MARCH 2025
Aim
The aim of this good practice point is to alert clinicians to the increased risk profile of pregnancy resultant of assisted reproductive treatment.
Background
In 2023, there were 30,152 assisted reproduction treatment cycles for 16,952 women in Victoria (VARTA, 2023). Pregnancies conceived with assisted reproductive technology are associated with greater perinatal risk than those conceived spontaneously.
There is systematic review evidence of more stillbirths in women who conceive with IVF in comparison to women who conceive without medical intervention (OR 1.82 CI-1.37-2.42) (Sarmon et al., 2021). Pregnancies conceived with IVF are also at greater risk of preterm birth. The summary rate of preterm delivery in 2021 at < 37 completed weeks is 11.5% (fresh embryo transfer) and 9.8% (frozen embryo transfer) compared to 8% for those spontaneously conceived pregnancies (Newman, Paul and Chambers, 2023). Delivery of women with pregnancies conceived with IVF are more likely to be complicated by placental adhesive disorders (Matsuzaki et al., 2021). IVF conception is also considered a minor risk factor for fetal growth restriction (Pandey et al., 2021; PSANZ and Stillbirth CRE, 2023).
Recommendations
- Maternity care providers should ensure cervical length screening at the time of the morphology scan is performed optimally. This will usually mean a transvaginal approach with an experienced sonographer / sonologist.
- Clinicians should have a low threshold to provide earlier cervical length screening for those with additional risk factors (vaginal bleeding, prior uterine surgery etc).
- A comprehensive assessment for risk factors for fetal growth restriction should be performed and fetal growth surveillance planned in accordance with local protocols (PSANZ and Stillbirth CRE, 2023).
- In late pregnancy the increased risk of stillbirth and potential placental adhesive disorder should be considered with respect to gestation at birth and place of birth.
References
- Matsuzaki, S., Nagase, Y., Takiuchi, T., Kakigano, A., Mimura, K., Lee, M., Matsuzaki, S., Ueda, Y., Tomimatsu, T., Endo, M. and Kimura, T. (2021) Antenatal diagnosis of placenta accreta spectrum after in vitro fertilization-embryo transfer: A systematic review and meta-analysis. Scientific Reports, 11(1), p.9205.
- Newman, J.E., Paul, R.C. and Chambers, G.M. (2023) Assisted reproductive technology in Australia and New Zealand 2021. Sydney: National Perinatal Epidemiology and Statistics Unit, the University of New South Wales, Sydney.
- Pandey, S., Shetty, A., Hamilton, M., Bhattacharya, S. and Maheshwari, A. (2012) Obstetric and perinatal outcomes in singleton pregnancies resulting from IVF/ICSI: a systematic review and meta-analysis. Human reproduction update, 18(5), pp.485-503
- Perinatal Society of Australia and New Zealand and Centre of Research Excellence in Stillbirth, (2023) Position statement: Detection and management of fetal growth restriction in singleton pregnancies. Centre of Research Excellence in Stillbirth. Brisbane, Australia.
- available at: https://learn.stillbirthcre.org.au/wp-content/uploads/2023/05/FGR_Position-Statement_V2_August2023.pdf
- Sarmon, K.G., Eliasen, T., Knudsen, U.B. and Bay, B. (2021) Assisted reproductive technologies and the risk of stillbirth in singleton pregnancies: a systematic review and meta-analysis. Fertility and Sterility, 116(3), pp.784-792.
- Victorian Assisted Reproductive Treatment Authority (2023). VARTA 2023 Annual report. Victorian Government Department of Health. available at https://www.varta.org.au/resources/annual-reports