Does contemporary ART lead to pre-eclampsia? A cohort study and meta-analysis

Area of Science:

• Reproductive Endocrinology
• Obstetrics and Gynecology
• Public Health

Background:

• Previous studies indicated higher pre-eclampsia (PE) risk with frozen-thawed embryo transfers (FET) compared to fresh in vitro fertilization embryo transfers (IVF-ET).
• These earlier findings may not reflect current assisted reproductive technology (ART) practices due to evolving protocols.
• Assessing PE incidence in contemporary ART is crucial for patient safety and informed clinical decision-making.

Purpose of the Study:

• To evaluate the incidence of pre-eclampsia (PE) in current assisted reproductive technology (ART) practices.
• To compare PE risk between frozen-thawed embryo transfers (FET), fresh in vitro fertilization embryo transfers (IVF-ET), and natural conceptions (NC) using recent data.
• To provide an updated meta-analysis of PE risk in ART versus natural conception.

Main Methods:

• A cohort study analyzing all births in Ontario, Canada, from 2013-2017.
• Inclusion of data for FET, IVF-ET, and natural conceptions (NC).
• Meta-analysis incorporating over 4 million births to compare findings with previous studies.

Main Results:

• Contemporary ART practices show comparable PE risk between FET and IVF-ET.
• The risk of PE in both FET and IVF-ET is higher than in natural conceptions (NC).
• Meta-analysis confirms updated risk profiles in current ART.

Conclusions:

• Current ART, including FET, is associated with a comparable risk of PE to fresh IVF-ET.
• The risk of PE in ART pregnancies remains higher than in naturally conceived pregnancies.
• Utilizing ovulatory endometrial preparation for FETs may further reduce the risk of PE.