IN VITRO FERTILIZATION IN NORTHERN FINLAND 1990-1995 Prenatal and early childhood outcome until three years of age

The aim of this population-based cohort study was to evaluate prenatal and child outcome and costs resulting from prenatal and neonatal care after in vitro fertilization (IVF) in comparison to those after natural conception using a cohort of 304 IVF exposed children born between 1990–1995 in Northern Finland, and two cohorts of unexposed control children (I: n = 569, representing general population in proportion of multiple births; II: n = 103, matched for plurality). The control children were randomly chosen from the Finnish Medical Birth Register (FMBR) and matched for sex, year of birth, area of residence, parity, maternal age and socioeconomic status. Analyses were performed by comparing the whole IVF population with controls representing general population as well as stratifying by singleton or twin status. IVF mothers carried a higher risk for vaginal bleeding, threatened preterm birth and intrahepatic cholestasis of pregnancy than control mothers, and they used specialized antenatal care more than others. Neonatal outcome was also poorer after IVF in terms of gestational age, birthweight, morbidity and intensive care treatment. The prevalence of congenital heart malformations (septal defects) was 4-fold for IVF children in comparison to controls. The three year follow-up showed delayed growth and increased morbidity for IVF children, but their psychomotor development was similar to that of the control children. Health care costs were 1.3-fold for IVF singletons in comparison to control singletons, but for twins the costs were equal. Multiple births increased the costs ∼3-fold when compared to singleton births. IVF increased the health risks for the pregnancies and the offspring, seen mostly in the comparison between the whole IVF population and controls representing natural proportion of multiple births, indicating that multiple birth is the strongest determinant of medical outcome after IVF. The effects of fertility therapy and maternal characteristics related to infertility cannot be ruled out at this point. The increased health care costs after IVF were mostly due to the high proportion of multiple births. In order to improve the outcomes and to reduce the health care costs after IVF, the amount of multiple births should be limited to a minimum by using single embryo transfer when possible.