Are pregnancy complications associated with conception methods in female same-sex couples? A retrospective, matched cohort study

RESEARCH QUESTION: Are pregnancies in female same-sex couples at higher risk when using reception of oocytes from partner (ROPA) compared with intrauterine insemination (IUI)? DESIGN: A retrospective, single-centre, matched cohort study was performed from January 2015 to January 2023 in a fertility clinic and included 577 unique female same-sex couples using donor semen who became pregnant (88 following ROPA, 489 following IUI). Patients were included according to their first treatment choice; none opting for ROPA had previously failed IUIs. Pregnancies following ROPA and IUI were matched for age, body mass index, parity and date of embryo transfer/IUI in a 1:1 ratio. Patient and treatment cycle characteristics, pregnancy rates and perinatal outcomes were compared. Primary outcomes were the incidence of hypertensive disorder of pregnancy (HDP) and pre-eclampsia. Secondary outcomes were all other pregnancy complications, neonatal outcomes and delivery mode. RESULTS: After matching, 154 pregnancies (73 ROPA and 77 IUI) were eligible for inclusion. No significant differences in HDP/pre-eclampsia rates were observed except for a significantly higher incidence of preterm pre-eclampsia following ROPA (P = 0.04). A subgroup analysis showed significantly more preterm pre-eclampsia following ROPA when an artificially prepared frozen embryo transfer was performed (P = 0.04). ROPA pregnancies were associated with a higher incidence of preterm birth and first-trimester bleeding (P = 0.002). No statistically significant differences were observed regarding neonatal weight, fetal structural malformations and Caesarean section rates. CONCLUSION: The study highlights potentially increased obstetric risks after ROPA, especially following artificially prepared frozen embryo transfer. These data are crucial to counsel lesbian couples in their decision regarding the method of conception.