Purpose: To evaluate the risk of prematurity and infant mortality by maternal fertility status, and for in vitro fertilization (IVF) pregnancies, by oocyte source and embryo state combinations. Methods: Women in 14 States who had IVF-conceived live births during 2004–13 were linked to their infant’s birth and death certificates; a 10:1 sample of non-IVF births was selected for comparison; those with an indication of infertility treatment on the birth certificate were categorized as subfertile, all others were categorized as fertile. Risks were modeled separately for the fertile/subfertile/IVF (autologous-fresh only) group and for the IVF group by oocyte source-embryo state combinations, using logistic regression, and reported as adjusted odds ratios (AORs) and 95% confidence intervals (CI). Results: The study population included 2,474,195 pregnancies. Placental complications (placenta previa, abruptio placenta, and other excessive bleeding) and prematurity were both increased with pregestational and gestational diabetes and hypertension, among subfertile and IVF groups, and in IVF pregnancies using donor oocytes. Both subfertile and IVF pregnancies were at risk for prematurity and NICU admission; IVF infants were also at risk for small-for-gestation birthweight, and subfertile infants had greater risks for neonatal and infant death. Within the IVF group, pregnancies with donor oocytes and/or thawed embryos were at greater risk of large-for-gestation birthweight, and pregnancies with thawed embryos were at greater risk of neonatal and infant death. Conclusions: Prematurity was associated with placental complications, diabetes and hypertension, subfertility and IVF groups, and in IVF pregnancies, donor oocytes and/or thawed embryos.
Bibliographical noteFunding Information:
This study involved linking data from the national IVF database, the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS), to birth certificates as part of a larger study in 14 States on assisted reproductive technology (ART) and risk of childhood cancer (NIH grant R01 CA151973). The data for this analysis was limited to live births (≥ 22 weeks’ gestation and ≥ 300 g birthweight). Two comparison groups were identified. First, women classified as fertile, subfertile, and IVF-treated (limited to autologous oocytes-fresh embryos [autologous-fresh]) were compared, with fertile women as the reference group (fertile and subfertile are defined in the birth certificate section below). Second, within the IVF-treated population, women were categorized by oocyte source-embryo state combinations (autologous-fresh, autologous-thawed, donor-fresh, and donor-thawed) used in their IVF cycle, with women using autologous-fresh cycles as the reference group.
Source of funding The project described was supported by grant R01CA151973 from the National Cancer Institute. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health, nor any of the State Departments of Health which contributed data.
The authors wish to thank SART and all of its members for providing clinical information to the SART CORS database for use by patients and researchers. Without the efforts of their members, this research would not have been possible. The authors also gratefully acknowledge the following State agencies for their assistance in conducting this study: California Department of Public Health, Office of Health Information and Research Colorado Department of Public Health and Environment Connecticut Department of Public Health Florida Department of Health Illinois Department of Public Health Massachusetts Department of Public Health Michigan Department of Health and Human Services, Division for Vital Records and Health Statistics New Jersey Department of Health New York City Department of Health and Mental Hygiene, Bureau of Vital Statistics New York State Department of Health, Bureau of Health Informatics, Vital Statistics Unit North Carolina Department of Health Ohio Department of Health, Bureau of Vital Statistics Pennsylvania Department of Health, Bureau of Health Statistics and Research Texas Department of State Health Services, Center for Health Statistics Virginia Department of Health. The project described was supported by grant R01CA151973 from the National Cancer Institute. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health, nor any of the State Departments of Health which contributed data.
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- Embryo state
- Fertility status
- Infant morbidity
- Infant mortality
- Oocyte source
- Placental complications