Developmental Outcomes of Preterm Infants Conceived Through in Vitro Fertilization

Emma Johns, Southern Illinois University School of Medicine, Springfield, IL, United States; Taylor Badger, Southern Illinois University School of Medicine, United States; Erin M. Bauer, Southern Illinois University School of Medicine, Springfield, IL, United States; Kathleen Groesch, Southern Illinois University School of Medicine, Springfield, IL, United States; Teresa Wilson, Southern Illinois University School of Medicine, Springfield, IL, United States; Paula Diaz-Sylvester, Southern Illinois University School of Medicine, Springfield, IL, United States; Albert Botchway, Southern Illinois University School of Medicine, IL, United States; Beau Batton, Southern Illinois University School of Medicine, IL, United States; Ricardo Loret de Mola, Southern Illinois University School of Medicine, United States

Background: Infants conceived with in vitro fertilization (IVF) account for ~1.6% of live births in the United States. IVF is associated with an increased risk of low birth weight, multifetal gestation, and preterm birth. Full-term infant outcomes for reproductive endocrinology and infertility (REI) assisted conception practices such as IVF have been well reported, but there remains a paucity of data focused on outcomes of preterm IVF infants.

Objectives: This retrospective review aims to describe inpatient demographics, complications of prematurity, and neurodevelopmental (ND) outcomes for a large single center cohort of preterm infants conceived via IVF between January 1, 2010 and December 31, 2019.

Design/Methods: Very preterm infants conceived via IVF who were born < 31 6/7 weeks gestation who survived to NICU discharge were matched 2:1 to control patients based on GA at birth, birth weight, and gender. All patients were cared for in the level III NICU at HSHS St. John’s Hospital which serves as the only regional perinatal center for the primarily rural population of south central Illinois. In-hospital and ND outcome data (Bayley Infant Neurodevelopmental Screener [BINS]) for the two cohorts were analyzed. T-tests and chi-square were used to analyze continuous and categorical outcomes, respectively.

Results: There were 769 IVF births (33% preterm; 6% very preterm) and 34,957 non-IVF births (11% preterm, 3% very preterm). When compared to controls, very preterm IVF conceived infants were born to older women (mean ± SD of 32.4 ± 5.9 vs 28.5 ± 6.4 years, p=0.01), but other demographic data (primigravida status, race, ethnicity, rural residence, receipt of antenatal corticosteroids) were similar. IVF-conceived patients were more likely to have RDS and receive surfactant therapy (9 [33%] vs 34 [63%], p=0.006). Other in-hospital outcomes (IVH, BPD, NEC, ROP) were similar between the two cohorts. Neurodevelopmental data were also similar between cohorts at 5 – 6 months (15% of controls at high risk for ND delay vs 16% of IVF babies, p=0.97), 12 months (9% vs 4%, p=0.41), and 24 months (14% vs 19%, p=0.32).

Conclusion: Infants born preterm after IVF conception have similar in-hospital and ND outcomes when compared to matched preterm infants. This is reassuring information that can be shared with individuals considering IVF conception. The reasons for a higher than expected incidence of preterm birth after IVF conception are unclear and require further investigation.