Congenital heart defects in IVF/ICSI pregnancy: systematic review and meta-analysis (original) (raw)
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Human Reproduction, 2012
background: While intrauterine insemination (IUI), a simple, inexpensive and non-invasive technique, is the most used assisted reproduction technology (ART) worldwide, the risk of major birth defects following IUI is paradoxically not well documented. methods: Retrospective cohort study performed in Burgundy, France, over a 9-year period which consisted of the cross analysis of two prospective databases, the Burgundy perinatal network database and the database of the assisted conception units in . A total of 1348 ART singletons [in vitro fertilization technologies (IVFT): n ¼ 903; IUI: n ¼ 445] matched with 4044 infants conceived naturally, 552 ART twins (IVFT: n ¼ 362; IUI: n ¼ 190) matched with 1656 twins who were conceived naturally. The major birth defects were categorized according to the European Surveillance of Congenital Anomalies classification EUROCAT.
Outcome of pregnancies derived from assisted reproductive technologies: IVF versus ICSI
Journal of assisted reproduction and genetics, 2000
To compare the course and outcome of in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) pregnancies. A retrospective study was conducted in a university-affiliated IVF unit with 200 patients who conceived in 1996-1997, 100 with ICSI and 100 with IVF. Data were retrieved from our prospectively created computerized database. In addition, all patients were interviewed by telephone, and the interviewing physician completed a detailed questionnaire. Findings for the IVF and ICSI pregnancies were compared. The main outcome measures were maternal age, implantation rate, early pregnancy complications, clinical abortion rate, multiple pregnancy delivery rate, gestational age at delivery, mode of delivery, and birth weight. In all, 238 children were born, including 104 singleton infants (45 IVF, 59 ICSI), 49 twin pairs (28 IVF, 21 ICSI), and 12 triplet sets (3 IVF, 9 ICSI). Statistically significant differences between the ICSI and IVF groups were noted for maternal age ...
Obstetric outcome and incidence of congenital anomalies in 2351 IVF/ICSI babies
Journal of Assisted Reproduction and Genetics, 2016
The aim of this study was to provide a comprehensive follow-up of fetal and perinatal outcome and the incidence of congenital anomalies in babies born after fresh embryo transfers compared to those conceived spontaneously in infertile couples. Methods Retrospective comparative analysis of all clinical pregnancies from fresh cleavage-stage embryo transfer cycles (IVF and ICSI) compared with infertile patients who conceived spontaneously in the same time period (control). Congenital anomalies were classified following the European Surveillance of Congenital Anomalies (EUROCAT) classification. Results A total of 2414 assisted reproductive technology (ART) pregnancies were compared to 582 spontaneous conceptions in the control infertile group representing 2306 deliveries. No significant differences were found in pregnancy outcome between the two groups (delivery rate, abortion rate, ectopic pregnancies, medical abortions for fetal anomalies, single and twins mean gestational age, and weight at delivery). A significant difference (p < 0.001) was found in the twin (21.3 vs 2.3 %) and triplet rates (2.3 vs 0 %). A total of 2351 babies were delivered in the ART group and 449 in the control group. A total of 90 babies (3.8 %) were diagnosed with a major congenital anomaly in the ART group and 15 (3.3 %) in the control group (p = ns). The overall rate of major congenital anomalies (105/2800) in ART and spontaneous pregnancies in infertile couples was significantly higher when compared to the EUROCAT 2.0 versus 3.75 % (p = 0.0002). Discussion Babies born after ART treatments and from spontaneous conception in infertile couples had rates of congenital anomalies higher than those recorded by the EUROCAT. However, the rates of anomalies were not different within the infertile population whether conceived by ART or spontaneously. These data suggest that the diagnosis of infertility in itself is the common denominator for the increase in the rates of anomalies seen in both ART and spontaneous conceptions.
