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Early pregnancy wastage after gamete manipulation
1PIVET Medical Centre, Perth, Western Australia.
British Journal of Obstetrics and Gynaecology
|November 1, 1988
Summary
Subfertile women experience high pregnancy loss rates, averaging 27% across various infertility treatments. Deficiencies in sperm handling, gamete techniques, and embryo culture contribute to these outcomes.
Area of Science:
- Reproductive Medicine
- Infertility Management
- Obstetrics and Gynecology
Background:
- Subfertile women undergoing assisted reproductive technologies (ART) face significant early pregnancy wastage.
- Maternal age is a critical factor in pregnancy outcomes, but its influence was controlled for in this study.
- Understanding pregnancy wastage rates across different ART methods is crucial for improving success rates.
Purpose of the Study:
- To detail the pregnancy outcomes of 1034 women undergoing various infertility treatments.
- To compare early pregnancy wastage rates among different ART groups.
- To identify specific ART procedures associated with higher risks of pregnancy loss and ectopic pregnancies.
Main Methods:
- Retrospective analysis of 1034 pregnancies in seven infertility treatment groups.
- Calculation of mean early pregnancy wastage rates (before 20 weeks gestation) for each group.
- Comparison of pregnancy loss categories including ectopic pregnancy, blighted ovum, and biochemical pregnancy across groups.
- Statistical analysis to assess differences between groups, controlling for maternal age.
Main Results:
- Overall early pregnancy wastage was 27%, ranging from 18% (artificial insemination by donor semen - AID) to 33% (in-vitro fertilization and embryo transfer - IVF-ET).
- Gamete intrafallopian transfer (GIFT) showed a significantly higher rate of ectopic pregnancy.
- Blighted ovum was the most common cause of early loss, highest after artificial insemination by husband's semen (AIH).
- Biochemical pregnancies were more frequent after GIFT, pronuclear stage tubal transfer (PROST), and IVF-ET.
Conclusions:
- Subfertile women have a high rate of early pregnancy wastage, irrespective of ART method.
- Specific ART techniques, including GIFT and IVF-ET, are associated with increased risks of ectopic and biochemical pregnancies.
- Improvements are needed in sperm separation, gamete handling, and in-vitro fertilization/embryo culture techniques to reduce pregnancy wastage.