title: Ovulatory disorders are an independent risk factor for pregnancy complications in women receiving assisted reproduction treatments.
abstract: BACKGROUND
  Conception using assisted reproduction treatments (ART) has been associated with an increased risk of pregnancy complications. It is uncertain if this is caused by ART directly, or is an association of the underlying factors causing infertility.
  
  
  OBJECTIVE
  We assessed the relationship between assisted conception (AC) and maternal or fetal complications in a large retrospective cohort study. In a nested cohort of women receiving infertility treatment, we determined if such risk rests predominantly with certain causes of infertility.
  
  
  METHODS
  Retrospective database analysis of 50 381 women delivering a singleton pregnancy in four public hospital obstetric units in western Sydney, and a nested cohort of 508 women receiving ART at a single fertility centre, in whom the cause of infertility was known.
  
  
  RESULTS
  A total of 1727 pregnancies followed AC; 48 654 were spontaneous conceptions. Adjusted for age, body mass index and smoking, AC was associated with increased risk of preterm delivery (OR 1.73, 95% CI 1.50-2.02), hypertension (OR 1.55, 95% CI 1.34-1.82) and diabetes (OR 1.51, 95% CI 1.30-1.75). In the nested cohort, ovulatory dysfunction was present in 145 women and 336 had infertility despite normal ovulatory function. Ovulatory dysfunction was associated with increased risk of diabetes (OR 2.94, 95% CI 1.72-5.02) and hypertension (OR 2.40, 95% CI 1.15-5.00) compared to women with normal ovulatory function.
  
  
  CONCLUSIONS
  Assisted conception is associated with increased risk of pregnancy complications. This risk appears greatest for women whose underlying infertility involves ovulatory dysfunction. Such disorders probably predispose towards diabetes and hypertension, which is then exacerbated by pregnancy.
authors.affiliation: Westmead Hospital, Westmead, NSW, Australia.|School of Medicine, Western Sydney University, Campbelltown, Australia.
authors.forename: Sumita
authors.initials: S
authors.lastname: Barua
authors.affiliation: Blacktown Hospital, Blacktown, NSW, Australia.
authors.forename: Tien-Ming
authors.initials: TM
authors.lastname: Hng
authors.affiliation: Westmead Hospital, Westmead, NSW, Australia.
authors.forename: Howard
authors.initials: H
authors.lastname: Smith
authors.affiliation: Blacktown Hospital, Blacktown, NSW, Australia.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Bradford
authors.affiliation: School of Medicine, Western Sydney University, Campbelltown, Australia.|Blacktown Hospital, Blacktown, NSW, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: McLean
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D007247:Infertility, Female / Q000503:physiopathology*; D009517:New South Wales / Q000453:epidemiology; D010060:Ovulation / Q000502:physiology*; D011247:Pregnancy; D047928:Premature Birth / Q000453:epidemiology*; D027724:Reproductive Techniques, Assisted; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
keywords: assisted reproduction; gestational diabetes; hypertension; infertility