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Long-term maternal health outcomes following autologous in vitro fertilization compared with medically unassisted
Hila Shalev-Ram1,2, Amir Wiser3,4, Roni Rahav-Koren3,4
1IVF Unit, Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel. hilashalev7@gmail.com.
Purpose:
The use of in vitro fertilization (IVF) has increased substantially, raising interest in the long-term health outcomes of women undergoing these treatments.
Objective:
To assess the association between conception through autologous IVF and the long-term incidence of chronic diseases, compared with two reference groups: women who conceived through medically unassisted conception (UC) and age-matched nulliparous women.
Methods:
This retrospective cohort study used electronic health records from a large health maintenance organization and included women who delivered before age 45 between 2000 and 2018. Three pairwise comparisons were performed: IVF mothers versus UC mothers, IVF mothers versus nulliparous women, and UC mothers versus nulliparous women. For the IVF versus UC comparison, each IVF mother was matched to a UC mother by age and parity at delivery. For comparisons with nulliparous women, controls were matched by age according to the mother's age at first delivery. The delivery date served as the index date for follow-up. Primary outcomes were chronic diseases diagnosed after the index pregnancy and persisting for at least three years.
Results:
The study included 17,425 IVF mothers matched to 17,425 UC mothers, 10,358 IVF mothers matched to 10,358 nulliparous women, and 38,810 UC mothers matched to 38,810 nulliparous women. Compared with UC, IVF was associated with a higher risk of thyroid disease (HR 1.11, p < 0.05). Compared with nulliparous women, IVF mothers had higher risks of thyroid disease (HR 2.07), rheumatologic disease (HR 1.87), neurologic disease (HR 2.51), and psychiatric conditions (HR 1.34) (all p < 0.05). UC mothers also had higher risks of thyroid disease (HR 1.67), rheumatologic disease (HR 1.79), cardiology disease (HR 1.47), and psychiatric conditions (HR 1.47) compared with nulliparous women (all p < 0.05).
Conclusions:
Long-term health outcomes after autologous IVF were largely comparable to those after UC, except for a modestly increased risk of thyroid disease. Compared with nulliparous women, both IVF and UC mothers had higher risks of several chronic conditions, suggesting that pregnancy itself may contribute to long-term maternal health trajectories. Thyroid function monitoring may be considered for women who conceive through autologous IVF.
