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Perinatal outcomes associated with assisted reproductive technology: the Massachusetts Outcomes Study of Assisted Reproductive Technologies (MOSART)
Conclusion(s): The use of a population-based comparison group of subfertile births without ART demonstrated significantly higher rates of preterm birth and low birth weight in ART singleton births, but these differences are smaller than differences between ART and fertile births. Further refinement of the measurement of subfertile births and examination of the independent risks of subfertile births is warranted.
179. Perinatal outcomes associated with assisted reproductive technology: the Massachusetts Outcomes Study of Assisted Reproductive Technologies (MOSART) [Forum/Discussion]
from: Administrator (office@fertaid.com), Australia on 15/03/2015 7:19:01 AM Profession:
Comment: Outcomes from ART conceptions are higher than for births from sub-fertility couples and both are poorer compared to fertile births showing that the underlying fertilty issues can influence outcomes
Submission: This new publication from the MOSART study in the USA looked at a number of birth outcomes (preterm birth, low birth weight, small for gestational age [SGA], and perinatal death) and found that ART (all treatments) has a higher perinatal risk for preterm births and SGA than for conceptions to sub-fertile women not involving ART treatment and that both ART and non-ART/sub-fertile conceptions had a higher risk of perinatal risk than for conceptions to fertile women (couples). The authors inferred that part of the ART risk may be attributed to sub-fertile women rather than the treatment. Preterm deaths were less for ART twin conceptions than for fertile women possibly due to increased clinical care but this was not the main aim of the study. This observation is a common theme in many ART birth outcome studies - that is that there are intrinsic and treatment risks and both contribute to adverse outcomes. The primary note that can be drawn form this work is that couples undertaking ART should have this information explained as part of their informed consent. A problem is that IVF is changing rapidly. Most changes can only lead to a better perinatal risk for ART but can do nothing to reduce the sub-fertility risk. Single embryo transfers, FET conceptions, managed stimulation or low FSH dose regimens and social infertility such as the treatment of single (fertile) women by IVF are changes that should lower the ART risk. It is unclear whether improved embryo selection or day 5 transfers will lower the risk even further. It may take another 10+ years to gather sufficient data to show this. In summary, the IVF industry should accept there is are birth risks attached to ART treatment that while significant can only reduced over time and rather than stopping treatment need to be addressed by improving cycle management and informed consent.
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