Obstetric and perinatal outcomes in singleton pregnancies resulting from the transfer of frozen thawed versus fresh embryos generated through in vitro fertilization treatment

a systematic review and meta-analysis

Abha Maheshwari, Shilpi Pandey, Ashalatha Shetty, Mark Hamilton, Siladitya Bhattacharya

Research output: Contribution to journalArticle

260 Citations (Scopus)

Abstract

Objective
To perform a systematic review and meta-analysis of obstetric and perinatal complications in singleton pregnancies after the transfer of frozen thawed and fresh embryos generated through IVF.

Design
Systematic review.

Setting
Observational studies, comparing obstetric and perinatal outcomes in singleton pregnancies subsequent to frozen thawed ET versus fresh embryo transfer, were included from Medline, EMBASE, Cochrane Central Register of Clinical Trials, DARE, and CINAHL (1984–2012).

Patient(s)
Women undergoing IVF/intracytoplasmic sperm injection (ICSI).

Intervention(s)
Two independent reviewers extracted data and assessed the methodological quality of the relevant studies using critical appraisal skills program scoring. Risk ratios and risk differences were calculated in Rev Man 5.1. Subgroup analysis was performed on matched cohort studies.

Main Outcome Measure(s)
Antepartum hemorrhage, very preterm birth, preterm birth, small for gestational age, low birth weight, very low birth weight, cesarean section, congenital anomalies, perinatal mortality, and admission to neonatal intensive care unit.

Result(s)
Eleven studies met the inclusion criteria. Singleton pregnancies after the transfer of frozen thawed embryos were associated with better perinatal outcomes compared with those after fresh IVF embryos. The relative risks (RR) and 95% confidence intervals (CI) of antepartum hemorrhage (RR = 0.67, 95% CI 0.55–0.81), preterm birth (RR = 0.84, 95% CI 0.78–0.90), small for gestational age (RR = 0.45, 95% CI 0.30–0.66), low birth weight (RR = 0.69, 95% CI 0.62–0.76), and perinatal mortality (RR = 0.68, 95% CI 0.48–0.96) were lower in women who received frozen embryos.

Conclusion(s)
Although fresh ET is the norm in IVF, results of this systematic review of observational studies suggest that pregnancies arising from the transfer of frozen thawed IVF embryos seem to have better obstetric and perinatal outcomes.
Original languageEnglish
Pages (from-to)368-377.e9
Number of pages10
JournalFertility and Sterility
Volume98
Issue number2
Early online date13 Jun 2012
DOIs
Publication statusPublished - Aug 2012

Fingerprint

Fertilization in Vitro
Obstetrics
Meta-Analysis
Embryonic Structures
Pregnancy
Confidence Intervals
Premature Birth
Perinatal Mortality
Low Birth Weight Infant
Therapeutics
Gestational Age
Hemorrhage
Very Low Birth Weight Infant
Intracytoplasmic Sperm Injections
Embryo Transfer
Neonatal Intensive Care Units
Cesarean Section
Observational Studies
Cohort Studies
Odds Ratio

Keywords

  • IVF
  • ICSI
  • obstetric outcomes
  • perinatal outcomes
  • frozen replacement cycles

Cite this

@article{a3bb6dfe4c554c59a401b81f4d770b53,
title = "Obstetric and perinatal outcomes in singleton pregnancies resulting from the transfer of frozen thawed versus fresh embryos generated through in vitro fertilization treatment: a systematic review and meta-analysis",
abstract = "Objective To perform a systematic review and meta-analysis of obstetric and perinatal complications in singleton pregnancies after the transfer of frozen thawed and fresh embryos generated through IVF. Design Systematic review. Setting Observational studies, comparing obstetric and perinatal outcomes in singleton pregnancies subsequent to frozen thawed ET versus fresh embryo transfer, were included from Medline, EMBASE, Cochrane Central Register of Clinical Trials, DARE, and CINAHL (1984–2012). Patient(s) Women undergoing IVF/intracytoplasmic sperm injection (ICSI). Intervention(s) Two independent reviewers extracted data and assessed the methodological quality of the relevant studies using critical appraisal skills program scoring. Risk ratios and risk differences were calculated in Rev Man 5.1. Subgroup analysis was performed on matched cohort studies. Main Outcome Measure(s) Antepartum hemorrhage, very preterm birth, preterm birth, small for gestational age, low birth weight, very low birth weight, cesarean section, congenital anomalies, perinatal mortality, and admission to neonatal intensive care unit. Result(s) Eleven studies met the inclusion criteria. Singleton pregnancies after the transfer of frozen thawed embryos were associated with better perinatal outcomes compared with those after fresh IVF embryos. The relative risks (RR) and 95{\%} confidence intervals (CI) of antepartum hemorrhage (RR = 0.67, 95{\%} CI 0.55–0.81), preterm birth (RR = 0.84, 95{\%} CI 0.78–0.90), small for gestational age (RR = 0.45, 95{\%} CI 0.30–0.66), low birth weight (RR = 0.69, 95{\%} CI 0.62–0.76), and perinatal mortality (RR = 0.68, 95{\%} CI 0.48–0.96) were lower in women who received frozen embryos. Conclusion(s) Although fresh ET is the norm in IVF, results of this systematic review of observational studies suggest that pregnancies arising from the transfer of frozen thawed IVF embryos seem to have better obstetric and perinatal outcomes.",
keywords = "IVF, ICSI, obstetric outcomes, perinatal outcomes, frozen replacement cycles",
author = "Abha Maheshwari and Shilpi Pandey and Ashalatha Shetty and Mark Hamilton and Siladitya Bhattacharya",
year = "2012",
month = "8",
doi = "10.1016/j.fertnstert.2012.05.019",
language = "English",
volume = "98",
pages = "368--377.e9",
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TY - JOUR

