Perinatal outcomes among singletons after assisted reproductive technology with single-embryo or double-embryo transfer versus no assisted reproductive technology

Objective: To examine outcomes of singleton pregnancies conceived without assisted reproductive technology (non-ART) compared with singletons conceived with ART by elective single-embryo transfer (eSET), nonelective single-embryo transfer (non-eSET), and double-embryo transfer with the establishment of 1 (DET - 1) or >= 2 (DET >= 2) early fetal heartbeats. Design: Retrospective cohort using linked ART surveillance data and vital records from Florida, Massachusetts, Michigan, and Connecticut. Setting: Not applicable. Patient(s): Singleton live-born infants. Intervention(s): None. Main Outcome Measure(s): Preterm birth (PTB < 37 weeks), very preterm birth (VPTB < 32 weeks), small for gestational age birth weight (< 10th percentile), low birth weight (LBW < 2,500 g), very low birth weight (VLBW < 1,500 g), 5-minute Apgar score < 7, and neonatal intensive care unit (NICU) admission. Result(s): After controlling for maternal characteristics and employing a weighted propensity score approach, we found that singletons conceived after eSET were less likely to have a 5-minute Apgar< 7 (adjusted odds ratio [aOR] 0.33; 95% CI, 0.15-0.69) compared with non-ART singletons. There were no differences among outcomes between non-ART and non-eSET infants. We found that PTB, VPTB, LBW, and VLBW were more likely among DET - 1 and DET >= 2 compared with non-ART infants, with the odds being higher for DET >= 2 (PTB aOR 1.58; 95% CI, 1.09-2.29; VPTB aOR 2.46; 95% CI, 1.20-5.04; LBW aOR 2.17; 95% CI, 1.24-3.79; VLBW aOR 3.67; 95% CI, 1.38-9.77). Conclusion(s): Compared with non-ART singletons, singletons born after eSET and non-eSET did not have increased risks whereas DET - 1 and DET >= 2 singletons were more likely to have adverse perinatal outcomes. (C) 2017 by American Society for Reproductive Medicine.