Is infertility treatment linked with risk of pregnancy complications?

  • Dayan N & al.
  • CMAJ

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • The risk for severe maternal morbidity or death was modestly increased among women whose pregnancy was achieved by infertility treatment, especially in vitro fertilisation.
  • Women undergoing non-invasive infertility treatment, such as intrauterine insemination, were not at increased risk.

Why this matters

  • Although infertility treatment improves the chances of pregnancy among infertile couples, there is no clarity if women who conceived using infertility treatment have more indicators of severe maternal morbidity.

Study design

  • Cohort study used data from population-based registries (Ontario) between 2006 and 2012.
  • Pregnancies achieved by fertility treatment (n=11,546; invasive: n=5974 and non-invasive treatment: n=5572) were compared with unassisted pregnancies (n=47,553) using propensity score matching.
  • Primary outcome: occurrence of composite severe morbidity or mortality between 20 weeks' gestation and 42 days postpartum.
  • Funding: Canadian Institutes of Health Research.

Key results

  • Severe maternal morbidity or death occurred in 356 pregnancies resulting from infertility treatment (30.8 per 1000 deliveries) vs 1054 untreated pregnancies (22.2 per 1000 deliveries) (adjusted relative risk [aRR], 1.39; 95% CI, 1.23-1.56). 
  • Compared with untreated pregnancies, severe maternal morbidity or death occurred in 121 pregnancies achieved through non-invasive treatment (21.7 per 1000 deliveries; aRR, 0.98; 95% CI, 0.81-1.18) and in 235 pregnancies through invasive treatment (39.3 per 1000 deliveries, aRR, 1.77; 95% CI, 1.54-2.03).
  • The odds of having 3 or more indicators of severe maternal morbidity were higher among women who used infertility treatment (aOR, 2.28; 95% CI, 1.56-3.33).
  • No association was seen for non-invasive infertility treatment (aOR, 0.99; 95% CI, 0.57-1.72).

Limitations

  • Possible non-differential misclassification of exposure.