Adverse Obstetric and Perinatal Outcomes in Subfertile Women Conceiving Without Assisted Reproductive Technologies

It is unclear whether assisted reproductive technologies (ART) or factors associated with infertility contribute to adverse perinatal outcomes in subfertile women who undergo in vitro fertilization. Some investigators have suggested that specific effects of ART due to the laboratory procedures are largely responsible for adverse perinatal outcomes. Others believe that procedures involved with in vitro fertilization are not causative, but factors related to the health of the infertile woman are responsible.This cohort study compared the prevalence of adverse perinatal birth outcomes among subfertile women who conceived and delivered without ART and women from the general population (controls). The study subjects were 2171 subfertile women who registered at 2 fertility clinics and subsequently conceived and gave birth to singleton infants without ART. A total of 4363 controls, matched by maternal age and year of infantʼs birth were selected randomly from birth records. The primary study outcome measures were adverse obstetric and perinatal outcomes. Multivariable analysis was used to adjust for known confounders.Compared with controls, there were increased odds among subfertile women of hypertension or preeclampsia (adjusted odds ratio [aOR],1.29; 95% confidence interval [CI], 1.02–1.61); antepartum hemorrhage (aOR, 1.41; 95% CI, 1.05–1.89); preterm birth < 37 weeks (aOR, 1.32; 95% CI, 1.05–1.67) or < 31 weeks (aOR; 2.37; 95% CI, 1.35–4.13); low birth weight (aOR,1.44; 95% CI, 1.11–1.85); perinatal death (aOR, 2.19; 95% CI, 1.10–4.36); and cesarean delivery (aOR, 1.56; 95% CI, 1.37–1.77; P values for all these comparisons were