Infertility, Assisted Reproductive Technology, and Adverse Pregnancy Outcomes

TLDR

ART pregnancies carry higher risks of adverse outcomes, including increased rates of multiple gestations, prematurity, small for gestational age infants, and maternal complications such as preeclampsia and gestational diabetes. The workshop aimed to summarize ART‑related pregnancy risks, create a counseling framework for couples, and set a research agenda. Experts convened in a National Institute of Child Health and Human Development workshop to review evidence, identify knowledge gaps, and outline basic science, clinical, and epidemiologic studies needed. The workshop identified significant gaps in knowledge and proposed a research agenda to address them.

Abstract

In Brief The National Institute of Child Health and Human Development held a workshop on September 12–13, 2005, to summarize the risks for adverse pregnancy outcomes after assisted reproductive technology (ART), develop an approach to counseling couples regarding these risks, and establish a research agenda. Although the majority of ART children are normal, there are concerns about the increased risk for adverse pregnancy outcomes. More than 30% of ART pregnancies are twins or higher-order multiple gestations (triplets or greater) and more than one half of all ART neonates are the products of multifetal gestations, with an attendant increase in prematurity complications. Assisted reproductive technology singleton pregnancies also demonstrate increased rates of perinatal complications—small for gestational age infants, preterm delivery, and perinatal mortality—as well as maternal complications, such as preeclampsia, gestational diabetes, placenta previa, placental abruption, and cesarean delivery. Although it is not possible to separate ART-related risks from those secondary to the underlying reproductive pathology, the overall increased frequency of obstetric complications, including preterm birth and small for gestational age neonates, should be discussed with the couple. Significant gaps in knowledge were identified, and the basic science and clinical and epidemiologic research required to address these gaps is outlined. Experts reviewed the evidence for adverse pregnancy outcomes associated with infertility and assisted reproductive technology.