ABSTRACT

CORRESPONDING AUTHOR:
Dr. Priyanka Singh,
Jwala House,
130, Hari Marg, Civil Lines,
Jaipur.
Email: dr_priya_jaipur@yahoo.com

ABSTRACT: AIM: Retrospective study of early (0-7 days) outcome of babies born after ART (Assisted Reproductive Technology) In vitro fertilization (IVF) is the fertilization of a woman’s egg and a man’s sperm in a laboratory dish. In vitro means “outside the body.” Fertilization means the sperm has attached to and entered the egg. IVF is a form of assisted reproductive technology (ART). This means special medical techniques are used to help a woman become pregnant. There are five basic steps to IVF- Step 1: Stimulation, also called super ovulation, Step 2: Egg retrieval, Step 3: Insemination and Fertilization, Step 4: Embryo culture, Step 5: Embryo transfer. OBJECTIVE: To study the early (0-7 days) outcome of babies born after ART (Assisted Reproductive Technology) METHODS: This is a retrospective study conducted in Department of Pediatrics, Mahatma Gandhi Medical College & Hospital, Jaipur between Jan 2009- Jan 2010. Inclusion criteria consists of all IVF babies born at Mahatma Gandhi Medical College & Hospital, Jaipur and exclusion criteria consists of all out born babies and IVF babies delivered at another center. CONCLUSION: There were 54.28% male and 45.72% female babies. Most of the babies were above 1.5 kg (44.28% NBW +45.71% LBW= 89.99%). There were only 5.71% babies born before 32 weeks of gestation. 61.42% were Singleton. Complication rate was low with Respiratory Distress in 10 babies, Sepsis in 4 babies and Jaundice in 22. All were treated successfully. There was no mortality.

INTRODUCTION: In vitro fertilization (IVF) is the fertilization of a woman’s egg and a man’s sperm in a laboratory dish. In vitro means “outside the body.” Fertilization means the sperm has attached to and entered the egg. IVF is a form of assisted reproductive technology (ART). This means special medical techniques are used to help a woman become pregnant: Step 1: Stimulation, also called super ovulation. Step 2: Egg retrieval, Step. Step 3: Insemination and Fertilization, Step 4: Embryo culture. Step 5: Embryo transfer.

World’s first successful IVF baby Louise Joy Brown in 1978 by Sir Robert Geoffrey Edwards and Patrick Streptoe.

MOVIE STARS WHO WENT FOR IVF DUE TO ADVANCED MATERNAL AGE:

Review: IVF is associated with an increased risk for some neonatal complications, not only among singletons but also among twins.

It is well documented that infants born after ART, even singletons, have a poorer perinatal outcome than spontaneously conceived children. Romundstad et al⁽¹⁾ conducted a sibling analysis comparing birth weight, gestational age and the risk of perinatal mortality in siblings born after ART and spontaneous conception. They concluded that parental stigmata, rather than the technique, was likely to cause the adverse perinatal outcomes among ART children.

The major complication of IVF is the risk of multiple births. This is directly related to the practice of transferring multiple embryos at embryo transfer. Multiple births are related to increased risk of pregnancy loss, obstetrical complications, prematurity and neonatal morbidity with the potential for long term damage.

A double blind, randomised study followed IVF pregnancies that resulted in 73 infants (33 boys and 40 girls) and reported that 8.7% of singleton infants and 54.2% of twins had a birth weight of < 2, 500 grams (5.5 lb).⁽²⁾

A review in 2013 came to the result that infants resulting from IVF (with or without ICSI) have a relative risk of birth defects of 1.32 (95% confidence interval 1.24–1.42) compared to naturally conceived infants.⁽³⁾

In 2008, an analysis of the data of the National Birth Defects Study in the US found that certain birth defects were significantly more common in infants conceived through IVF, notably septal heart defects, cleft lip with or without cleft palate, esophageal atresia, and anorectal atresia; the mechanism of causality is unclear.⁽⁴⁾

An IVF-associated incidence of cerebral palsy and neurodevelopmental delay are believed to be related to the confounders of prematurity and low birth weight.⁽⁵⁾

Similarly, an IVF-associated incidence of autism and attention-deficit disorder are believed to be related to confounders of maternal and obstetric factors.⁽⁶⁾

Joseph P Alukal, Dolores J Lamb, et al (7) in 2009 studied that the risk of multiple gestation continues to be of major concern because of its association with low birth weight, preterm delivery and increased perinatal mortality. Other ART outcomes typically includes: 1) Congenital abnormality 2) Developmental delay or abnormality 3) Hormonal dysfunction 4) Epigastric effect.

