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Interpregnancy Interval and Singleton Live Birth Outcomes From In Vitro Fertilization

Quinn, Molly, M., MD; Rosen, Mitchell, P., MD; Huddleston, Heather, G., MD; Cedars, Marcelle, I., MD; Fujimoto, Victor, Y., MD

doi: 10.1097/AOG.0000000000002644
Obstetrics: Original Research: PDF Only

OBJECTIVE: To describe the relationship between a short interpregnancy interval and adverse pregnancy outcomes in the population undergoing assisted reproductive technology.

METHODS: This is a retrospective analysis using data from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System. The cohort includes patients with a history of live birth from assisted reproductive technology who returned for a fresh, autologous in vitro fertilization (IVF) cycle from 2004 to 2013. Interpregnancy interval was defined as the interval from live birth to cycle start. Logistic regression models of preterm delivery (less than 37 weeks of gestation) and low birth weight (less than 2,500 g) on interpregnancy interval were fit with adjustment for age, body mass index, and history of preterm delivery. Predicted probabilities were generated from the logistic model.

RESULTS: Of 51,997 fresh IVF cycles after an index live birth, 17,536 resulted in a repeat live birth with 11,271 singleton live births from autologous IVF. An interpregnancy interval of less than 18 months occurred in 40.9% of cycles. Compared with a reference interpregnancy interval of 12 to less than 18 months, the adjusted odds ratio for singleton preterm delivery was 1.66 (95% CI 1.05–2.65) for an interpregnancy interval less than 6 months and 1.34 (95% CI 1.06–1.69) for 6 to less than 12 months. An interpregnancy interval 6 to less than 12 months was associated with a 3.0% increase in preterm delivery (13.6±1.1% vs 10.6±0.7%, P=.030) and a 2.7% increase in low birth weight (8.0±0.9% vs 5.3±0.5%, P=.025) compared with an interpregnancy interval of 12 to less than 18 months.

CONCLUSION: In this nationally representative population, an interval from delivery to treatment start of less than 12 months is associated with increased rates of preterm delivery and low birth weight in singleton live births from assisted reproductive technology. The data support delaying the start of IVF treatment 12 months from a live birth, but do not suggest a benefit from a longer interval as has been recommended for naturally conceiving couples.

An interpregnancy interval of less than 12 months is associated with increased rates of preterm delivery in singleton live births from in vitro fertilization in a national cohort.

Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, California.

Corresponding author: Molly M. Quinn, MD, Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Reproductive Endocrinology and Infertility, 550 16th Street, 7th Floor, San Francisco, CA 94158-2519; email: molly.quinn@ucsf.edu.

Supported by the National Center for Advancing Translational Sciences, National Institutes of Health, UCSF-CTSI Grant Number UL1TR001872.

Financial Disclosure The authors did not report any potential conflicts of interest.

Presented at the American Society for Reproductive Medicine’s annual conference, October 30–November 1, 2017, San Antonio, Texas.

The authors thank the Society for Assisted Reproductive Technology (SART) and its members for providing clinical information to the SART Clinic Outcome Reporting System database for use by patients and researchers. Without the efforts of SART members, this research would not have been possible.

Each author has indicated that he or she has met the journal's requirements for authorship.

Received January 31, 2018. Received in revised form March 16, 2018. Accepted March 23, 2018.

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.