Risk of maternal morbidity in IVF and non-IVF births: a US study in five states

OBJECTIVE: To evaluate the risk of maternal morbidity due to IVF, plurality, and maternal age. DESIGN: Longitudinal case-control cohort study MATERIALS AND METHODS: IVF cycles from the Society for Assisted Reproductive Technology Clinic Online Reporting System were linked to birth certificates of singletons and twins in CA (2004-09), and PA, MI, NY, TX (2004-10) (IVF births); a 10:1 sample of non-IVF births were controls. Maternal morbidity was identified from six items on the birth certificate (see below). Using logistic regression, the risk of each morbidity was modeled by maternal age, IVF versus non-IVF conception, and plurality (twin versus singleton), separately for each mode of delivery. Parity was included in the model for perineal laceration. RESULTS: The study population included 53,053 IVF births (37,193 singletons and 15,860 twin births) and 576,880 non-IVF control births (567,856 singletons and 9,024 twin births). Regardless of mode of delivery, older maternal age was associated with an increased risk of unplanned hysterectomy and unplanned operations; twin pregnancy with blood transfusion, admission to intensive care, and unplanned operations; and IVF pregnancy with blood transfusion. Women with vaginal IVF births were at increased risk for unplanned hysterectomy, unplanned operations, and 3rd or 4th degree perineal lacerations. Cesarean twin births were at increased risk of unplanned hysterectomy. CONCLUSIONS: The risks of maternal morbidity at delivery are increased with IVF, twin pregnancy, and older maternal age. (Table Presented).