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Assisted reproductive technology relatively safe in the US
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The use of autologous and donor assisted reproductive technology was associated with low stimulation and surgical complication risks, according to a research letter published in the Journal of the American Medical Association.
“This study affirms that assisted reproductive technology (ART) treatment is relatively safe and that reported complications remain rare,” Jennifer F. Kawwass, MD, of Emory University School of Medicine, Atlanta, Georgia, told Endocrine Today. “Ovarian hyperstimulation syndrome (OHSS) was the most frequently reported complication among autologous and donor cycles, though less frequent in donor cycles. Obstetric mortality which may or may not be related to ART was very rare.”
Jennifer F. Kawwass
Kawwass and colleagues examined incidence and trends between 2000 and 2011 based on data from the federally-mandated US Centers for Disease Control and Prevention National ART Surveillance System; as of 2011, the system included 97% of cycles and 94% of all US ART clinics.
Defined as directly related to ART and occurring within 12 weeks of cycle start, reported complications were: infection, hemorrhage requiring transfusion, OHSS, medication adverse event, anesthetic complication, hospitalization, patient death within 12 weeks of stimulation and other complications. Whether severe or moderate, OHSS was reported in a single category due to subjective delineation. Maternal death prior to infant birth was also reported.
Among 1,135,206 autologous cycles, OHSS (peak of 153.5/10,000 autologous cycles; 95% CI, 146-161.3) and hospitalizations (peak of 34.8/10,000 autologous cycles; 95% CI, 30.9-39.3) were the most commonly reported patient complications. The rates for other complications were <10/10,000 cycles. Reported medication adverse events (P=.02) and hospitalizations (P<.001) declined between 2000 and 2011.
No other significant trends were observed among reported infections, hemorrhages, OHSS, severe OHSS, anesthetic-related complications and deaths within 12 weeks of stimulation start or during pregnancy (P>.1 trend for all tests).
Overall, 58 deaths (18 stimulation related, 40 maternal deaths prior to infant birth) were reported, with no temporal patterns noted. Maternal death rate ranged from 14.2 per 100,000 ART-conceived live births in 2004 to 1.6 in 2008.
Following donor ART cycles (n=112,254), complications were less frequent, and none showed a significant trend; the most common were OHSS (peak of 31/10,000 cycles; 95% CI, 22.9-44.3) and hospitalizations (peak of 10.5/10,000 cycles; 95% CI, 5.5-20.1).
“Increased awareness of the most common complication, OHSS, may prompt additional study to characterize predictors of this and other adverse events to inform the development of effective approaches necessary to decrease complication occurrence,” the researchers wrote.
For more information:
Jennifer F. Kawwass, MD, can be reached at Emory Reproductive Center Suite, 1800, 550 Peachtree St., Atlanta, GA 30308; email: jennifer.kawwass@emory.edu.
Disclosure: The researchers report no relevant disclosures.
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