Risk of stillbirth following in vitro methods of conception: a systematic review and meta-analysis

Wong, Karen (2021) Risk of stillbirth following in vitro methods of conception: a systematic review and meta-analysis. Masters thesis, Memorial University of Newfoundland.

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Abstract

Objective The purpose of this systematic review and meta-analysis is to determine if there is an increased risk of stillbirth among singleton gestations following in vitro methods of conception (including in vitro fertilization and intracytoplasmic sperm injection) compared with non-in vitro methods of conception (including spontaneous conception, intrauterine insemination, or ovarian stimulation). Methods Medline, EMBASE, CINAHL, and Cochrane Library databases were searched from inception to June 2019. Reference lists of included studies and obstetric guidelines were also reviewed. Metaanalysis was undertaken using a random effects model and inverse variance methods to produce a summary odds ratio. Subgroup analyses were completed by type of in vitro or non-in vitro method. Results Thirty-three cohort studies, and one case-control study met the inclusion criteria for this systematic review. There was an increased odds of stillbirth associated with in vitro methods of conception, (OR 1.43, 95% CI 1.23-1.67). A subgroup analysis demonstrated no increased risk when comparing in vitro methods to those conceiving with a history of infertility. Conclusion Compared to non-in vitro methods of conception, in vitro methods are associated with an increased risk of stillbirth. There is insufficient evidence to determine whether this risk is due to the treatment modality or underlying infertility.

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