The Impact of Assisted Reproductive Technologies on Perinatal Outcomes
Pp. 20-34 (15)
Patricia Monnier, Maria del Pilar Vélez and Thierry Forges
The success of Assisted Reproductive Technologies (ART) during the last decades has
transformed the evaluation and treatment of infertility. Nonetheless, there are concerns about the risk
for adverse pregnancy outcomes. Research on ART and perinatal outcomes faces several
methodological challenges that need to be considered to allow reliable interpretation of results. Major
perinatal risks are consequence of the high rate of multiple gestations associated with ART treatment.
The improvement of embryo cryopreservation programmes and the development of elective Single
Embryo Transfer policies will reduce significantly the number of multiple pregnancies while
maintaining acceptable overall pregnancy rates. Although the great majority of singleton ART
pregnancies are uncomplicated, numerous studies have raised questions concerning a range of adverse
pregnancy outcomes in singleton ART pregnancies. Spontaneous abortion, first trimester vaginal
bleeding, ectopic pregnancies, adnexal torsion, chromosomal abnormalities, imprinting disorders,
preterm birth, low birth weight and small for gestational age infants, birth defects, preeclampsia,
placenta praevia and placental abruption have been associated with ART. Nonetheless, questions
remain about the underlying mechanisms. Maternal age is an important confounder, as well as the role
of the underlying infertility in the observed adverse perinatal outcomes. There are many data gaps to
date. Future research initiatives are emergently needed, with enhancing transdisciplinary collaboration.
Assisted reproductive technologies, in vitro fertilization, intracytoplasmic sperm injection,
obstetric outcomes, perinatal outcomes.
McGill Reproductive Centre, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, McGill University, Royal Victoria Hospital, Montreal, QC, Canada, H3A 1A1