Human Reproduction, 2002
BACKGROUND: To evaluate the safety of ICSI, this study compared data of IVF and ICSI children by collecting data on neonatal outcome and congenital malformations during pregnancy and at birth. METHODS: The followup study included agreement to genetic counselling and eventual prenatal diagnosis, followed by a physical examination of the children after 2 months, after 1 year and after 2 years. 2840 ICSI children (1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999) and 2955 IVF children (1983)(1984)(1985)(1986)(1987)(1988)(1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997)(1998)(1999) were liveborn after replacement of fresh embryos. ICSI was carried out using ejaculated, epididymal or testicular sperm. RESULTS: In the two cohorts, similar rates of multiple pregnancies were observed. ICSI and IVF maternal characteristics were comparable for medication taken during pregnancy, pregnancy duration and maternal educational level, whereas maternal age was higher in ICSI and a higher percentage of first pregnancies and first children born was observed in the ICSI mothers. Birthweight, number of neonatal complications, low birthweight, stillbirth rate and perinatal death rate were compared between the ICSI and the IVF groups and were similar for ICSI and IVF. Prematurity was slightly higher in the ICSI children (31.8%) than in the IVF children (29.3%). Very low birthweight was higher in the IVF pregnancies (5.7%) compared with ICSI pregnancies (4.4%). Major malformations (defined as those causing functional impairment or requiring surgical correction), were observed at birth in 3.4% of the ICSI liveborn children and in 3.8% of the IVF children (P ⍧ 0.538). Malformation rate in ICSI was not related to sperm origin or sperm quality. The number of stillbirths (born ≥20 weeks of pregnancy) was 1.69% in the ICSI group and 1.31% in the IVF group. Total malformation rate taking into account major malformations in stillborns, in terminations and in liveborns was 4.2% in ICSI and 4.6% in IVF (P ⍧ 0.482). CONCLUSIONS: The comparison of ICSI and IVF children taking part in an identical follow-up study did not show any increased risk of major malformations and neonatal complications in the ICSI group.
JBRA assisted reproduction, 2017
Since 1992, the development of intra-cytoplasmic sperm injection (ICSI) has allowed infertile couples and couples affected by severe male factor infertility in particular, many of which with a history of failed traditional IVF, to become parents. This has generated considerable controversy over the safety of the procedure for the offspring. This systematic review seeks to determine whether evidence indicates that the use of ICSI increases the risk of congenital malformation in children born from singleton pregnancies versus naturally conceived children. Twenty-one of the 104 publications listed in the literature search were included in the analysis. Observational studies reported mostly an increased risk for congenital malformation; the risk of congenital malformations is 7.1% in ICSI and 4.0% in the general population (OR 1.99 (95% CI [1.87 - 2.11]). However, attributing higher risk solely to ICSI might seem far-fetched, as in vitro and simulation procedures, patient diseases, and ...
In vitro fertilization is associated with an increase in major birth defects
Fertility and Sterility, 2005
Objective: To determine the risk of major birth defects in cohorts of children conceived through IVF or through IUI as compared with naturally conceived children. Design: Retrospective cohort study. Setting: Academic medical center. Patient(s): Children conceived by IVF or IUI at the University of Iowa from 1989 through 2002, compared with a matched cohort of naturally conceived children. Intervention(s): None. Main Outcome Measure(s): Outcome data were obtained from Iowa state birth and fetal death certificates and from the Iowa Birth Defects Registry. Result(s): Ninety of 1,462 IVF-conceived children (6.2%) and 17 of 343 IUI-conceived children (5.0%) had a major birth defect, compared with 369 of 8,422 naturally conceived children (4.4%). The adjusted odds ratio of a major birth defect in all IVF-conceived children was 1.30 (95% confidence interval [CI] 1.00-1.67) and 1.11 (95% CI 0.67-1.84) for IUI-conceived children. The birth defect rate was increased after IVF when the analysis was limited to term singletons. Cardiovascular and musculoskeletal defects and known birth defect syndromes were increased after IVF. Among IVF-conceived children, there was no difference in birth defect rates after intracytoplasmic sperm injection (ICSI) or after transfer of cryopreserved embryos. Conclusion(s): Infants conceived through IVF have a slightly higher rate of major birth defects. More birth defects are noted among children born to infertile couples treated with IUI, although this difference is not statistically significant. Larger studies of infants conceived by infertile couples after all types of infertility treatment are needed to definitively determine whether the increased risk of birth defects is secondary to problems inherent in the infertile couple and/or factors associated with some aspect of the treatment.
