Top

Published in:

Open Access 01-12-2021 | ICSI | Research article

Caesarean section in pregnancies conceived by assisted reproductive technology: a systematic review and meta-analysis

Authors: Nakeisha A. Lodge-Tulloch, Flavia T. S. Elias, Jessica Pudwell, Laura Gaudet, Mark Walker, Graeme N. Smith, Maria P. Velez

Published in: BMC Pregnancy and Childbirth | Issue 1/2021

Abstract

Background

Caesarean section rates are higher among pregnancies conceived by assisted reproductive technology (ART) compared to spontaneous conceptions (SC), implying an increase in neonatal and maternal morbidity. We aimed to compare caesarean section rates in ART pregnancies versus SC, overall, by indication (elective versus emergent), and by type of ART treatment (in-vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), fresh embryo transfer, frozen embryo transfer) in a systematic review and meta-analysis.

Methods

We searched Medline, EMBASE and CINAHL databases using the OVID Platform from 1993 to 2019, and the search was completed in January 2020. The eligibility criteria were cohort studies with singleton conceptions after in-vitro fertilization and/or intracytoplasmic sperm injection using autologous oocytes versus spontaneous conceptions. The study quality was assessed using the Newcastle Ottawa Scale and GRADE approach. Meta-analyses were performed using odds ratios (OR) with a 95% confidence interval (CI) using random effect models in RevMan 5.3, and I-squared (I²) test > 75% was considered as high heterogeneity.

Results

One thousand seven hundred fifty studies were identified from the search of which 34 met the inclusion criteria. Compared to spontaneous conceptions, IVF/ICSI pregnancies were associated with a 1.90-fold increase of odds of caesarean section (95% CI 1.76, 2.06). When stratified by indication, IVF/ICSI pregnancies were associated with a 1.91-fold increase of odds of elective caesarean section (95% CI 1.37, 2.67) and 1.38-fold increase of odds of emergent caesarean section (95% CI 1.09, 1.75). The heterogeneity of the studies was high and the GRADE assessment moderate to low, which can be explained by the observational design of the included studies.

Conclusions

The odds of delivering by caesarean section are greater for ART singleton pregnancies compared to spontaneous conceptions. Preconception and pregnancy care plans should focus on minimizing the risks that may lead to emergency caesarean sections and finding strategies to understand and decrease the rate of elective caesarean sections.

Available only for authorised users

National Institute of Child Health and Human Development. How common is infertility? 2019. Available from: https://www.nichd.nih.gov/health/topics/infertility/conditioninfo/common

World Health Organization. Infertility definitions and terminology; 2019. Available from: https://www.who.int/reproductivehealth/topics/infertility/definitions/en/

Velez MP, Hamel C, Hutton B, Gaudet L, Walker M, Thuku M, et al. Care plans for women pregnant using assisted reproductive technologies: a systematic review. Reprod Health. 2019;16(1):9. https://doi.org/10.1186/s12978-019-0667-z.CrossRefPubMedPubMedCentral

Pandey S, Shetty A, Hamilton M, Bhattacharya S, Maheshwari A. Obstetric and perinatal outcomes in singleton pregnancies resulting from IVF/ICSI: a systematic review and meta-analysis. Hum Reprod Update. 2012;18(5):485–503. https://doi.org/10.1093/humupd/dms018.CrossRefPubMed

Betran A, Torloni M, Zhang J, Gülmezoglu A, Section tWWGoC. WHO statement on caesarean section rates. BJOG. 2016;123(5):667–70. https://doi.org/10.1111/1471-0528.13526.CrossRefPubMed

Boerma T, Ronsmans C, Melesse DY, Barros AJD, Barros FC, Juan L, et al. Global epidemiology of use of and disparities in caesarean sections. Lancet. 2018;392(10155):1341–8. https://doi.org/10.1016/S0140-6736(18)31928-7.CrossRefPubMed

Maheshwari A, Pandey S, Shetty A, Hamilton M, Bhattacharya S. 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. Fertil Steril. 2012;98(2):368–77 e1–9.CrossRef

Jeve YB, Potdar N, Opoku A, Khare M. Donor oocyte conception and pregnancy complications: a systematic review and meta-analysis. BJOG. 2016;123(9):1471–80. https://doi.org/10.1111/1471-0528.13910.CrossRefPubMed

Qin JB, Wang H, Sheng X, Xie Q, Gao S. Assisted reproductive technology and risk of adverse obstetric outcomes in dichorionic twin pregnancies: a systematic review and meta-analysis. Fertil Steril. 2016;105(5):1180–92. https://doi.org/10.1016/j.fertnstert.2015.12.131.CrossRefPubMed

10.

