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Ovulation induction/intrauterine insemination in infertile couples is associated with low-birth-weight infants,☆☆

https://doi.org/10.1067/mob.2003.5Get rights and content

Abstract

Objective: The study was undertaken to determine the outcome of singleton pregnancies conceived through ovulation induction and intrauterine insemination using a partner's (OI/IUI) or donor sperm (OI/IUID) by comparison with naturally conceived singletons within a national cohort. Study Design: Retrospective cohort study in primigravid women who were treated with OI/IUI (n = 97) or OI/IUID (n = 35) at Glasgow Royal Infirmary between March 1993 and March 1997 and identified within the Scottish national cohort (n = 109,443) delivering during the same period. Univariate and multivariate logistic regression models were used to examine outcomes and to determine the factors associated with infertility treatment and low birth weight. Results: OI/IUI singletons were more likely to be lighter, of clinically low birth weight, and born more prematurely than natural conceptions. After adjustment for associated factors, these infants were 4.85 times (95% CI 2.25-10.48) more likely to be of low birth weight. We could not demonstrate any differences between OI/IUID and natural conceptions. Conclusion: The perinatal outcome of singletons born to subfertile mothers conceived through OI/IUI is poorer than that of matched natural conceptions. We suggest that intrinsic factors in subfertile couples predispose them to having smaller infants and that “infertility” should be added to the list of recognized factors associated with low birth weight. (Am J Obstet Gynecol 2003;188:611-6.)

Section snippets

Patients and treatment

The OI/IUI treatment records at Glasgow Royal Infirmary were analyzed to obtain the complete cohort of pregnancies between March 1993 and March 1997, and a database was constructed to record all pregnancy outcomes. Most of the women were primigravid. The cause of their infertility was oligomenorrhea (most commonly polycystic ovary syndrome [PCOS] but also hypogonadotropic hypogonadism) or unexplained infertility. The latter included women with mild endometriosis and men in whom swim-up tests

Results

The Figure provides a comprehensive account of all 298 pregnancies in the OI/IUI program during the study period.

Figure. Outcomes of OI/IUI pregnancies.

Miscarriages, multiple pregnancies, and singleton pregnancies in parous women were excluded from subsequent analyses. The singleton pregnancies progressing beyond 167 days' gestation (n = 158) were successfully linked and identified in the national database in 154 cases (97.5%). Of these, 132 were recorded as primigravid, and subsequent analyses

Comment

The Scottish national database is a powerful resource to explore factors influencing perinatal events. The reliability of the routinely collected national data was validated by the highly significant correlation between the known gestations of the treatment cases compared with the data recorded in the national database for the same patients.

Singleton infants delivered to subfertile, primigravid women treated with OI/IUI using a partner's sperm were smaller, were born earlier, were at greater

Acknowledgements

We thank James Boyd of the ISD for his help with statistical analyses. M. G. and R. F. were the originators of the concept behind the study. ITC arranged the collaboration with the Scottish Information and Statistics Division and contributed to the writing of the manuscript. R. D. undertook the analyses in consultation with A. F. and J. C. M. G. and R. F. wrote the original draft and subsequent drafts after feedback from all the other authors. All six authors contributed to the study design and

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Supported by the Departments of Obstetrics and Gynaecology at the Universities of Southampton and Glasgow.

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Reprint requests: Richard Fleming, PhD, University Department of Obstetrics and Gynaecology, Level 3, Queen Elizabeth Building, Alexandra Parade, Royal Infirmary, Glasgow G31 2ER, United Kingdom. E-mail: [email protected]

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