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Pontesilli M, Hof MH, Ravelli ACJ, van Altena AJ, Soufan AT, Mol BW, Kostelijk EH, Slappendel E, Consten D, Cantineau AEP, van der Westerlaken LAJ, van Inzen W, Dumoulin JCM, Ramos L, Baart EB, Broekmans FJM, Rijnders PM, Curfs MHJM, Mastenbroek S, Repping S, Roseboom TJ, Painter RC. Effect of parental and ART treatment characteristics on perinatal outcomes. Hum Reprod 2021; 36:1640-1665. [PMID: 33860303 PMCID: PMC8129595 DOI: 10.1093/humrep/deab008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 12/14/2020] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Do parental characteristics and treatment with ART affect perinatal outcomes in singleton pregnancies? SUMMARY ANSWER Both parental and ART treatment characteristics affect perinatal outcomes in singleton pregnancies. WHAT IS KNOWN ALREADY Previous studies have shown that singleton pregnancies resulting from ART are at risk of preterm birth. ART children are lighter at birth after correction for duration of gestation and at increased risk of congenital abnormalities compared to naturally conceived children. This association is confounded by parental characteristics that are also known to affect perinatal outcomes. It is unclear to which extent parental and ART treatment characteristics independently affect perinatal outcomes. STUDY DESIGN, SIZE, DURATION All IVF clinics in the Netherlands (n = 13) were requested to provide data on all ART treatment cycles (IVF, ICSI and frozen-thawed embryo transfers (FET)), performed between 1 January 2000, and 1 January 2011, which resulted in a pregnancy. Using probabilistic data-linkage, these data (n = 36 683) were linked to the Dutch Perinatal Registry (Perined), which includes all children born in the Netherlands in the same time period (n = 2 548 977). PARTICIPANTS/MATERIALS, SETTING, METHODS Analyses were limited to singleton pregnancies that resulted from IVF, ICSI or FET cycles. Multivariable models for linear and logistic regression were fitted including parental characteristics as well as ART treatment characteristics. Analyses were performed separately for fresh cycles and for fresh and FET cycles combined. We assessed the impact on the following perinatal outcomes: birth weight, preterm birth below 37 or 32 weeks of gestation, congenital malformations and perinatal mortality. MAIN RESULTS AND THE ROLE OF CHANCE The perinatal outcomes of 31 184 out of the 36 683 ART treatment cycles leading to a pregnancy were retrieved through linkage with the Perined (85% linkage). Of those, 23 671 concerned singleton pregnancies resulting from IVF, ICSI or FET. Birth weight was independently associated with both parental and ART treatment characteristics. Characteristics associated with lower birth weight included maternal hypertensive disease, non-Dutch maternal ethnicity, nulliparity, increasing duration of subfertility, hCG for luteal phase support (compared to progesterone), shorter embryo culture duration, increasing number of oocytes retrieved and fresh embryo transfer. The parental characteristic with the greatest effect size on birth weight was maternal diabetes (adjusted difference 283 g, 95% CI 228–338). FET was the ART treatment characteristic with the greatest effect size on birth weight (adjusted difference 100 g, 95% CI 84–117) compared to fresh embryo transfer. Preterm birth was more common among mothers of South-Asian ethnicity. Preterm birth was less common among multiparous women and women with ‘male factor’ as treatment indication (compared to ‘tubal factor’). LIMITATIONS, REASONS FOR CAUTION Due to the retrospective nature of our study, we cannot prove causality. Further limitations of our study were the inability to adjust for mothers giving birth more than once in our dataset, missing values for several variables and limited information on parental lifestyle and general health. WIDER IMPLICATIONS OF THE FINDINGS Multiple parental and ART treatment characteristics affect perinatal outcomes, with birth weight being influenced by the widest range of factors. This highlights the importance of assessing both parental and ART treatment characteristics in studies that focus on the health of ART-offspring, with the purpose of modifying these factors where possible. Our results further support the hypothesis that the embryo is sensitive to its early environment. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by Foreest Medical School, Alkmaar, the Netherlands (grants: FIO 1307 and FIO 1505). B.W.M. reports grants from NHMRC and consultancy for ObsEva, Merck KGaA, iGenomics and Guerbet. F.B. reports research support grants from Merck Serono and personal fees from Merck Serono. A.C. reports travel support from Ferring BV. and Theramex BV. and personal fees from UpToDate (Hyperthecosis), all outside the remit of the current work. The remaining authors report no conflict of interests. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- M Pontesilli
- Department of Obstetrics and Gynaecology, Northwest Clinics, Alkmaar, The Netherlands.,Department of Clinical Epidemiology Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - M H Hof
- Department of Clinical Epidemiology Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - A C J Ravelli
- Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.,Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - A J van Altena
- Department of Clinical Epidemiology Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - A T Soufan
- Center for Reproductive Medicine, Amsterdam Reproduction & Development Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - B W Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - E H Kostelijk
- Center for Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - E Slappendel
- Center for Reproductive Medicine, Nij Geertgen Clinic, Elsendorp, The Netherlands
| | - D Consten
- Center for Reproductive Medicine, St. Elisabeth Hospital, Tilburg, The Netherlands
| | - A E P Cantineau
- Center for Reproductive Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - W van Inzen
- Center for Reproductive Medicine, IVF Center Medisch Centrum Kinderwens, Leiderdorp, The Netherlands
| | - J C M Dumoulin
- Department of Obstetrics and Gynaecology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, The Netherlands
