Annals of African Medicine

ORIGINAL ARTICLE
Year
: 2010  |  Volume : 9  |  Issue : 2  |  Page : 77--80

Obstetric management after infertility treatment


Haifa A Al-Turki 
 King Fahd University Hospital and College of Medicine, University of Dammam, Dammam, Saudi Arabia

Correspondence Address:
Haifa A Al-Turki
P.O. BOX 40286, King Fahd University Hospital, Al-Khobar 31952
Saudi Arabia

Abstract

Objective: King Fahd University Hospital, Al-Khobar is a tertiary care center without the facility for in-vitro fertilization (IVF) and embryo transfer, but ovulation induction (OI) is done routinely. The objective of this analysis was to study the obstetric outcome of patients who conceived after IVF and OI. Design: Retrospective analysis. Patients and Methods: One hundred and twenty patients were analysed within the study period of January 1996 and December 2006. Patients were divided into two groups viz; those who became pregnant after IVF and embryo transfer and those who conceived after OI. The obstetric outcome measures analysed include: antenatal and intrapartum complications, the number of babies delivered and the mode of delivery. The data was entered into the database and analysed using SPSS Inc. version 14. Results: The average age was 37.31 ± 4.1 years (range 21-43 years), primary infertility was seen in 74 women and secondary infertility in 46 patients. In 73 (60.8%) of the women, pregnancy occurred after OI and the rest of the patients underwent IVF at other centers. Sixty-nine (57.5%) of women had no previous pregnancy. Antenatal complications were similar in both groups but intrapartum complications were significantly higher in IVF group, P = 0.05. Multiple pregnancies were significantly higher in the IVF group (P = 0.001). Normal vaginal deliveries (NVD) were common in the OI group, and cesarean sections (CS) was significantly higher in IVF group (P = 0.001). Conclusion: This study shows that in pregnancy after IVF and embryo transfer, intrapartum complications were more and CS was the common mode of delivery when compared with those that had only OI.



How to cite this article:
Al-Turki HA. Obstetric management after infertility treatment.Ann Afr Med 2010;9:77-80


How to cite this URL:
Al-Turki HA. Obstetric management after infertility treatment. Ann Afr Med [serial online] 2010 [cited 2021 Oct 26 ];9:77-80
Available from: https://www.annalsafrmed.org/text.asp?2010/9/2/77/64753


Full Text

 Introduction



In the eastern province of Saudi Arabia with a population of 6 million people, only three private hospitals have facilities for in-vitro fertilization (IVF) and embryo transfer, hence there is limited literature from the area on the aspect of IVF and ovulation induction (OI). Risk of complications after IVF and OI are many folds higher than in normal conception. [1],[2],[3],[4],[5] Since the Saudi population characteristics are changing and there is a high percentage of younger population, pregnancies due to IVF and OI are bound to increase in near future. It is paramount that an assessment is made on the obstetric and neonatal outcomes of pregnancies due to such procedures. Moreover, there is little data in literature that has compared obstetric management and outcome after IVF and OI. We believe this analysis will serve as a guide to obstetricians that manage pregnancies resulting from IVF and OI as a result of infertility treatment. Hence we carried out this study to assess the obstetric outcome of pregnancies due to IVF and OI seen at King Fahd University Hospital, Al-Khobar, Saudi Arabia.

 Patients and Methods



One hundred and twenty patients were analysed within the study period of January 1997 to December 2007. Patients were divided into two groups viz; those who became pregnant after IVF and embryo transfer and those who had OI. Only deliveries of gestation of ≥24 weeks were included in the analysis. Data retrieved included age of the patient, parity, infertility either primary or secondary, method of conception, prenatal complications, gestational age, intrapartum and postpartum complications. Modes of delivery, Apgar scores and weight of the babies were noted. The prenatal complications that were compared were gestational diabetes mellitus (GDM), pregnancy induced hypertension (PIH), oligo and polyhydramnios, premature rupture of membranes, pre-eclampsia and intrauterine growth restriction (IUGR). A glucose tolerance test was performed before confirming GDM and three blood pressure readings at different times of ≥140/90 mm Hg after 20 weeks of gestation was labeled as PIH.

All the data was entered into the database and analysed using SPSS Inc. version 14. The χ2 -test or Fisher's Exact test was used for categorical variables, and students YES (Chi-square).

t-test was used for continuous variables. Odds ratio (OR) at 95% confidence interval (CI) were computed, and P-value of P = 0.001 (OR P = 0.05 (OR P = 0.01 (OR P = 0.001 (OR et al, [6] reported age difference between patients who underwent IVF and OI. They reported that patients with OI were younger than those in the IVF group. In this study, we did not find any significant age difference between the two groups. WHY? Any possible explanation? Gestational diabetes is probably the first antenatal complication of any pregnancy. Among the antenatal complications, 12.8% in IVF group and 10.95% in the OI group developed GDM. This in comparison to the findings of Maman et al, [6] is much lower, but higher than that reported by Reubinoff et al, [7] of 6.2% in their IVF group. Recently, Caserta et al, [8] reported no difference between the prevalence of gestational diabetes among the IVF and naturally conceived women. Pregnancy-induced hypertension (PIH) was significantly more frequent in women who became pregnant after assisted reproduction. [9],[10]

Intrapartum complications like placenta previa and placental abruption are known complications in assisted reproductive technology as compared to pregnancy due to normal conception. [11],[12],[13] Jackson et al, [14] after a meta-analysis suggested that there is a three-fold higher risk of placenta previa after assisted fertilization. Romundstad et al, [15] reported a prevalence of 1.59% of placenta previa in patients who conceived after assisted fertilization and suggested that that the increased risk may be caused by factors related to the reproductive technology. Isaksson et al, [10] reported placenta previa was not significantly different in the control group and IVF, whereas placental abruption was more common in the assisted reproduction group.

In our series, one patient had placenta previa in the OI group and none in the IVF group, indicating the incidence of placenta previa in patients with assisted fertilization is becoming comparatively similar to its occurrence in women who become pregnant after normal conception.

Pregnancies conceived after assisted reproduction is always considered precious, hence, obstetricians avoid taking chances with the mode of delivery. Shunji and Hidehiko [16] reported that the elective CS rate in pregnancies following IVF was significantly higher than that in the control group, whereas Maman et al, [6] found significantly higher rate of CS in the IVF and OI groups compared to the normal conception. The CS rate was reported to be significantly higher among IVF patients 41.9% versus 15.5% in women with normal conception. [7] In our patients, the CS rate was significantly more in the IVF group when compared to the OI group.

In conclusion our study indicates that in pregnancy after IVF and OI, antenatal complications were similar but intrapartum complications were higher in the IVF group. In OI patients NVD was the usual outcome whereas in patients with IVF, CS was the most common mode of delivery. Pregnancies achieved by IVF appear to carry higher risk for intrapartum obstetric complications and close surveillance during pregnancy and delivery should be considered.

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