title: Comparison of live-birth defects after luteal-phase ovarian stimulation vs. conventional ovarian stimulation for in vitro fertilization and vitrified embryo transfer cycles.
abstract: OBJECTIVE
  To assess live-birth defects after a luteal-phase ovarian-stimulation regimen (LPS) for in vitro fertilization (IVF) and vitrified embryo transfer (ET) cycles.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Tertiary-care academic medical center.
  
  
  METHODS
  Infants who were born between January 1, 2013 and May 1, 2014 from IVF with intracytoplasmic sperm injection (ICSI) treatments (n = 2,060) after either LPS (n = 587), the standard gonadotropin-releasing hormone-agonist (GnRH-a) short protocol (n = 1,257), or mild ovarian stimulation (n = 216).
  
  
  METHODS
  The three ovarian-stimulation protocols described and assisted reproductive technology (ART) treatment (IVF or ICSI, and vitrified ET) in ordinary practice.
  
  
  METHODS
  The main measures were: gestational age, birth weight and length, multiple delivery, early neonatal mortality, and birth defects. Associations were assessed using logistic regression by adjusting for confounding factors.
  
  
  RESULTS
  The final sample included 2,060 live-born infants, corresponding to 1,622 frozen-thawed (FET) cycles, which led to: 587 live-born infants from LPS (458 FET cycles); 1,257 live-born infants from the short protocol (984 FET cycles); and 216 live-born infants from mild ovarian stimulation (180 FET cycles). Birth characteristics regarding gestational age, birth weight and length, multiple delivery, and early neonatal death were comparable in all groups. The incidence of live-birth defects among the LPS group (1.02%) and the short GnRH-a protocol group (0.64%) was slightly higher than in the mild ovarian-stimulation group (0.46%). However, none of these differences reached statistical significance. For congenital malformations, the risk significantly increased for the infertility-duration factor and multiple births; the adjusted odds ratios were 1.161 (95% confidence interval [CI]: 1.009-1.335) and 3.899 (95% CI: 1.179-12.896), respectively. No associations were found between congenital birth defects and various ovarian-stimulation regimens, maternal age, body mass index, parity, insemination method, or infant gender.
  
  
  CONCLUSIONS
  To date, the data do not indicate an elevated rate of abnormality at birth after LPS, but further study with larger populations is needed to confirm these results. However, infertility itself poses a risk factor for congenital malformation. A higher likelihood of birth defects in multiple births may lead couples to favor elective, single ET; couples undertaking ART should be made aware of the known increased birth defects associated with a twin birth.
authors: Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.
authors: Hong
authors: H
authors: Chen
authors: Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.
authors: Yun
authors: Y
authors: Wang
authors: Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.
authors: Qifeng
authors: Q
authors: Lyu
authors: Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.
authors: Ai
authors: A
authors: Ai
authors: Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.
authors: Yonglun
authors: Y
authors: Fu
authors: Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.
authors: Hui
authors: H
authors: Tian
authors: Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.
authors: Renfei
authors: R
authors: Cai
authors: Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.
authors: Qingqing
authors: Q
authors: Hong
authors: Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.
authors: Qiuju
authors: Q
authors: Chen
authors: Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, Israel.
authors: Zeev
authors: Z
authors: Shoham
authors: Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China. Electronic address: Kuangyanp@126.com.
authors: Yanping
authors: Y
authors: Kuang
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D001724:Birth Weight; D016009:Chi-Square Distribution; D002681:China; D000013:Congenital Abnormalities / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D015925:Cryopreservation; D004624:Embryo Transfer / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007246:Infertility / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D050498:Live Birth; D016015:Logistic Models; D008183:Luteal Phase / Q000187:drug effects* / Q000378:metabolism; D016017:Odds Ratio; D010062:Ovulation Induction / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D011247:Pregnancy; D018873:Pregnancy Rate; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020554:Sperm Injections, Intracytoplasmic / Q000009:adverse effects* / Q000401:mortality; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D058989:Vitrification
keywords: Luteal phase ovarian stimulation; congenital malformation; frozen embryo transfer; intracytoplasmic sperm injection; in vitro fertilization; live birth