McDonald S, Murphy K, Beyene J, Ohlsson A. Perinatal outcomes of in vitro fertilization twins: a systematic review and meta-analyses. Am J Obstet Gynecol. 2005;193(1):141–52. https://doi.org/10.1016/j.ajog.2004.11.064.CrossRefPubMed

11.

Jackson RA, Gibson KA, Wu YW, Croughan MS. Perinatal outcomes in singletons following in vitro fertilization: a meta-analysis. Obstet Gynecol. 2004;103(3):551–63. https://doi.org/10.1097/01.AOG.0000114989.84822.51.CrossRefPubMed

12.

Helmerhorst FM, Perquin DAM, Donker D, Keirse MJNC. Perinatal outcome of singletons and twins after assisted conception: a systematic review of controlled studies. BMJ. 2004;328(7434):261.CrossRef

13.

Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. 2009;62(10):1006–12. https://doi.org/10.1016/j.jclinepi.2009.06.005.CrossRefPubMed

14.

Lucas DN, Yentis SM, Kinsella SM, Holdcroft A, May AE, Wee M, et al. Urgency of caesarean section: a new classification. J R Soc Med. 2000;93(7):346–50. https://doi.org/10.1177/014107680009300703.CrossRefPubMedPubMedCentral

15.

Wells GA, Shea B, O'Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa scale (NOS) for assessing the quality if nonrandomized studies in meta-analyses; 2009. Available from: http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm

16.

Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, et al. Cochrane handbook for systematic reviews of interventions version 6.1 (updated September 2020): Cochrane; 2020. Available from: www.training.cochrane.org/handbook

17.

Schünemann H, Brozek J, Guyatt G, Oxman A. GRADE handbook for grading quality of evidence and strength of recommendation. Version 3.6. Hamilton: McMaster University, GRADE Working Group; 2011.

18.

Fedder J, Loft A, Parner ET, Rasmussen S, Pinborg A. Neonatal outcome and congenital malformations in children born after ICSI with testicular or epididymal sperm: a controlled national cohort study. Hum Reprod. 2013;28(1):230–40. https://doi.org/10.1093/humrep/des377.CrossRefPubMed

19.

Katalinic A, Rosch C, Ludwig M. Pregnancy course and outcome after intracytoplasmic sperm injection: a controlled, prospective cohort study. Fertil Steril. 2004;81(6):1604–16. https://doi.org/10.1016/j.fertnstert.2003.10.053.CrossRefPubMed

20.

Koudstaal J, Braat DD, Bruinse HW, Naaktgeboren N, Vermeiden JPW, Visser GHA. Obstetric outcome of singleton pregnancies after IVF: a matched control study in four Dutch university hospitals. Hum Reprod. 2000;15(8):1819–25. https://doi.org/10.1093/humrep/15.8.1819.CrossRefPubMed

21.

Olivennes F, Rufat P, Andre B, Pourade A, Quiros MC, Frydman R. The increased risk of complication observed in singleton pregnancies resulting from in-vitro fertilization (IVF) does not seem to be related to the IVF method itself. Hum Reprod. 1993;8(8):1297–300. https://doi.org/10.1093/oxfordjournals.humrep.a138245.CrossRefPubMed

22.

Shevell T, Malone FD, Vidaver J, Porter TF, Luthy DA, Comstock CH, et al. Assisted reproductive technology and pregnancy outcome. Obstet Gynecol. 2005;106(5 I):1039–45.CrossRef

23.

Wennerholm UB, Henningsen AA, Romundstad LB, Bergh C, Pinborg A, Skjaerven R, et al. Perinatal outcomes of children born after frozen-thawed embryo transfer: a Nordic cohort study from the CoNARTaS group. Hum Reprod. 2013;28(9):2545–53. https://doi.org/10.1093/humrep/det272.CrossRefPubMed

24.

Källén B, Finnström O, Nygren KG, Otterblad Olausson P, Wennerholm UB. In vitro fertilisation in Sweden: obstetric characteristics, maternal morbidity and mortality. BJOG. 2005;112(11):1529-35. https://doi.org/10.1111/j.1471-0528.2005.00745.x

25.

