Type of Conception and Outcomes in Women with Singleton Pregnancy

Background:An estimated 4.9 million women in India are infertile. If we add secondary infertility to these estimates, the number of infertile couples in India may rise to 17.9 million. Increased use of assisted conception services and information on outcomes after assisted conceptions are useful, to appropriately counsel women who utilize such services. Aim: To determine as to whether outcomes of pregnancy differ between assisted conceptions and natural conceptions in pregnant women with singleton foetuses. Settings and Design: A retrospective observational study done a single tertiary care centre in southern India. Materials and Methods: This study included pregnant women with singleton gestations, who delivered at the study institute in 2012. Assisted conception was considered to include all invasive and non-invasive methods like ovulation induction (01), Intrauterine insemination (IUD, in vitro fertilization (IVF), intracytopalsmic sperm injection (ICSI). Outcomes of interest included gestational age at delivery, birth weight, small for gestational age babies, still births, neonatal deaths and caesarean sections. Point estimates and the 95% Confidence Intervals (CI) around point estimates of associations with assisted conceptions and outcomes were determined by using bivariate analysis and a multivariate logistic regression model. Results: This study included 6,712 women who were pregnant with a singleton foetus, including 460 (6.85%, 95% Cl: 6.27, 7.48) women who conceived with assistance Women who conceived with assistance were more likely to be older (p<0,001), nulliparous (p<0.001), who had a higher prevalence of obesity (p<0.001), pre-gestational diabetes mellitus (p=0.009), gestational diabetes (p<0.001) and pre-pregnancy hypothyroidism (p<0.001) in this population. Assisted conceptions were not significantly associated with small for gestational age babies (p=0.09), still births (p=0.56), or neonatal deaths (p=0.89). Assisted conceptions were associated with a higher incidence of caesarean sections (adjusted OR: 1.37, 95%Cl: 1.11-1.70) in a multivariate logistic regression model. Conclusion: After adjusting for differences in maternal characteristics, pregnant women with singleton foetuses, who conceived with assistance, had similar outcomes, except for higher caesarean section rates, as compared to women who conceived naturally.