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. 2024 Apr;41(4):915-928.
doi: 10.1007/s10815-024-03060-6. Epub 2024 Mar 12.

Ovulation induction and subfertile untreated conception groups offer improved options for interpreting risks associated with ART

Michele Hansen  1 , Roger J Hart  2   3 , Elizabeth Milne  4 , Carol Bower  4 , Melanie L Walls  2   3 , John L Yovich  5   6 , Peter Burton  7 , Yanhe Liu  8   9 , Hamish Barblett  10 , Anna Kemp-Casey  11
Affiliations

Ovulation induction and subfertile untreated conception groups offer improved options for interpreting risks associated with ART

Michele Hansen et al. J Assist Reprod Genet. 2024 Apr.

Abstract

Purpose: To identify and characterise appropriate comparison groups for population studies of health outcomes in ART-conceived births: ovulation induction (OI), subfertile untreated and fertile natural conceptions. Our secondary objective was to examine whether known risks of pregnancy complications and adverse birth outcomes in ART births are elevated in comparison with subfertile (untreated and OI) conception groups.

Methods: We linked State and Commonwealth datasets to identify all live and stillbirths (≥ 20 weeks) in Western Australia from 2003 to 2014 by method of conception. Demographic characteristics, maternal pre-existing conditions, adverse obstetric history and pregnancy complications were compared across conception groups. Generalised estimating equations were used to estimate adjusted risk ratios (aRRs) and 95% confidence intervals (CI) for pregnancy complications and birth outcomes in singletons.

Results: We identified 9456 ART, 3870 OI, 11,484 subfertile untreated and 303,921 fertile naturally conceived deliveries. OI and subfertile untreated groups more closely resembled the ART group than the fertile group; however, some differences remained across parity, maternal age, pre-existing conditions and obstetric history. In multivariate analyses, ART singletons had greater risks of placental problems (e.g. placenta praevia aRR 2.42 (95% CI 1.82-3.20)) and adverse birth outcomes (e.g. preterm birth aRR 1.38 (95% CI 1.25-1.52)) than the subfertile untreated group, while OI singletons were more similar to the subfertile group with higher risk of preeclampsia and gestational diabetes.

Conclusion: OI and subfertile untreated conception groups offer improved options for interpreting health outcomes in ART births. Pregnancy complications (particularly placental disorders) and adverse outcomes at delivery are more common following ART.

Keywords: ART outcomes; Assisted reproductive technology; IVF; Ovulation induction; Subfertility.

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Conflict of interest statement

Professor Hart is the Medical Director of Fertility Specialists of Western Australia and National Medical Director of City Fertility Clinic, a shareholder in CHA SMG; he has received educational sponsorship from MSD, Merck-Serono, Origio, Igenomix and Ferring Pharmaceuticals; Adjunct Clinical Professor John Yovich was the Medical Director and a shareholder in PIVET Medical Centre, recently acquired by Monash IVF (2023). The other authors have no competing interests to disclose.

Figures

Fig. 1
Fig. 1
Data sources used to identify conception groups. Ovulation induction (OI) conceptions are those with OI medication dispensed within the relevant time period prior to last menstrual period (LMP). ART conceptions are those that linked to an ART cycle on the Reproductive Technology Register (RTR). Subfertile untreated conceptions are deliveries with any of the following in the 5 years prior to birth—ART cycle on RTR, fertility treatment flag associated with a previous birth in Midwives’ data, infertility diagnosis in hospital data. Fertile natural conceptions represent all other births
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References

    1. Qin J, Liu X, Sheng X, Wang H, Gao S. Assisted reproductive technology and the risk of pregnancy-related complications and adverse pregnancy outcomes in singleton pregnancies: a meta-analysis of cohort studies. Fertil Steril. 2016;105(73–85):e1–6. - PubMed
    1. Qin JB, Wang H, Sheng X, Xie Q, Gao S. Assisted reproductive technology and risk of adverse obstetric outcomes in dichorionic twin pregnancies: a systematic review and meta-analysis. Fertil Steril. 2016;105:1180–1192. doi: 10.1016/j.fertnstert.2015.12.131. - DOI - PubMed
    1. Bosdou JK, Anagnostis P, Goulis DG, Lainas GT, Tarlatzis BC, Grimbizis GF, et al. Risk of gestational diabetes mellitus in women achieving singleton pregnancy spontaneously or after ART: a systematic review and meta-analysis. Hum Reprod Update. 2020;26:514–544. doi: 10.1093/humupd/dmaa011. - DOI - PMC - PubMed
    1. Vermey BG, Buchanan A, Chambers GM, Kolibianakis EM, Bosdou J, Chapman MG, et al. Are singleton pregnancies after assisted reproduction technology (ART) associated with a higher risk of placental anomalies compared with non-ART singleton pregnancies? A Syst Rev Meta-anal BJOG. 2019;126:209–218. - PubMed
    1. Sarmon KG, Eliasen T, Knudsen UB, Bay B. Assisted reproductive technologies and the risk of stillbirth in singleton pregnancies: a systematic review and meta-analysis. Fertil Steril. 2021;116:784–792. doi: 10.1016/j.fertnstert.2021.04.007. - DOI - PubMed