Abstract
Purpose
To compare perinatal outcomes in in-vitro fertilization (IVF) pregnancies versus spontaneous conceptions in woman of advanced maternal age (AMA), and to evaluate the effect of increasing age on IVF pregnancies’ outcomes.
Methods
A retrospective population-based cohort study including pregnant women who delivered between 2008–2014 in the US. First, we included women aged 38–43 years and compared those with IVF conceptions (cases) to women with spontaneous conceptions (controls). Thereafter, we compared IVF pregnancies in women aged 38–43 years to IVF pregnancies at < 38 years of age. Multivariate logistic regression was performed to compare both groups regarding pregnancy,delivery, and neonatal outcomes after adjusting for plausible confounders.
Results
Three hundred nine thousand five hundred sixty-seven pregnant women aged 38–43 years were identified, with 2,762 composing the IVF group, and 306,805 composing the control group. After adjusting for confounders, the IVF group had a higher risk of several adverse obstetrical outcomes, including hypertensive disorders of pregnancy (aOR 1.31,95%CI 1.06–1.62), gestational diabetes (aOR 1.26,95%CI 1.13–1.41),preterm delivery (aOR 1.45,95%CI 1.16–1.81), cesarean section (CS) (aOR 1.84,95%CI 1.55- 2.19),postpartum hemorrhage (aOR 1.68,95%CI 1.27- 2.24), and maternal infection (aOR 1.90,95%CI 1.31–2.77), with comparable neonatal outcomes. For the second analysis, 9712 IVF pregnancies were included (n = 6950 < 38 years, and n = 2762 ≥ 38 years). Women ≥ 38 years who underwent IVF were more likely to experience hypertensive disorders of pregnancy, CS, hysterectomy and blood transfusion, with comparable neonatal outcomes.
Conclusion
IVF AMA pregnancies have a significant increase in myriad perinatal complications compared to spontaneous AMA pregnancies. Younger women undergoing IVF have mildly less complications than their older counterparts.
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Data availability
All relevant data for this study are included in the article.
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All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Ahmad Badeghiesh, Alyssa Hochberg and Noha Elsherbini. The first draft of the manuscript was written by Ahmad Badeghiesh and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
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Badeghiesh, A., Hochberg, A., Elsherbini, N. et al. How does IVF conception affect pregnancy complications in an older cohort of women, at least 38 years of age? Study of a population database. J Assist Reprod Genet 40, 2139–2148 (2023). https://doi.org/10.1007/s10815-023-02890-0
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DOI: https://doi.org/10.1007/s10815-023-02890-0