IVF, intrauterine insemination tied to higher maternal morbidity odds

Key takeaways:

• Women who underwent invasive assisted reproduction treatments had higher maternal morbidity risk.
• The relationship was partially explained by higher prevalence of multifetal gestation with assisted reproduction.

Women who underwent in vitro fertilization or intrauterine insemination were more likely to experience maternal morbidity compared with unassisted pregnancies, according to findings published in Obstetrics & Gynecology.

In an analysis of nearly 470,000 deliveries in Utah between 2009 and 2017, researchers also found that the higher prevalence of multifetal gestation in pregnancies conceived via more invasive assisted reproductive technology (ART) partially explained the association, adding that the maternal morbidity for singleton births remains lower.

“The choice of medically assisted reproductive procedures depends on factors such as infertility duration, diagnosis, availability and cost, typically progressing from less to more invasive treatments,” Alina Pelikh, PhD, senior research fellow in demography and deputy research director at the Centre for Longitudinal Studies at the Social Research Institute at the University College London, and colleagues wrote. “Limited large-scale data have restricted studies investigating maternal morbidity differences by medically assisted reproduction treatment types.”

Pelikh and colleagues evaluated data from 469,919 deliveries occurring between 2009 and 2017 from the Utah Population Database. Researchers defined maternal morbidity as the presence of blood transfusion, unplanned operating room procedure, ICU admission, eclampsia, unplanned hysterectomy or ruptured uterus. Researchers evaluated maternal morbidity among women with pregnancies using vs. not using medically assisted reproduction.

Overall, 4.8% of pregnancies used medically assisted reproduction. Most used fertility-enhancing drugs (60.4%), 14.4% used intrauterine insemination, 23.5% used ART with autologous oocytes and 1.7% used ART with donor oocytes.

The most common maternal morbidity condition observed was blood transfusion (69 per 10,000 births), unplanned operating room procedure (18 per 10,000 births) and ICU admission (12 per 10,000 births).

Women with vs. without pregnancies achieved through medically assisted reproduction had higher maternal morbidity risks (OR = 1.76; 95% CI, 1.57-1.98) with increased odds for more invasive treatments including ART with donor oocytes (OR = 5.71; 95% CI, 3.5-9.31), ART using autologous oocytes (OR = 3.2; 95% CI, 2.69-3.81) and intrauterine insemination (OR = 1.85; 95% CI, 1.39-2.46).

These associations lowered when accounting for multifetal gestation and when controlling for obstetric comorbidities. Despite this, compared with unassisted pregnancies, ART with autologous oocytes continued to have higher odds of maternal morbidity (OR = 1.46; 95% CI, 1.2-1.78).

Associations between maternal morbidity odds and medically assisted reproduction were no longer statistically significant in models including only singleton gestations and after controlling for obstetric comorbidities.

According to the researchers, increased maternal morbidity risk with medically assisted reproduction-related multifetal pregnancies highlights the potential adverse health effects and costs, suggesting that minimizing multifetal gestation is “crucial.”

“The lack of state-funded provision and high treatment costs may encourage multiple embryo transfers in the United States, emphasizing the need for awareness campaigns on elective single embryo transfer’s benefits, which can offer comparable pregnancy success rates while reducing maternal morbidity risks,” the researchers wrote. “Public health initiatives promoting elective single embryo transfer and counseling on maternal morbidity risks associated with medically assisted reproduction-related multifetal pregnancies can guide safer treatment choices, potentially lowering maternal morbidity rates and related costs.”