| | - L Ramos
- Center for Reproductive Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - E B Baart
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - F J M Broekmans
- Center for Reproductive Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P M Rijnders
- Center for Reproductive Medicine, Reinier de Graaf Hospital, Delft, The Netherlands
| | - M H J M Curfs
- Center for Reproductive Medicine, Isala, Zwolle, The Netherlands
| | - S Mastenbroek
- Center for Reproductive Medicine, Amsterdam Reproduction & Development Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - S Repping
- Center for Reproductive Medicine, Amsterdam Reproduction & Development Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - T J Roseboom
- Department of Clinical Epidemiology Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.,Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - R C Painter
- Department of Obstetrics and Gynaecology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
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MacKenna A, Schwarze JE, Crosby J, Zegers-Hochschild F. Factors associated with embryo splitting and clinical outcome of monozygotic twins in pregnancies after IVF and ICSI. Hum Reprod Open 2020; 2020:hoaa024. [PMID: 32432173 PMCID: PMC7225016 DOI: 10.1093/hropen/hoaa024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 03/18/2020] [Indexed: 11/15/2022] Open
Affiliation(s)
- A MacKenna
- Unit of Reproductive Medicine, Clinica Las Condes, Lo Fontecilla 441, 7591046, Santiago, Chile
| | - J E Schwarze
- Unit of Reproductive Medicine, Clinica Las Condes, Lo Fontecilla 441, 7591046, Santiago, Chile
| | - J Crosby
- Unit of Reproductive Medicine, Clinica Las Condes, Lo Fontecilla 441, 7591046, Santiago, Chile
| | - F Zegers-Hochschild
- Unit of Reproductive Medicine, Clinica Las Condes, Lo Fontecilla 441, 7591046, Santiago, Chile.,Program of Ethics and Public Policies in Human Reproduction, Universidad Diego Portales, Ejercito 250, 8370056, Santiago, Chile
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Ferraretti AP, Nygren K, Andersen AN, de Mouzon J, Kupka M, Calhaz-Jorge C, Wyns C, Gianaroli L, Goossens V. Trends over 15 years in ART in Europe: an analysis of 6 million cycles. Hum Reprod Open 2017; 2017:hox012. [PMID: 31486803 PMCID: PMC6276702 DOI: 10.1093/hropen/hox012] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 06/21/2017] [Accepted: 07/26/2017] [Indexed: 11/25/2022] Open
Abstract
Study question Was the European IVF Monitoring (EIM) Consortium, established in 1999 by ESHRE, able to monitor the trend over time of ART in Europe? Summary answer The initial aims of the EIM programme (to collect and publish regional European data on census and trends on ART utilization, effectiveness, safety and quality) have been achieved. What is already known ART data in Europe have been collected and reported annually in Human Reproduction. Study design, size, duration A retrospective data analysis and summary of the first 15 years of ART activity in Europe (1997–2011) was carried out, using the key figures from the annual ESHRE reports and focusing on how the practice of ART has evolved over the years. Participants/materials, setting, method A total of 5 919 320 ART cycles are reported, including IVF, ICSI, frozen embryo relacment and egg donation, resulting in the birth of more than 1 million infants. A total of 1 548 967 IUIs are also reported, including husband/partner’s semen and donor semen cycles. The most relevant and complete data are analysed and discussed. Main results and the role of chance With some fluctuations, the number of countries and clinics reporting to EIM increases significantly from 1997 to 2011. A constant increase was also registered in the number of annual cycles reported. Since 2005, the estimation of the EIM coverage on the total European activity was >80%. In countries with 100% of coverage, the mean availability of ART increased from 765 cycles per million inhabitants in 1997 to 1269 cycles per million inhabitants in 2011, and the proportion of ART infants of the total number of infants born in the country increased from 1.3% to 2.4%. The proportion of women aged > 39 years undergoing IVF and ICSI cycles gradually increased. For 12 consecutive years, the proportion of ICSI versus IVF cycles showed a marked increase before reaching a plateau from 2008. The proportion of transfers with three or more embryos decreased constantly and the proportion of SETs increased over the time period. The triplets deliveries were reduced from 3.7% in 1997 to less than 1% since 2005 (0.6% in 2011). The effectiveness (evaluated as clinical pregnancy rate per aspiration and per embryo transfer) increased until 2007, then the figure remained stable. The cumulative percentage of documented pregnancy losses was 17%. No differences have been noted in terms of outcomes in the IUI cycles. Limitations, reasons for caution The data presented are accumulated from countries with different collection systems, regulations, insurance coverage and different practices. Each year a number of countries have been unable to provide some of the data. Wider implications of the finding(s) The first summary of 15 years of the EIM reports offers interesting data on census and trends on ART utilization, safety and quality in Europe. The primary aim of the ESHRE effort in supporting European data collection has been reached. Owing to its importance inside and outside the professional community, European data collection and publication on ART have to be supported and implemented. Study funding/competing interest(s) None.
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Affiliation(s)
- A P Ferraretti
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | - K Nygren
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | | | - J de Mouzon
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | - M Kupka
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | - C Calhaz-Jorge
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | - C Wyns
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | - L Gianaroli
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
| | - V Goossens
- ESHRE Central Office, Meerstraat 60, Grimbergen B-1852, Belgium
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