A comprehensive assessment of outcomes in pregnancies conceived by in vitro fertilization/intracytoplasmic sperm injection.

OBJECTIVE: To assess the association between in vitro fertilization (IVF) with or without intracytoplasmic sperm injection (ICSI) and adverse birth outcomes. STUDY DESIGN: Retrospective cohort study involved IVF/ICSI patients who were treated in the Ottawa Fertility Centre from 1996 to 2005 with a viable pregnancy (>20 weeks of gestation) and mothers who conceived naturally. RESULTS: Eleven of the 1044 infants conceived with IVF/ICSI (1.1%) and 7 of the 1910 naturally conceived infants (0.4%) had congenital heart defects (P<0.01). Five of the 138 infants (3.6%) born to mothers with a body mass index>30 and conceived by IVF/ICSI had congenital heart defects, compared with none in the 240 infants born to mothers with a body mass index>30 and conceived naturally (P<0.01). CONCLUSION: Infants conceived with use of IVF/ICSI have three times as high a risk of a congenital heart defect as naturally conceived infants.

Pre-conception health awareness in infertility patients.

OBJECTIVE: Pre-conception counselling is important, as most pregnancies are unplanned. There are few published studies examining women's attitudes and knowledge in this area. As part of our ongoing education quality improvement program we evaluated the pre-conception knowledge and attitudes of women at an infertility clinic. METHODS: Women who presented for initial assessment to a university-affiliated infertility clinic completed a knowledge survey prior to the first physician consultation. RESULTS: Four hundred surveys were appropriately completed for data analysis. Patients were well informed about health optimization, folic acid consumption, infectious disease exposure, medication use, partner abuse, smoking, and recreational drug use. Patients were not well informed about the risks of daily alcohol consumption, advanced maternal age, exercise, cat litter exposure, and consumption of fish and certain other foods. They were uncertain about the importance of rubella immunization and family history. Nulliparous women were less knowledgeable about the significance of rubella immunization, exercise, recreational drug use, cat litter exposure, and fish consumption. Women who were more educated had more knowledge about the effects of the mother's age, exercise, alcohol exposure, and smoking on pregnancy. CONCLUSIONS: There are gaps in knowledge, even in the highly motivated population of infertile women who are planning to be pregnant. The results of this survey suggest that women need and want their physicians to educate them about optimal pre-pregnancy lifestyle. We will revise our education programs to account for these gaps. Larger population-based studies are needed to assess knowledge in the general population, so that appropriate health promotion and education programs can be implemented.

Timing intrauterine insemination either 33 or 39 hours after administration of human chorionic gonadotropin yields the same pregnancy rates as after superovulation therapy.

OBJECTIVE: To compare a short and long interval between hCG administration and IUI after superovulation for the treatment of infertility. DESIGN: Prospective, randomized clinical trial. SETTING: University hospital-based fertility clinic. PATIENT(S): Patients planning superovulation and IUI for the treatment of infertility. INTERVENTION(S): Patients with >or=2 years of infertility enrolled for superovulation and IUI treatment were randomized to IUI after a short (32-34-hour) or long (38-40-hour) interval after hCG injection. Superovulation was accomplished with hMG or recombinant FSH, with dose adjustment until the maturation of two to five follicles, at which time hCG was given. Sperm was prepared with a gradient centrifugation technique, with IUI performed high up in the uterine fundus. MAIN OUTCOME MEASURE(S): Pregnancy rates. RESULT(S): Of the 348 patient cycles randomized, 270 treatment cycles were initiated. Eighty-one initiated cycles were canceled, leaving 189 completed randomized cycles from 75 patients for analysis. Pregnancy rates were not significantly different between groups. There were pregnancies in 20 of the 96 short hCG-IUI interval cycles (21%) and in 14 of the 93 long hCG-IUI interval cycles (15%) (odds ratio = 0.673, 95% confidence interval 0.297-1.518). CONCLUSION(S): Pregnancy rates are the same after superovulation therapy whether IUI is done after a short or a long interval after hCG injection.