Complications of medically assisted conception in 3,500 cycles (original) (raw)
1998, Fertility and Sterility
https://doi.org/10.1016/S0015-0282(98)00250-7
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Abstract
Objective: To investigate the incidence of complications in the use of assisted reproductive technology in the management of infertile couples.
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In 2% of assisted reproductive techniques (ART) cycles complications occur. Some are preventable, some are not. In this paper, we will discuss risks and complications of the standard 'Western' approach in ART today and point to some measures to be taken when implementing ART in developing countries, where resources and access to medical care may be limited. Ovarian hyperstimulation syndrome (OHSS, and its thrombo-embolic complications) is responsible for the majority of cycle-related complications, followed by bleeding and infection at oocyte retrieval. ART pregnancies are complicated by first-trimester bleeding more often than spontaneous pregnancies, they are more often ectopic, but the major complication is the very high incidence of multiple pregnancies, when more than one embryo is transferred. OHSS can be prevented by screening patients at risk and by using mild or no stimulation. Simple measures can minimize the risks of bleeding or infection. Obviously single embryo transfer is the only way to avoid multiple pregnancies, which have a highly increased risk for severe maternal and neonatal morbidity and mortality (mainly due to prematurity). Special attention should be given to pre-existing pathologies. Risk minimization of ART in developing countries is not only mandatory from an economical but also an ethical point of view.
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The objectives of this analysis were to describe the characteristics of 1044 urban women who became pregnant through use of fertility assistance (medication, in vitro fertilization (IVF)/ intracytoplasmic sperm injection (ICSI) to natural conceptions and to describe the associated pregnancy and birth outcomes. Women who became pregnant through exclusive use of fertility medications were more likely to be 25 -34 years of age. Those using IVF and/or ICSI were more likely to be over the age of 35. The risk of pregnancy-induced hypertension (22.5%, 10.7%, and 11.1%) and gestational diabetes (2.8%, 0.0%, and 0.5%) was elevated in women who used fertility medications compared to women who used IVF/ICSI and spontaneous conception, respectively. Women who used IVF/ICSI had an elevated risked of premature rupture of the membranes (14.3%) and threatened premature delivery (33.9%). In women giving birth to singletons, the mean birth weight was significantly lower ( p < 0.05) for women who used IVF/ICSI (3091 g) compared to women using fertility medications (3336 g) and spontaneous conception (3373 g). There were increased risks of adverse pregnancy and birth outcomes associated with reproductive assistance, which may relate to maternal characteristics related to infertility and which differ according to the method of conception. D
Registers of in-vitro fertilization and assisted conception
Human Reproduction, 1996
Many countries now have registers of assisted conception that were initially set up to evaluate the effectiveness of treatment, to monitor pregnancy outcomes and the health of treated women, and to assess any immediate risks for the women and their children. World reports, based on information from national registers, have enabled international comparisons of the extent to which the various techniques of assisted conception are used to treat infertile couples, as well as comparisons of pregnancy outcome. The reports also provide comparative data on pregnancy rates in populations rather than in single in-vitro fertilization (FVF) centres. To determine whether newly introduced techniques such as intracytoplasmic sperm injection are associated with any increased risks of birth defects or other adverse outcomes, information notified to registers will often need to be supplemented by clinical reports or by linkage of data in FVF registers and other health data systems. Further efforts to improve the quality of information on assisted conception within each country and internationally need to be well supported so that the effectiveness of treatment and the outcomes of treated couples and their children can be evaluated properly.
JBRA Assisted Reproduction, 2020
Objective: To analyze the epidemiological profile of patients treated at the Fertility Outpatient Clinic of a tertiary public hospital in Juiz de Fora. Methods: This cross-sectional study analyzed the medical records of 448 patients who sought fertility treatment at a tertiary public hospital. The data collected from the medical records were used to assess the main causes of infertility, find the most frequently performed procedures, and the cases eligible to therapeutic or prophylactic intervention. Results: Of the 448 patients included in the study, 385 (86%) sought fertility consultation, 49 (10%) came in for repeated miscarriages, and 14 (3%) for other reasons. Of the 438 infertile patients, 280 (63.9%) had primary and 158 (36.1%) had secondary infertility. The top-three conditions of the 295 patients with established diagnoses were chronic anovulation (n=98; 33%); tubal factor infertility (n=86; 29%); and male factor infertility (n=59; 20%). Conclusions: Improving care in reproductive health requires a more profound comprehension of the epidemiological profile of patients seeking treatment. There are alternative cost-effective means to contain the development of infertility. Additional expenditure in public healthcare is needed to accommodate the growing number of individuals seeking fertility treatment in Brazil.
Outcome of assisted reproduction technology in infertile couples of consanguineous marriage
Journal of Assisted Reproduction and Genetics, 1996
The outcome of pregnancies resulting from assisted reproduction technology does not seem to differ from the outcome of those arising from spontaneous natural conception. Methods: There is increased risk of chromosomal abnormality in spontaneous natural pregnancies resulting from consanguineous marriage, with consequent higher rates of miscarriage, stillbirth, and congenital abnormalities. Results: This study has shown a trend of an increased miscarriage rate (but not statistically significant) in pregnancies achieved in infertile couples of consanguineous marriages by assisted reproductive technology. Conclusions: Selecting embryos for transfer on the basis of their morphology does not appear to reduce the risk of chromosomal abnormality in these couples.
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