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Risk of stillbirth in low-risk singleton term pregnancies following fertility treatment: a national cohort study
B Bay1,2, S Boie3, U S Kesmodel4
1The Fertility Clinic, Department of Gynaecology and Obstetrics, Regional Hospital Horsens, Horsens, Denmark.
Objective:
To assess the risk of stillbirth in low-risk in vitro fertilisation (IVF) pregnancies.
Design:
Register-based national cohort study.
Setting:
Denmark 2003-2013.
Population:
Cohort of 425 732 singleton pregnancies including 10 235 conceived following IVF/intracytoplasmic sperm injection (ICSI), 4521 conceived following intrauterine insemination (IUI), and 410 976 spontaneously conceived.
Methods:
Information on pregnancy, obstetrical risk factors, stillbirth, and fertility treatment was obtained from the Danish national health registers for all pregnancies after gestational week 21+6 . We estimated the overall and gestational age-specific risk of stillbirth in low-risk term pregnancies following IVF, ICSI, and IUI. Further, we estimated the association between stillbirth and IVF and ICSI respectively as well as fresh or frozen-thawed embryo transfer.
Main Outcome Measures:
Risk of stillbirth.
Results:
The number of stillbirths in spontaneously conceived and IVF/ICSI low-risk term pregnancies was 525 (0.1%) and 35 (0.3%), respectively. In multivariate analysis, the risk of stillbirth in pregnancies following IVF/ICSI was increased (odds ratio 2.1, 95% CI 1.4-3.1). The risk of stillbirth was correspondingly increased in time-to-event analyses taking risk time for each fetus into account from gestational week 37 and onwards (hazard ratio 2.4, 95% CI 1.6-3.6). In sub-analyses, the risk of stillbirth was increased for pregnancies following ICSI (odds ratio 2.2, 95% CI 1.2-3.1), but not IVF (odds ratio 1.7, 95% CI 0.9-3.1).
Conclusion:
We found a systematically increased risk of stillbirth in low-risk term pregnancies following IVF/ICSI. Whether the risk was related to the treatment or to underlying subfertility is uncertain. The results may indicate a need for obstetrical surveillance for these pregnancies when reaching term.
Tweetable Abstract:
Increased risk of stillbirth in low-risk term pregnancies following fresh cycle IVF/ICSI.
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