Bassil KL, et al⁽⁸⁾ in 2012 concluded that in IVF pregnancies, 2% of singleton weigh less than 2.5 kilograms at delivery, in contrast, 30-50% of twins and 92% of triplets weigh less than 2.5 kilograms and 24-31% of triplets weigh less than 1.5 kilograms at birth. In comparison to IVF babies out of the total 75 non IVF babies 27 babies (36%) had normal birth weight. 39 babies (52%) had low birth weight. 6 babies (8%) were very low birth weight and 3 babies (4%) were extremely low birth weight.

MATERIALS & METHODS:

Study location: Mahatma Gandhi Medical College & Hospital, Jaipur.

Study design: Retrospective study.

Study population: IVF babies born in Mahatma Gandhi Hospital.

Study period:  Jan 2009- Jan 2010.

Sample size:  IVF babies born from Jan 2009- Jan 2010.

Inclusion criteria: All IVF babies born at Mahatma Gandhi Medical College & Hospital, Jaipur.

Exclusion Criteria: All out born babies, IVF babies delivered at another center.

Observation Tables:

CONCLUSION: Mode of delivery was LSCS in 51 mothers, NVD in 1 mother out of 52. Presentation 53 Vertex, 22 Breech. Apgar score at 1 minute after birth <3 was 5, 4-7 was 2, 8-10 was 68. Apgar score at 5 minutes after birth <3 was 0, 4-7 was 3, 8-10 was 72. Mode of resuscitation after birth by bag, mask ventilation in 5 babies, Endotracheal intubation in none. There were 54.28% male and 45.72% female babies. Most of the babies were above 1.5 kg (44.28% NBW +45.71% LBW= 89.99%).

There were only 5.71% babies born before 32 weeks of gestation. 61.42% were Singleton. Complication rate was low with Respiratory Distress in 10 babies, Sepsis and Seizures in 4 babies and Jaundice in 22. All were treated successfully. The mean birth weight of IVF babies was 2.20 Kg (Standard Deviation, SD= 0.713). The mean age of mothers who went under IVF was 34.23 Years. There was no mortality.

REFERENCES:
1.    Romundstad LB, Romundstad PR, Sunde A, et al. Effects of technology or maternal factors on perinatal outcome after assisted fertilization: a population-based cohort study. Lancet 2008; 372: 737-43.
2.    Olivennes F, Mannaerts B, Struijs M, Bonduelle M, Devroey P (2001). "Perinatal outcome of pregnancy after GnRH antagonist (ganirelix) treatment during ovarian stimulation for conventional IVF or ICSI: a preliminary report". Hum. Reprod. 16 (8): 1588–91.
3.    Hansen M, Kurinczuk JJ, Milne E, de Klerk N, Bower C (2013). "Assisted reproductive technology and birth defects: a systematic review and meta-analysis". Hum. Reprod. Update 19 (4): 330–53. Reefhuis J, Honein MA, Schieve LA, Correa A, Hobbs CA, Rasmussen SA (February 2009). "Assisted reproductive technology and major structural birth defects in the United States". Hum. Reprod. 24 (2): 360–6.
4.    Hart R, Norman RJ (2013). "The longer-term health outcomes for children born as a result of IVF treatment. Part II-Mental health and development outcomes". Human Reproduction Update 19 (3): 244–250.
5.    Hart R, Norman RJ (2013). "The longer-term health outcomes for children born as a result of IVF treatment. Part II-Mental health and development outcomes". Human Reproduction Update 19 (3): 244–250.
6.    Joseph P Alukal, Dolores J Lamb. Intracytoplasmic Sperm Injection- What are the risks. Urol Clin North Am.2008; 35(2):277-288.
7.    Bassil KL, Shah PS, Barrington KJ, Harrison A, da silva OP, Lee SK, et al. The changing epidemiology of preterm twins and triplets admitted to neonatal intensive care units in Canada, 2003 to2008. Am J Perintol.2012; 29: 237-44.