Risk of stillbirth and neonatal death in singletons born after fresh and frozen embryo transfer: cohort study from the Committee of Nordic Assisted Reproduction Technology and Safety

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  • Kjersti Westvik-Johari
  • Deborah A. Lawlor
  • Liv Bente Romundstad
  • Christina Bergh
  • Ulla Britt Wennerholm
  • Mika Gissler
  • Henningsen, Anna-Karina Aaris
  • Siri E. Håberg
  • Aila Tiitinen
  • Anne Lærke Spangmose
  • Pinborg, Anja
  • Signe Opdahl

Objectives: To investigate whether risks of stillbirth and neonatal death differ after fresh embryo transfers (fresh-ETs) and frozen embryo transfers (frozen-ETs) compared with singletons conceived without medical assistance. Design: A population-based cohort study. Setting: Not applicable. Patient(s): Data linkage between the nationwide Medical Birth Registries in Denmark (1994–2014), Norway and Sweden (1988–2015), and national quality registries and databases on assisted reproductive technology identified a total of 4,590,853 singletons, including 78,642 conceived by fresh-ET and 18,084 by frozen-ET. Intervention(s): None Main Outcome Measure(s): Stillbirth (fetal death before and during delivery) and neonatal death (live born with death 0–27 days postpartum). Result(s): Overall, 17,123 (0.37%) singletons were stillborn and 7,685 (0.17%) died neonatally. Compared with singletons conceived without medical assistance, the odds of stillbirth were similar after fresh-ET and frozen-ET, whereas the odds of neonatal death were high after fresh-ET (odds ratio [OR], 1.69; 95% confidence interval [CI], 1.46–1.95) and frozen-ET (OR, 1.51; 95% CI, 1.08–2.10). Preterm birth (<37 gestational weeks) was more common after fresh-ET (8.0%) and frozen-ET (6.6%) compared with singletons conceived without medical assistance (5.0%), and strongly associated with neonatal mortality across all conception methods. Within gestational age categories, risk of stillbirth and neonatal death was similar for all conception methods, except that singletons from fresh-ET had a higher risk of stillbirth during gestational week 22–27 (OR, 1.85; 95% CI, 1.51–2.26). Conclusion(s): Overall, the risk of stillbirth was similar after fresh-ET and frozen-ET compared with singletons conceived without medical assistance, whereas neonatal mortality was high, possibly mediated by the high risk of preterm birth when compared with singletons conceived without medical assistance. Our results gave no clear support for choosing one treatment over the other.

OriginalsprogEngelsk
TidsskriftFertility and Sterility
Vol/bind119
Udgave nummer2
Sider (fra-til)265-276
Antal sider12
ISSN0015-0282
DOI
StatusUdgivet - 2023

Bibliografisk note

Funding Information:
Supported by the Nordic Trial Alliance : a pilot project jointly funded by the Nordic Council of Ministers and NordForsk grant (71450) the Central Norway Regional Health Authorities grant (46045000) received by L.B.R., the Nordic Federation of Obstetrics and Gynaecology grants (NF13041, NF15058, NF16026, and NF17043) received by U.B.W. and A.T., the Interreg Öresund-Kattegat-Skagerrak European Regional Development Fund (ReproUnion project) to A.P. and C.B., the Research Council of Norway’s Centre of Excellence funding scheme grant (262700) received by S.E.H. and L.B.R., the European Research Council ART-HEALTH 101021566 ERC Advanced grant received by D.A.L., Medical Research Council (MC_UU_00011/6 received by D.A.L.), Bristol National Institute of Health Research Biomedical Research Centre received by D.A.L., National Institute of Health Research Senior Investigator award (NF-0616-10102) received by D.A.L. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Funding Information:
Supported by the Nordic Trial Alliance: a pilot project jointly funded by the Nordic Council of Ministers and NordForsk grant (71450) the Central Norway Regional Health Authorities grant (46045000) received by L.B.R., the Nordic Federation of Obstetrics and Gynaecology grants (NF13041, NF15058, NF16026, and NF17043) received by U.B.W. and A.T., the Interreg Öresund-Kattegat-Skagerrak European Regional Development Fund (ReproUnion project) to A.P. and C.B., the Research Council of Norway's Centre of Excellence funding scheme grant (262700) received by S.E.H. and L.B.R., the European Research Council ART-HEALTH 101021566 ERC Advanced grant received by D.A.L., Medical Research Council (MC_UU_00011/6 received by D.A.L.), Bristol National Institute of Health Research Biomedical Research Centre received by D.A.L., National Institute of Health Research Senior Investigator award (NF-0616-10102) received by D.A.L. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.K.W.J. has nothing to disclose. D.A.L. has received support from Medtronic Ltd. and Roache Diagnostic for research unrelated to this paper. L.B.R. has nothing to disclose. C.B. has nothing to disclose. U.B.W. has nothing to disclose. M.G. has nothing to disclose. A.K.A.H. has nothing to disclose. S.E.H. has nothing to disclose. A.T. has nothing to disclose. A.L.S. has nothing to disclose. A.P. has nothing to disclose. S.O. has nothing to disclose.

Publisher Copyright:
© 2022 The Authors

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