Children conceived by in vitro fertilisation after fresh embryo transfer
a St Mary's Hospital, Manchester,
University Department of Child Health, b Department of Clinical Psychology, Winnicott Centre, c University Department of Obstetrics and
Gynaecology, d IVF Unit, e University of Manchester Institute of Science and Technology,
Department of Medical Informatics
Correspondence to: Dr S W D'Souza, Department of Child Health, St Mary's Hospital, Manchester M13 0JH.
Accepted 2 January 1997
AIMS
To compare the outcome in in vitro
fertilisation (IVF) children (after fresh embryo transfer) from
multiple and singleton births with one another, and with normally
conceived control children.
METHODSA cohort of 278 children (150 singletons,
100 twins, 24 triplets and four quadruplets), conceived by IVF after
three fresh embryos had been transferred, born between October 1984 and
December 1991, and 278 normally conceived control children (all
singletons), were followed up for four years after birth. They were
assessed for neonatal conditions, minor congenital anomalies, major
congenital malformations, cerebral palsy and other disabilities.
Control children, all born at term, were matched for age, sex and
social class.
RESULTSThe ratio of male:female births was 1.03. Forty six per cent of IVF children were from multiple births; 34.9%
were from preterm deliveries; and 43.2% weighed less than 2500 g at
birth. The IVF singletons were on average born one week earlier than
the controls, weighed 400 g less, and had a threefold greater chance of
being born by caesarean section. The higher percentage of preterm
deliveries was largely due to multiple births and they contributed to
neonatal conditions in 45.0% of all IVF children. The types of
congenital abnormalities varied: 3.6% of IVF children and 2.5% of
controls had minor congenital anomalies, and 2.5% of IVF children and
none of the controls had major congenital malformations. The numbers of
each specific type of congenital abnormality were small and were not
significantly related to multiple births. IVF children (2.1%) and
0.4% of the controls had mild/moderate disabilities. They were all
from multiple births, including two children with cerebral palsy who
were triplets.
CONCLUSIONSThe outcome of IVF treatment leading
to multiple births is less satisfactory than that in singletons
because of neonatal conditions associated with preterm delivery and
disabilities in later childhood. A reduction of multiple pregnancies by
limiting the transfer of embryos to two instead of three remains a high priority.
© 1997 by Archives of Disease in Childhood
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