Post on 30-May-2018
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The increased mortality after
ART: the egg or the hen?
Arne Sunde, PhD
Head, Fertility Clinic St.Olavs University HospitalProfessor, Norwegian Institute for Science and Technology
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Nordic ART registries
Similar structure:
ProfessionGovernmental
Body(ies)
ART registry
Mandatory report
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Nordic registries
Similar structure:
ProfessionGovernmental
Body (ies)
ART registry Birth registry
Cancer
registry
Hospital
discharge
Registry
Infant
registry
Mandatory report
Malformations
registry
Coupling trough a unique
personal number
given at birth
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Number of IVF/ICSI and FER cycles
per year in the Nordic countries
0
5 000
10 000
15 000
20 000
25 000
30 000
35 000
40 000
45 000
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
FER
IVF/ICSI
~ 40 000 cycles, ~25 million inhabitants: ~1600 cycles per million annually
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Children after ART
The major cause of:
increased premature births, increased mortality rate,
increased malformation rate
is the high multiple pregnancy rate
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Twins after IVF and ICSI
Nordic countries 1997 -2005
0
5
10
15
20
25
30
35
1997 2001 2002 2003 2004 2005
Denmark
Finland
Iceland
Norway
Sweden
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Question
The total cost of pregnancy care,delivery and neonatal care (1st week)for twins is approximately:
1 Similar to that of singletons
2) Twice as much as that of singletons
3) Four times as much as that of singletons 4) Six times as much as that of singletons
5) Ten times as much as that of singletons
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Question
The total cost of pregnancy care, delivery and
neonatal care (1st week) for triplets is
approximately:
1 Twice as much as that of singletons
2) Four times as much as that of singletons
3) Similar to that of twins
4) Ten times as much as that of singletons
5) Twenty times as much as that of singletons
5) Thirty times as much as that of singletons
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Proportion of single embryo transfers
Fresh embryos
St. Olavs University hospital in Trondheim
9 1011
54
75
84 8487
0
10
20
30
40
50
60
70
80
90
100
2001 2002 2003 2004 2005 2006 2007 2008
%
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Multiple pregnancy rate all transfers
(FER/IVF/ICSI)
St-Olavs University hospital in Trondheim
3032
36
17
85 4
2
0
5
10
15
20
25
30
35
40
2001 2002 2003 2004 2005 2006 2007 2008
IVF/ICSI
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Question
Concerning the neonatal mortality rate oftwins:
1) it is the same as that of singletons
2) it is two times as high as that of singletons
3) it is three times as high as that of singletons
4) I it is four times as high as that of singletons
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ART - Children
Outcome can be compiled form variousregistries
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Question
Concerning the neonatal mortality rate ofsingletons born after ART:
1) it is the same as spontaneously conceived
singletons
2) it is higher than spontaneously conceivedsingletons
3) it is lower than spontaneously conceivedsingletons
4) I dont know
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Swedish ART children, deaths
Klln et al. Fertil Steril 84:605 2005
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ART-singletons
Seems to be doing worse than spontaneously
conceived singletons
We initiated a line of research trying to find
out whether this was due to
The ART-Technology (The egg)
Maternal factors (The hen)
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The Norwegian Birth registry
All ART cycles reported (mandatory)
All ART pregnancies registered at week 16(mandatory)
The ART registry coupled to the general birthregistry
Information on outcome of pregnancies andbirths can be extracted and compared
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1st Trondheim study
births in the period 1988-2002
Two singletons from
the same mother
One spontaneousconception
One IVF/ICSI
1349 women
2698 children/births
Romundstad et al. Human Reproduction, 21, No.9, 23532358, 2006
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1st Trondheim study birthsin the period 1988-2002
Two singletons from the same mother Adjusted Odds ratio for placenta preavia:
Spontaneous conception ART OR OR (95% CI) 1.0 2,9 (1.46.1)
i.e. ART itself seems to increase the risk ofplacenta praevia. Its not the mother
Romundstad et al. Human Reproduction, 21, No.9, 23532358, 2006
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2nd study births in the period
1984-2006
Singletons
1 200 922 spontaneous conceptions inthe general population
8 229 following IVF/ICSI
Romundstad et al. The Lancet, online July 31, 2008
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2nd study births in the period
1984-2006
Singletons: Spontaneous conception in the general population
versus
conceptions after ART
Spontaneous ART
OR OR (95% CI)
SGA 1 1,3 (1.1-1,4)
Birth < 37 weeks 1 1,7 (1.6-1.9)
Perinatal death 1 1.3 (1.1-1.7)
Romundstad et al. The Lancet, online July 31, 2008
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2nd study births in the period
1984-2006
Two singletons from
the same mother
One spontaneousconception
One IVF/ICSI
2204 women
4408 children/births
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2. Trondheim study 1984-2006
Singletons Same mother,
one ART versus
one Spontaneous
Spontaneous ART
OR OR (95% CI)
SGA 1 1,0 (0,6-1,6)
Birth < 37 weeks 1 1,2 (0,9-1,6) Perinatal death 1 0,4 (0,2-0,7)
Romundstad et al. The Lancet, on line July 31, 2008
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Conclusion
The hen or the egg?
Concerning placenta praevia: The egg (ART)
Concerning, SGA and premature birth,perinatal death :
The hen (mother/infertility)
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Thank you