بسم الله الرحمن الرحیم

1. بسم الله الرحمن الرحیم

2. Pregnancy outcome after assisted reproductive technology DR H.TEHRANI DR Z.NAVABI

3. FIRST CASE • A35 Y/G1 with 10 years infertility • Pregnancy induced by IVF(FET) • GA=28 W • She admitted with BP=150/95 and headache • LAB [ HB=13/ PLT=130000/ PIH=NL/650/7/0.8 UA=Pr 2+ • Hospitlized Mg SO4 corticostroid

4. Embryo cryopreservation and preeclampsia risk Cynthia K. Sites, M.D.,a Donna Wilson, M.S.,b Maya Barsky, M.D.,a Dana Bernson, M.P.H.,cIra MPrevention, Atlanta, Georgia2017

5. Main Outcome Measure(s): We compared the frequency of preeclampsia diagnosis for FET versus fresh ET and

6. Result(s): • Among pregnancies conceived with autologous eggs resulting in singletons, preeclampsia was greater after FET versus fresh ET • preeclampsia with preterm delivery, and chronic hypertension with superimposed preeclampsia were more frequent after FET versus fresh ET • Among donoregg pregnancies, rates of FET cryopreserved-warmed and fresh ET

7. Second case A 28 Y G2 Ab1 male factor infertility+DOR TertatoAstenospermia count=5000000/motility=10%/ terato=98% AMH=0.1 Pregnancy with ICSI GA=30W PTL

8. Tirth case • A 34 Y G2 L1 with secondary infertility • She had 2 unsuccessfull IUI • She is known case of PCO • GA=27W • DX=GDM • BMI=NL • Insulin therapy

9. Assisted reproductive technology and the risk of pregnancy-related complications and adverse pregnancy outcomes in singleton pregnancies: a meta-analysis of cohort studies

10. Objective: To determine whether there are any increases in pregnancy-related complications and adverse pregnancy outcomes in singleton pregnancies after (ART) compared with those conceived naturally. • Design:Meta-analysis. • Patient(s): Singleton pregnancies conceived with ART and naturally. • Intervention(s): PubMed, Google Scholar, Cochrane Libraries and Chinese database were searched through March 2015 to identify • Main Outcome Measure(s): Pregnancy-related complications and adverse pregnancy outcom

11. RESULT: Fifty cohort studies comprising 161,370 ART and 2,280,241 spontaneously conceived singleton pregnancies were identified. The ART singleton pregnancies had a significantly increased risk of PIH GDM placenta previa placental abruption , antepartum hemorrhage, postpartum hemorrhage polyhydramnio oligohydramnios s cesarean sections , PTL ,VPTL, low birthweight very low birth weight SGA perinatal mortality congenital malformation

12. conclusion • The ART singleton pregnancies are associated with higher risks of adverse obstetric outcome.Obstetricians should manage these pregnancies as high risk.

13. Forth case: • A 41Y G2 AB2 with 10 years infertility and 5 episode IVF FAILOUR get a surrogate . • The surrogate was a 35 Y G3 L3 NVD.The patient at 29 w came with PPROM she admitede and observed .in 31 w with placenta abrapthion she was terminated.

14. ati Prospective randomized controlled trial studying the need for hospitalization of surrogates for a better pregnancy outcome. • India 2013 by P.C .Jindal. • Conclusion:hospitalization of surrogate leads to better pregnancy outcome. Surrogate mothers in hospital have a better maternal and neonatal outcome,due to physical and mental rest in calm hospital environment and have a planned and nutritious diet.

15. INTRODUCTION : •   The first pregnancy after (IVF) of a human egg and the first birth of an in vitro-fertilized baby were reported in 1976 and 1978, In HAMMER SMITH center in England EP.

16. Maternal

17. Fetal Multiple pregnancy cancer Pubertaldevelopment Congenital abnormality Neuro developmental issuse

18. Early loss : • Early loss — Early spontaneous pregnancy loss is common in pregnancies conceived naturally and with ART, • . In studies 2015 • , spontaneous loss of at least one gestation occurred in about 25 %of singleton pregnancies, 35% of twin pregnancies, and 55 % of triplet pregnancys . • The rate of second trimester loss does not appear to be impacted by ART.

19. Spontaneous abortion: •  Studies in USA 2015 have shown that spontaneous abortion rate after ART (IVF with or without ICSI) is the same as for the general population of the United States • when fresh fertilized embryos are used and adjustments are made for age and multiple gestation, but the rate may be somewhat higher with thawed embryos

20. Ectopic pregnancy : • EP risk among ART pregnancies varies according to the type of procedure (eg, higher with ZIFT) (eg, higher in those with tubal factor infertility) • . in one study 2014 china, standard IVF and transcervical embryo transfer resulted in 2.2% rate of ectopic pregnancy, whereas embryo transfer to a gestational surrogate was associated with only a 0.9. • Heterotopic pregnancy is far more common in pregnancies conceived by ART than spontaneous conceptions (1/100 versus 1/30,000).)

22. Monozygotic multiples : The frequency of monozygotic multiples is also increased from approximately 0.4 % to 1 to 5% of pregnancies. In one study at 8 year experience at a largIVFcenter in Bustun 2010, the frequency of monochorionic-diamniotic implantations was increased, but the frequency of monochorionic-monoamniotic implantations was not.

23. Neurodevelopmental issues A 2013 SYSTEMATIC REVIEW in AUSTRALIA that analysed from 80 studies shows: • psychomotor development of infants showed no deficits, but data on cognitive or behavioral development were limited. • toddlers consistently reported normal cognitive, behavioral, socio-emotional, and psychomotor development.

24. Pubertal development • A cohort study in 2011 in Holand of ICSI concived teenagers compared pubertal development at age 14 years with spontaneously concived control group only breast development was less advancedin ICSI females compared with spontaneouslyconceived. • A case report in Germany 2005 of 7 children (6 girls and 1 boy)age 5 to 21 months with premature thelarche and pubarche.

25. Congenital anomalies It may be related to infertility itself or to factors related to ART procedures, or both. Regardless, patients can be reassured that the absolute risk of having a child with a congenital anomaly is low; the population baseline risk of 2 to 4% is potentially increased by about one-third with ART

26. Chromosomal and genetic abnormalities: ICSI procedure itself may increase the risk of chromosomal and gene abnormalities in children conceived by ART. Subfertile men (and women) are more likely than fertile individuals to have chromosomal abnormalities (eg, aneuploidies, structural abnormalities, gene mutations, microdeletions) that may contribute to their subfertility and may be passed to their offspring.

27. Perinatal mortality : • Stillbirth and perinatal mortality rates appear to four-fold • , LBW, and multiple gestation. • In the USA, the stillbirth rate after IVF is approximately 0.6 %.

28. Long-term issues : . Hospitalizations appear to be more common , vascular dysfunction in children conceived by ART . carotid media thickness Increased risk of asthma in children conceived by ART related to prematurity, and maternal asthma.

29. CANCER • A 2013 systematic review in Denmark and meta-analysis 25 case –cohort studies reported an association between ART and offspring. • ART increased risk for hematological cancers,CNS,neural cancers and other solid cancers. • Specific cancer increase with ART :leukemia,neuroblastoma and retinoblastoma ,wilms tumor ,emberionalrhabdomyosarcoma

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