Inpatient hospitalizations in women with and without assisted reproductive technology live birth

Purpose The aim of this study is to evaluate frequency of hospitalization before, during, and after assisted reproductive technology (ART) treatment by cycle outcome.

Six thousand and one hundred thirty women residing in Massachusetts undergoing 17,135 cycles of ART reported to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SARTCORS) from 2004 to 2011 were linked to hospital discharges and vital records. Women were grouped according to ART treatment cycle outcome as: no pregnancy (n = 1840), one or more pregnancies but no live birth (n = 968), or one or more singleton live births (n = 3322). Hospital delivery discharges during 1998–2011 were categorized as occurring before, during, or after the ART treatment. The most prevalent ICD-9 codes for non-delivery hospital discharges were compared. Groups were compared using chi square test using SAS 9.3 software.

The proportion of any hospitalization was 57.0, 58.3, and 91.3% for women with no pregnancy, no live birth, and ART singleton live birth, respectively; the proportion of non-delivery hospitalizations was 30.4, 31.0, and 28.3%, respectively. The non-ART delivery proportion after ART treatment did not differ by group (33.4, 36.2, and 36.9%, respectively, p = 0.17). Most frequent non-delivery diagnoses (including fibroids, obesity, ectopic pregnancy, depression, and endometriosis) also did not differ by group. A secondary analysis limited to only women with no delivery discharges before the first ART cycle showed similar results.

All groups had live birth deliveries during the study period, suggesting an important contribution of non-ART treatment or treatment-independent conception to overall delivery and live births. Hospitalizations not associated with delivery suggested similarity in morbidity for all ART patients regardless of success with ART treatment. Similar content being viewed by others