Health outcomes of children born after IVF/ICSI: a review of current expert opinion and literature
Reproductive BioMedicine Online, 2014
The Sixth Evian Annual Reproduction (EVAR) Workshop Group Meeting was held to evaluate the impact of IVF/intracytoplasmic sperm injection on the health of assistedconception children. Epidemiologists, reproductive endocrinologists, embryologists and geneticists presented data from published literature and ongoing research on the incidence of genetic and epigenetic abnormalities and congenital malformations in assisted-conception versus naturally conceived children to reach a consensus on the reasons for potential differences in outcomes between these two groups. IVFconceived children have lower birthweights and higher peripheral fat, blood pressure and fasting glucose concentrations than controls. Growth, development and cognitive function in assisted-conception children are similar to controls. The absolute risk of imprinting disorders after assisted reproduction is less than 1%. A direct link between assisted reproduction and health-related outcomes in assisted-conception children could not be established. Women undergoing assisted reproduction are often older, increasing the chances of obtaining abnormal gametes that may cause deviations in outcomes between assisted-conception and naturally conceived children. However, after taking into account these factors, it is not clear to what extent poorer outcomes are due to the assisted reproduction procedures themselves. Large-scale, multicentre, prospective epidemiological studies are needed to investigate this further and to confirm long-term health consequences in assisted-conception children.
Risk of birth defects increased in pregnancies conceived by assisted human reproduction
Fertility and Sterility, 2009
Objective: To assess the risk of birth defects in infants born after assisted human reproduction (AHR). Design: Retrospective cohort study. Setting: Niday Perinatal Database for the province of Ontario, 82 sites, both primary and tertiary centers. Patient(s): In 2005, information about reproductive assistance was reported for 61,569 deliveries. Intervention(s): The prevalence of birth defects diagnosed in the prenatal period or at birth was estimated for all types of AHR together and then by type of procedure. Main Outcome Measure(s): The excess risks of birth defects by AHR were calculated by unconditional logistic regressions using spontaneously conceived pregnancies as the reference and were expressed by odds ratio and 95% confidence intervals and adjusted for maternal age, smoking, infant gender, gestation, and parity. Result(s): The prevalence of birth defects with AHR procedures was 2.91%, which was 1.55-fold higher (95% confidence interval [CI], 1.03-2.38) than in the non-AHR population (1.86%). Specific anomalies that increased with AHR were gastrointestinal (odds ratio [OR], 9.85; 95% CI, 3.44-28.44), cardiovascular (OR, 2.30; 95% CI, 1.11-4.77), and musculoskeletal defects (OR, 1.54; 95% CI, 0.48-4.94). The risks of birth defects by types of AHR were 2.35% for ovulation induction, 2.89% for IUI, and 3.45% for IVF. Conclusion(s): There is a significant increased risk of birth defects associated with AHR, and the risk is higher in IVF and IUI. The potential risk of anomalies associated with AHR may be considered in the counseling that is offered to infertile couples. (Fertil Steril Ò 2009;92:1557-61.
Maternal and Fetal Outcomes in Pregnancies Conceived with In-Vitro Fertilization
Journal of Bahria University Medical and Dental College, 2015
Objective: To assess the outcome of pregnancies conceived by in vitro fertilization. Materials and Methods: A retrospective study utilizing case notes of 110 cases of in vitro fertilization (IVF) delivered in East Sussex Hospital Trust (ESHT)was carried out from 2010 to 2011 in two district general hospitals, Eastbourne and Conquest hospital that come under ESHT. All cases with IVF during these two years were included. Demographic details, predisposing risk factors, body mass index, causes of infertility, antenatal care, onset of labour, mode of delivery and details of baby were collected and analysed. Results: Infertility was female related in 46% and male related in 38%. In females tubal factor was the main cause. 18% had pre-existing medical conditions, polycystic ovaries being the commonest. 75% had singleton pregnancy and 25% twin's .Nearly 6% had antepartum haemorrhage, twins having higher (11%) rates compared to singleton pregnancy (3.6%). The incidence of pregnancy induced hypertension and diabetes were the same being more in twin compared to singleton pregnancy .There were 8.4% singleton preterm deliveries. The singleton babies born with weight of less than 2500 gms were 4.8%. There were 2 (1.8%) stillbirths. 3.6% babies had congenital abnormality. In 42 % mode of delivery was caesarean section. Conclusion: Majority ofchildren born following IVF had a good outcome but increased risk of obstetrics and fetal complications was found when compared to spontaneously conceived pregnancies. Multiple births remain a major cause of morbidity among infertility patients