Worldwide prevalence of adverse pregnancy outcomes associated with in vitro fertilization/intracytoplasmic sperm injection among multiple births: a systematic review and meta-analysis based on cohort studies

• Published in: Archives of gynecology and obstetrics 2017-03, Vol.295 (3), p.577-597
• Main Authors: Qin, Jia-Bi, Sheng, Xiao-Qi, Wang, Hua, Chen, Guo-Chong, Yang, Jing, Yu, Hong, Yang, Tu-Bao
• Format: Article
• Language: English
• Subjects: Adult; Birth weight; Cohort analysis; Cohort Studies; Endocrinology; Female; Fertility; Fertilization in Vitro - adverse effects; Gynecology; Human Genetics; Humans; In vitro fertilization; Infant, Low Birth Weight; Infant, Newborn; Medicine; Medicine & Public Health; Meta-analysis; Multiple Birth Offspring - statistics & numerical data; Multiple births; Obstetrics/Perinatology/Midwifery; Perinatal Mortality; Pregnancy; Pregnancy Outcome - epidemiology; Premature birth; Premature Birth - epidemiology; Prevalence; Prospective Studies; Review; Sperm; Sperm Injections, Intracytoplasmic - adverse effects; Systematic review
• ISSN: 0932-0067; 1432-0711
• DOI: 10.1007/s00404-017-4291-2

Purpose To perform a systematic review and meta-analysis of reported estimates of adverse pregnancy outcomes among multiple births conceived with in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). Methods PubMed, Google Scholar, Cochrane Libraries and Chinese databases were searched through May 2016 for cohort studies assessing adverse pregnancy outcomes associated with IVF/ICSI multiple births. Random-effects meta-analyses were used to calculate pooled estimates of adverse pregnancy outcomes and, where appropriate, heterogeneity was explored in group-specific analyses. Results Sixty-four studies, with 60,210 IVF/ICSI multiple births and 146,737 spontaneously conceived multiple births, were selected for analysis. Among IVF/ICSI multiple births, the pooled estimates were 51.5% [95% confidence interval (CI): 48.7–54.3] for preterm birth, 12.1% (95% CI: 10.4–14.1) for very preterm birth, 49.8% (95% CI: 47.6–52.0) for low birth weight, 8.4% (95% CI: 7.1–9.9) for very low birth weight, 16.2% (95% CI: 12.9–20.1) for small for gestational age, 3.0% (95% CI: 2.5–3.7) for perinatal mortality and 4.7% (95% CI: 4.0–5.6) for congenital malformations. When the data were restricted to twins, the pooled estimates also showed a high prevalence of adverse outcomes. There was a similar prevalence of poor outcomes among multiple births conceived with IVF/ICSI and naturally (all P  ≥ 0.0792). Significant differences in different continents, countries, and income groups were found. Conclusions The IVF/ICSI multiple pregnancies have a high prevalence of adverse pregnancy outcomes. However, population-wide prospective adverse outcomes registries covering the entire world population for IVF/ICSI pregnancies are needed to determine the exact perinatal prevalence.