Chandra A, Copen CE, Stephen EH. Infertility service use in the United States: data from the National Survey of Family Growth, 1982–2010. National Health Statistics Reports, No. 73, January 22, 2014. Toner JP, Coddington CC, Doody K, Van Voorhis B, Seifer DB, Ball GD, et al. Society for Assisted Reproductive Technology and assisted reproductive technology in the United States: a 2016 update. Fertil Steril. 2016;106:541–6. Centers for Disease Control and Prevention. Figures from the 2014 Assisted Reproductive Technology National Summary Report. https://www.cdc.gov/art/pdf/2014-national-summary-slides/art_2014_graphs_and_charts.pdf. Accessed 12/14/2016. Olivius C, Friden B, Borg G, Bergh C. Why do couples discontinue in vitro fertilization treatment? A cohort study. Fertil Steril. 2004;81:258–61. Van Dongen AJCM, Verhagen TEM, Dumoulin JCM, Land JA, Evers JLH. Reasons for dropping out from a waiting list for in vitro fertilization. Fertil Steril. 2010;94:1713–6. Shimizu Y, Kodama H, Fukuda J, Murata M, Kumagai J, Tanaka T. Spontaneous conception after the birth of infants conceived through in vitro fertilization treatment. Fertil Steril. 1999;71:35–9. Shimizu Y, Yamaguchi W, Takashima A, Kaku S, Kita N, Murakami T. Long-term cumulative pregnancy rate in women with unexplained infertility after laparoscopic surgery followed by in vitro fertilization or in vitro fertilization. J Obstet Gynecol Res. 2011;37:412–5. doi:10.1111/j.1447-0756.2010.01369.x. Troude P, Bailly E, Guibert J, Bouyer J, de la Rochebrochard E. Spontaneous pregnancies among couples previously treated by in vitro fertilization. Fertil Steril. 2012;98:63–8. Ludwig AK. Spontaneous pregnancy after successful ICSI treatment: evaluation of risk factors in 899 families in Germany. RBM Online. 2008;17:403–9. Hennelly B, Harrison RF, Kelly J, Jacob S, Barrett T. Spontaneous conception after a successful attempt at in vitro fertilization/intracytoplasmic sperm injection. Fertil Steril. 2000;73:774–8. Helmerhorst FM, Perquin DAM, Donker D, Keirse JNC. Perinatal outcome of singletons and twins after assisted conception: a systematic review of controlled studies. BMJ. 2004;328:261–6. Henningsen AKA, Pinborg A, Lidegaard Ø, Vestergaard C, Forman JL, Andersen AN. Perinatal outcome of singleton siblings born after assisted reproductive technology and spontaneous conception: Danish national sibling-cohort study. Fertil Steril. 2011;95:959–63. Hansen M, Kurinczuk JJ, Bower C, Webb S. The risk of major birth defects after intracytoplasmic sperm injection and in vitro fertilization. N Engl J Med. 2002;346:725–30. Pinborg A, Wennerholm UB, Romundstad LB, Loft A, Aittomaki K, Soderstrom-Anttila V, et al. Why do singletons conceived after assisted reproduction technology have adverse perinatal outcome? Systematic review and meta-analysis. Hum Reprod Update. 2013;19:87–104. doi:10.1093/humupd/dms044. 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;98:368–77. Allen VM, Wilson RD, Cheung A, Blight C, Desilets VA, Gagnon A, et al. Pregnancy outcomes after assisted reproductive technology. J Obstet Gynaecol Can. 2006;28:220–33. Declercq ER, Belanoff C, Diop H, Gopal D, Hornstein MD, Kotelchuck M, et al. Identifying women with indicators of subfertility in a statewide population database: operationalizing the missing link in assisted reproductive technology research. Fertil Steril. 2014;101:463–71. Luke B, Stern JE, Kotelchuck M, Declercq E, Gopal D, Hoang L, et al. Adverse pregnancy outcomes after in vitro fertilization: effect of number of embryos transferred and plurality at conception. Fertil Steril. 2015;104:79–86. Stern JE, Luke B, Tobias M, Gopal D, Hornstein MD, Diop H. Adverse pregnancy and birth outcomes by infertility diagnoses with and without ART treatment. Fertil Steril. 2015;103:1438–45. Belanoff CB, Declercq ER, Diop H, Gopal D, Kotelchuck M, Luke B, et al. Severe maternal morbidity and the use of assisted reproductive technology in Massachusetts. Obstet Gynecol. 2016;127:527–34. Martin AS, Monsour M, Kissin DM, Jamieson DJ, Callaghan WM, Boulet SL. Trends in severe maternal morbidity after assisted reproductive technology in the United States, 2008–2012. Obstet Gynecol. 2016;127:59–66. Azem F, Yovel AMI, Amit A, Lessing JB, Kupferminc MJ. Increased rates of thrombophilia in women with repeated IVF failures. Hum Reprod. 2004;19:368–70. doi:10.1093/humrep/deh069. Althuis MD, Moghissi KS, Westhoff CL, Scoccia B, Lamb MJ, Lubin JH, et al. Uterine cancer after use of clomiphene citrate to induce ovulation. Amer J Epidemiol. 2005;161:607–15. Ness RB. The consequences for human reproduction of a robust inflammatory response. Q Rev Biol. 2004;79:383–93. Declercq ER, Luke B, Belanoff C, Cabral H, Diop H, Gopal D, et al. Perinatal outcomes associated with assisted reproductive technology: the Massachusetts Outcomes Study of Assisted Reproductive Technologies (MOSART). Fertil Steril. 2015;103:888–95. Dunietz GL, Holzman C, McKane P, Li C, Boulet SL, Todem D, et al. Assisted reproductive technology and the risk of preterm birth among primiparas. Fertil Steril. 2015;103:974–9. Luke S, Sappenfield WM, Kirby RS, McKane P, Bernson D, Zhang Y, et al. The impact of ART on live birth outcomes: differing experiences across three states. Paediatr Perinat Epidemiol. 2016;30:209–16. Cohen B, Bernson D, Sappenfield W, Kirby RS, Kissin D, Zhang Y, et al., States Monitoring Assisted Reproductive Technology (SMART) Collaborative. Accuracy of assisted reproductive technology information on birth certificates: Florida and Massachusetts, 2004–06. Paediatr Perinat Epidemiol. 2014;28:181–90. Kawwass JF, Kissi DM, Kulkarni AD, Creanga AA, Session DR, Callaghan WM, et al. Safety of assisted reproductive technology in the United States, 2000–2011. JAMA. 2015;313:88–90. Bosteels J, Weyers S, Mathieu C, Mol W, Hooghe TD. The effectiveness of reproductive surgery in the treatment of female infertility: facts, views and vision. F, V & V IN OBGyN. 2010;2:232–52. Hassa H, Aydin Y. The role of laparoscopy in the management of infertility. J Obstet Gynaecol. 2014;34:1–7. Kodaman PH. Current strategies for endometriosis management. Obstet Gynecol Clinics. 2015;42:87–101. Costello MF, Ledger WL. Evidence-based management of infertility in women with polycystic ovary syndrome using surgery or assisted reproductive technology. Women's Health. 2012;8:291–300. Yli-Kuha AN, Gissler M, Klemetti R, Luoto R, Koivisto E, Hemminki E. Psychiatric disorders leading to hospitalization before and after infertility treatments. Hum Reprod. 2010;25:2018–23. Baldur-Felskov B, Kjaer SK, Albieri V, Steding-Jessen M, Kjaer T, Johansen C, et al. Psychiatric disorders in women with fertility problems: results from a large Danish register-based cohort study. Hum Reprod. 2013;28:683–90. doi:10.1093/humrep/des422. Kotelchuck M, Hoang L, Stern JE, Diop H, Belanoff C, Declercq ER. The MOSART database: linking the SART CORS clinical database to the population-based Massachusetts PELL reproductive public health data system. Maternal Child Health Journal. 2014;18:2167–78. Acknowledgments SART wishes to thank all of its members for providing clinical information to the SARTCORS database for use by patients and researchers. Without the efforts of our members, this research would not have been possible. We wish to acknowledge the excellent technical support from the Massachusetts Center for Health Information and Analysis. Author information Authors and Affiliations Corresponding author Ethics declarations Conflict of interest BL is a research consultant to the Society for Assisted Reproductive Technology (SART). JES, DG, SM, CCC have no conflicts to declare. Funding NIH 2R01HD067270 The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Child Health and Human Development or the National Institutes of Health. Rights and permissions About this article Cite this article Stern, J.E., Gopal, D., Diop, H. et al. Inpatient hospitalizations in women with and without assisted reproductive technology live birth. J Assist Reprod Genet 34, 1043–1049 (2017). https://doi.org/10.1007/s10815-017-0961-z Received: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s10815-017-0961-z