Wennerholm UB, Hamberger L, Nilsson L, Wennergren M, Wikland M, Bergh C. Obstetric and perinatal outcome of children conceived from cryopreserved embryos. Hum Reprod. 1997;12(8):1819-25. https://doi.org/10.1093/humrep/12.8.1819.

26.

Anzola AB, Pauly V, Riviere O, Sambuc R, Boyer P, Vendittelli F, et al. Birthweight of IVF children is still a current issue and still related to maternal factors. Reprod Biomed Online. 2019;39(6):991–9.

27.

Apantaku O, Chandrasekaran I, Bentick B. Obstetric outcome of singleton pregnancies achieved with in vitro fertilisation and intracytoplasmic sperm injection: experience from a district general hospital. J Obstet Gynaecol. 2008;28(4):398–402. https://doi.org/10.1080/01443610802091792.CrossRefPubMed

28.

Buckett WM, Chian R-C, Holzer H, Dean N, Usher R, Tan SL. Obstetric outcomes and congenital abnormalities after in vitro maturation, in vitro fertilization, and intracytoplasmic sperm injection. Obstet Gynecol. 2007;110(4):885–91. https://doi.org/10.1097/01.AOG.0000284627.38540.80.CrossRefPubMed

29.

D'Souza SW, Rivlin E, Cadman J, Richards B, Buck P, Lieberman BA. Children conceived by in vitro fertilisation after fresh embryo transfer. Arch Dis Child Fetal Neonatal Ed. 1997;76(2):F70–4. https://doi.org/10.1136/fn.76.2.F70.CrossRefPubMedPubMedCentral

30.

Ensing S, Abu-Hanna A, Roseboom TJ, Repping S, Van Der Veen F, Mol BWJ, et al. Risk of poor neonatal outcome at term after medically assisted reproduction: a propensity score-matched study. Fertil Steril. 2015;104(2):384–390.e1. https://doi.org/10.1016/j.fertnstert.2015.04.035.CrossRefPubMed

31.

Gillet E, Martens E, Martens G, Cammu H. Prelabour caesarean section following IVF/ICSI in older-term nulliparous women: too precious to push? J Pregnancy. 2011;2011(101553823):362518.PubMedPubMedCentral

32.

Ochsenkuhn R, Strowitzki T, Gurtner M, Strauss A, Schulze A, Hepp H, et al. Pregnancy complications, obstetric risks, and neonatal outcome in singleton and twin pregnancies after GIFT and IVF. Arch Gynecol Obstet. 2003;268(4):256–61. https://doi.org/10.1007/s00404-003-0518-5.CrossRefPubMed

33.

Olson CK, Keppler-Noreuil KM, Romitti PA, Budelier WT, Ryan G, Sparks AET, et al. In vitro fertilization is associated with an increase in major birth defects. Fertil Steril. 2005;84(5):1308–15. https://doi.org/10.1016/j.fertnstert.2005.03.086.CrossRefPubMed

34.

Perri T, Chen R, Yoeli R, Merlob P, Orvieto R, Shalev Y, et al. Are singleton assisted reproductive technology pregnancies at risk of prematurity? J Assist Reprod Genet. 2001;18(5):245–9. https://doi.org/10.1023/A:1016614217411.CrossRefPubMedPubMedCentral

35.

Pinborg A, Loft A, Henningsen AA, Rasmussen S, Andersen AN. Infant outcome of 957 singletons born after frozen embryo replacement: the Danish National Cohort Study 1995-2006. Fertil Steril. 2010;94(4):1320–7. https://doi.org/10.1016/j.fertnstert.2009.05.091.CrossRefPubMed

36.

Poikkeus P, Gissler M, Unkila-Kallio L, Hyden-Granskog C, Tiitinen A. Obstetric and neonatal outcome after single embryo transfer. Hum Reprod. 2007;22(4):1073–9. https://doi.org/10.1093/humrep/del492.CrossRefPubMed

37.

Stojnic J, Radunovic N, Jeremic K, Kotlica BK, Mitrovic M, Tulic I. Perinatal outcome of singleton pregnancies following in vitro fertilization. Clin Exp Obstet Gynecol. 2013;40(2):277–83.PubMed

38.

Sun L-M, Lanes A, Kingdom CH, Kramer M, Wen SW, et al. Intrapartum interventions for singleton pregnancies arising from assisted reproductive technologies. J Obstet Gynaecol Can. 2014;36(9):795–802. https://doi.org/10.1016/S1701-2163(15)30481-3.CrossRefPubMed

39.

Tomic V, Tomic J. Neonatal outcome of IVF singletons versus naturally conceived in women aged 35 years and over. Arch Gynecol Obstet. 2011;284(6):1411–6. https://doi.org/10.1007/s00404-011-1873-2.CrossRefPubMed

40.

Beyer DA, Amari F. Maternal risk factors and neonatal outcomes after ART treatment - a German monocenter experience. Middle East Fertil Soc J. 2016;21(3):155–60. https://doi.org/10.1016/j.mefs.2015.12.001.CrossRef

41.

Carbillon L, Gronier H, Cedrin-Durnerin I, Pharisien I, Nguyen T, Valensi P, et al. The impact of ovulation induction and ovarian stimulation on the risk of pregnacy-induced hypertension and on neonatal outcomes: a case/control study. Eur J Obstet Gynecol Reprod Biol. 2017;217:137–43. https://doi.org/10.1016/j.ejogrb.2017.08.032.CrossRefPubMed

42.

Dayan N, Fell DB, Guo Y, Wang H, Velez MP, Spitzer K, et al. Severe maternal morbidity in women with high BMI in IVF and unassisted singleton pregnancies. Hum Reprod. 2018;33(8):1548–56. https://doi.org/10.1093/humrep/dey224.CrossRefPubMed

43.

Ernstad EG, Bergh C, Khatibi A, Kallen B, Westlander G, Nilsson S, et al. Neonatal and maternal outcome after blastocyst transfer: a population-based registry study. Am J Obstet Gynecol. 2016;214(3):1–10.CrossRef

44.

Farhi A, Reichman B, Boyko V, Hourvitz A, Ron-El R, Lerner-Geva L. Maternal and neonatal health outcomes following assisted reproduction. Reprod Biomed Online. 2013;26(5):454–61. https://doi.org/10.1016/j.rbmo.2013.01.014.CrossRefPubMed

45.

Gambadauro P, Iliadis S, Brann E, Skalkidou A. Conception by means of in vitro fertilization is not associated with maternal depressive symptoms during pregnancy or postpartum. Fertil Steril. 2017;108(2):325–32. https://doi.org/10.1016/j.fertnstert.2017.06.006.CrossRefPubMed

46.

Harlev A, Walfisch A, Oran E, Har-Vardi I, Friger M, Lunenfeld E, et al. The effect of fertility treatment on adverse perinatal outcomes in women aged at least 40 years. Int J Gynaecol Obstet. 2018;140(1):98–104. https://doi.org/10.1002/ijgo.12345.CrossRefPubMed

47.

Malchau SS, Loft A, Henningsen A-KA, Nyboe Andersen A, Pinborg A. Perinatal outcomes in 6,338 singletons born after intrauterine insemination in Denmark, 2007 to 2012: the influence of ovarian stimulation. Fertil Steril. 2014;102(4):1110–6.e2.CrossRef

48.

Rahu K, Allvee K, Karro H, Rahu M. Singleton pregnancies after in vitro fertilization in Estonia: a register-based study of complications and adverse outcomes in relation to the maternal socio-demographic background. BMC Pregnancy Childbirth. 2019;19(1):51. https://doi.org/10.1186/s12884-019-2194-x.CrossRefPubMedPubMedCentral

49.

Romundstad LB, Romundstad PR, Sunde A, von During V, Skjaerven R, Gunnell D, et al. Effects of technology or maternal factors on perinatal outcome after assisted fertilisation: a population-based cohort study. Lancet. 2008;372(9640):737–43. https://doi.org/10.1016/S0140-6736(08)61041-7.CrossRefPubMed

50.

Sazonova A, Kallen K, Thurin-Kjellberg A, Wennerholm UB, Bergh C. Obstetric outcome in singletons after in-vitro fertilization with cryopreserved/thawed embryos. Hum Reprod. 2012;27(5):1343–50. https://doi.org/10.1093/humrep/des036.CrossRefPubMed

51.

Suzuki S, Miyake H. Obstetric outcomes of elderly primiparous singleton pregnancies conceived by in vitro fertilization compared with those conceived spontaneously. Reprod Med Biol. 2007;6(4):219–22. https://doi.org/10.1111/j.1447-0578.2007.00188.x.CrossRefPubMedPubMedCentral

52.

Toshimitsu M, Nagamatsu T, Nagasaka T, Iwasawa-Kawai Y, Komatsu A, Yamashita T, et al. Increased risk of pregnancy-induced hypertension and operative delivery after conception induced by in vitro fertilization/intracytoplasmic sperm injection in women aged 40 years and older. Fertil Steril. 2014;102(4):1065–70.e1.CrossRef

53.

Liu J, Linara E, Zhao W, Ma H, Ahuja K, Wang J. Neonatal and obstetric outcomes of in vitro fertilization (IVF) and natural conception at a Chinese reproductive unit. Clin Exp Obstet Gynecol. 2015;42(4):452–6.PubMed

54.

Vogel JP, Betran AP, Vindevoghel N, Souza JP, Torloni MR, Zhang J, et al. Use of the Robson classification to assess caesarean section trends in 21 countries: a secondary analysis of two WHO multicountry surveys. Lancet Glob Health. 2015;3(5):e260–70. https://doi.org/10.1016/S2214-109X(15)70094-X.CrossRefPubMed

55.

Bhatia M, Banerjee K, Dixit P, Dwivedi LK. Assessment of variation in cesarean delivery rates between public and private health facilities in India from 2005 to 2016. JAMA Netw Open. 2020;3(8):e2015022. https://doi.org/10.1001/jamanetworkopen.2020.15022.CrossRefPubMedPubMedCentral

56.

Sk R. Does delivery in private hospitals contribute largely to caesarean section births? A path analysis using generalised structural equation modelling. PLoS One. 2020;15(10):e0239649. https://doi.org/10.1371/journal.pone.0239649.CrossRefPubMedPubMedCentral

57.

Chambers GM, Sullivan EA, Ishihara O, Chapman MG, Adamson GD. The economic impact of assisted reproductive technology: a review of selected developed countries. Fertil Steril. 2009;91(6):2281–94. https://doi.org/10.1016/j.fertnstert.2009.04.029.CrossRefPubMed

58.

Elias FTS, Weber-Adrian D, Pudwell J, Carter J, Walker M, Gaudet L, et al. Neonatal outcomes in singleton pregnancies conceived by fresh or frozen embryo transfer compared to spontaneous conceptions: a systematic review and meta-analysis. Arch Gynecol Obstet. 2020;302(1):31–45. https://doi.org/10.1007/s00404-020-05593-4.CrossRefPubMedPubMedCentral

59.

Dayan N, Joseph KS, Fell D, Laskin C, Basso O, Park A, et al. Infertility treatment and risk of severe maternal morbidity: a propensity score- matched cohort study. Can Med Assoc J. 2019;191(5):E118–E27. https://doi.org/10.1503/cmaj.181124.CrossRef

60.

Bermudez-Tamayo C, Fernandez Ruiz E, Pastor Moreno G, Maroto-Navarro G, Garcia-Mochon L, Perez-Ramos FJ, et al. Barriers and enablers in the implementation of a program to reduce cesarean deliveries. Reprod Health. 2017;14(1):106. https://doi.org/10.1186/s12978-017-0369-3.CrossRefPubMedPubMedCentral

Title: Caesarean section in pregnancies conceived by assisted reproductive technology: a systematic review and meta-analysis
Authors: Nakeisha A. Lodge-Tulloch
Flavia T. S. Elias
Jessica Pudwell
Laura Gaudet
Mark Walker
Graeme N. Smith
Maria P. Velez
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: ICSI
Sectio Ceasarea
Sectio Caesarea
Published in: BMC Pregnancy and Childbirth / Issue 1/2021
Electronic ISSN: 1471-2393
DOI: https://doi.org/10.1186/s12884-021-03711-x

2024 ASCO Annual Meeting

Springer Medicine

Caesarean section in pregnancies conceived by assisted reproductive technology: a systematic review and meta-analysis

Abstract

Background

Methods

Results

Conclusions

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2021

The effect of nutrition and reproductive health education of pregnant women in Indonesia using quasi experimental study

The views of postnatal women and midwives on midwives providing contraceptive advice and methods: a mixed method concurrent study

Association of placental chorangiosis with pregnancy complication and prenatal outcome: a case-control study

Iodine monitoring models contribute to avoid adverse birth outcomes related more than adequate iodine intake

Ultrasonic diagnosis of asymptomatic rupture of uterine in second trimester of pregnancy after laparoscopic surgery for interstitial pregnancy: a case report

Acute relaxation during pregnancy leads to a reduction in maternal electrodermal activity and self-reported stress levels