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Pregnancy outcome after assisted reproductive technology

Richard Paulson, MD
Section Editors
Charles J Lockwood, MD, MHCM
Robert L Barbieri, MD
Deputy Editor
Kristen Eckler, MD, FACOG


The first pregnancy after in vitro fertilization (IVF) of a human egg and the first birth of an in vitro-fertilized baby were reported in 1976 and 1978, respectively [1,2]. Since then, over five million pregnancies have been achieved worldwide by IVF and its modifications [3]. These procedures are known generically as assisted reproductive technology (ART) and include gamete intrafallopian transfer (GIFT), and zygote intrafallopian transfer (ZIFT). In the United States, approximately 1.5 percent of all births [4] and 20 percent of all multiple births are the result of IVF [5]; the rate is higher when all types of medically-assisted conception are considered.

As experience has accumulated, ART success rates have increased and the indications for these procedures have expanded. Concerns about the outcome of these pregnancies have accompanied their increasing prevalence. Both short and long-term outcomes have been studied and the findings are generally reassuring [6,7]. However, research in this field is complicated by the need to distinguish between the effects of ART on outcomes in offspring versus multiple other confounding or mediating factors. Furthermore, these outcomes are influenced by technological changes in the performance of ART, as well as changes in obstetrical and neonatal care, over time [6].

The outcome of pregnancies conceived by ART will be discussed here. An in-depth discussion of IVF and intracytoplasmic sperm injection (ICSI) procedures themselves can be found separately. (See "In vitro fertilization" and "Intracytoplasmic sperm injection".)


Pregnancy rates after ART are influenced by a variety of factors, which are discussed in detail separately. (See "In vitro fertilization", section on 'Pre-cycle factors associated with success' and "In vitro fertilization", section on 'Pregnancy and live birth rate'.)


Conception by IVF is associated with an increased incidence of several obstetrical and perinatal complications. Most of these are related to the high incidence of multiple gestations. Whereas multiple gestations achieved by IVF appear to have similar outcomes to those of multiple gestations conceived spontaneously, singleton pregnancies after IVF are associated with an increased incidence of complications [8]. The precise reasons for this increase in adverse outcomes are not clear, but potential candidates include: maternal and paternal characteristics, underlying medical conditions associated with subfertility and infertility, sperm factors, the use of fertility medications, laboratory conditions during embryo culture, culture medium, cryopreservation and thawing, prenatal genetic diagnosis (if performed), differences in obstetrical management, increased proportion of multiple gestations and vanishing twins, or a combination of these factors. The effects of advanced maternal age also need to be considered since many women who undergo IVF are older and older women are more likely to have pregnancy complications. (See "Effect of advanced age on fertility and pregnancy in women".)


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Literature review current through: Nov 2016. | This topic last updated: Mon Nov 21 00:00:00 GMT 2016.
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