T1 - Obstetric and perinatal outcomes in singleton pregnancies resulting from the transfer of frozen thawed versus fresh embryos generated through in vitro fertilization treatment

T2 - a systematic review and meta-analysis

AU - Maheshwari, Abha

AU - Pandey, Shilpi

AU - Shetty, Ashalatha

AU - Hamilton, Mark

AU - Bhattacharya, Siladitya

PY - 2012/8

Y1 - 2012/8

N2 - Objective To perform a systematic review and meta-analysis of obstetric and perinatal complications in singleton pregnancies after the transfer of frozen thawed and fresh embryos generated through IVF. Design Systematic review. Setting Observational studies, comparing obstetric and perinatal outcomes in singleton pregnancies subsequent to frozen thawed ET versus fresh embryo transfer, were included from Medline, EMBASE, Cochrane Central Register of Clinical Trials, DARE, and CINAHL (1984–2012). Patient(s) Women undergoing IVF/intracytoplasmic sperm injection (ICSI). Intervention(s) Two independent reviewers extracted data and assessed the methodological quality of the relevant studies using critical appraisal skills program scoring. Risk ratios and risk differences were calculated in Rev Man 5.1. Subgroup analysis was performed on matched cohort studies. Main Outcome Measure(s) Antepartum hemorrhage, very preterm birth, preterm birth, small for gestational age, low birth weight, very low birth weight, cesarean section, congenital anomalies, perinatal mortality, and admission to neonatal intensive care unit. Result(s) Eleven studies met the inclusion criteria. Singleton pregnancies after the transfer of frozen thawed embryos were associated with better perinatal outcomes compared with those after fresh IVF embryos. The relative risks (RR) and 95% confidence intervals (CI) of antepartum hemorrhage (RR = 0.67, 95% CI 0.55–0.81), preterm birth (RR = 0.84, 95% CI 0.78–0.90), small for gestational age (RR = 0.45, 95% CI 0.30–0.66), low birth weight (RR = 0.69, 95% CI 0.62–0.76), and perinatal mortality (RR = 0.68, 95% CI 0.48–0.96) were lower in women who received frozen embryos. Conclusion(s) Although fresh ET is the norm in IVF, results of this systematic review of observational studies suggest that pregnancies arising from the transfer of frozen thawed IVF embryos seem to have better obstetric and perinatal outcomes.

AB - Objective To perform a systematic review and meta-analysis of obstetric and perinatal complications in singleton pregnancies after the transfer of frozen thawed and fresh embryos generated through IVF. Design Systematic review. Setting Observational studies, comparing obstetric and perinatal outcomes in singleton pregnancies subsequent to frozen thawed ET versus fresh embryo transfer, were included from Medline, EMBASE, Cochrane Central Register of Clinical Trials, DARE, and CINAHL (1984–2012). Patient(s) Women undergoing IVF/intracytoplasmic sperm injection (ICSI). Intervention(s) Two independent reviewers extracted data and assessed the methodological quality of the relevant studies using critical appraisal skills program scoring. Risk ratios and risk differences were calculated in Rev Man 5.1. Subgroup analysis was performed on matched cohort studies. Main Outcome Measure(s) Antepartum hemorrhage, very preterm birth, preterm birth, small for gestational age, low birth weight, very low birth weight, cesarean section, congenital anomalies, perinatal mortality, and admission to neonatal intensive care unit. Result(s) Eleven studies met the inclusion criteria. Singleton pregnancies after the transfer of frozen thawed embryos were associated with better perinatal outcomes compared with those after fresh IVF embryos. The relative risks (RR) and 95% confidence intervals (CI) of antepartum hemorrhage (RR = 0.67, 95% CI 0.55–0.81), preterm birth (RR = 0.84, 95% CI 0.78–0.90), small for gestational age (RR = 0.45, 95% CI 0.30–0.66), low birth weight (RR = 0.69, 95% CI 0.62–0.76), and perinatal mortality (RR = 0.68, 95% CI 0.48–0.96) were lower in women who received frozen embryos. Conclusion(s) Although fresh ET is the norm in IVF, results of this systematic review of observational studies suggest that pregnancies arising from the transfer of frozen thawed IVF embryos seem to have better obstetric and perinatal outcomes.

KW - IVF

KW - ICSI

KW - obstetric outcomes

KW - perinatal outcomes

KW - frozen replacement cycles

U2 - 10.1016/j.fertnstert.2012.05.019

DO - 10.1016/j.fertnstert.2012.05.019

M3 - Article

VL - 98

SP - 368-377.e9

JO - Fertility and Sterility

JF - Fertility and Sterility

SN - 0015-0282

IS - 2

ER -