achieved through use of in vitro fertilization.
abstract: OBJECTIVE
  To determine the associations of specific components of IVF treatment with abnormal perinatal outcomes.
  
  
  METHODS
  Case-control study.
  
  
  METHODS
  University-based and community-based infertility centers.
  
  
  METHODS
  All viable pregnancies achieved through IVF procedures performed between January 1999 and March 2004.
  
  
  METHODS
  None.
  
  
  METHODS
  Infertility etiology, gonadotropin exposure, embryo manipulation, and quality.
  
  
  RESULTS
  Of 455 viable pregnancies identified during the study period, 435 met inclusion criteria. While adjusting for maternal age, race, parity, body mass index, infertility center, and year of IVF procedure, multiple gestations were associated with a 12-fold increased risk of poor perinatal outcome compared to singletons. Ovarian hyperstimulation syndrome significantly increased the risk more than 3-fold (odds ratio = 3.14; 95% confidence interval, 1.08-9.14), while endometrial thickness was found to have a significant protective effect (odds ratio = 0.89; 95% confidence interval, 0.80-0.99). We found no effect of etiology of infertility, dose or type of medication used for stimulation, use of embryo-manipulation techniques, or quality on perinatal outcome.
  
  
  CONCLUSIONS
  These data confirm and quantify the risk of perinatal morbidity associated with multiple births. After adjusting for multiple births, ovarian hyperstimulation syndrome and suboptimal endometrial development are associated with adverse outcomes in pregnancies achieved through IVF. Our findings suggest that it may be the endometrium rather than the embryo that influences fetal growth and perinatal outcomes after IVF.
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, Pennsylvania, USA. karinech@usc.edu <karinech@usc.edu>
authors.forename: Karine
authors.initials: K
authors.lastname: Chung
authors.forename: Christos
authors.initials: C
authors.lastname: Coutifaris
authors.forename: Raffi
authors.initials: R
authors.lastname: Chalian
authors.forename: Kathleen
authors.initials: K
authors.lastname: Lin
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Ratcliffe
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Castelbaum
authors.forename: Martin F
authors.initials: MF
authors.lastname: Freedman
authors.forename: Kurt T
authors.initials: KT
authors.lastname: Barnhart
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005260:Female; D005307:Fertilization in Vitro / Q000401:mortality*; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007247:Infertility, Female / Q000401:mortality* / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D010414:Pennsylvania / Q000453:epidemiology; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome