Infertility Treatments And Preterm Birth

Infertility treatments have allowed thousands of couples who have difficulty conceiving to fulfill their desire to have children. In the United States in 2002, 7.3 million women, or 12 percent of women ages 15 to 44, had physical difficulty becoming pregnant or carrying a baby to term. Approximately 2.1 million of these women, or 7 percent of all women between the ages of 15 and 44, were infertile, defined as not becoming pregnant after 12 months when the couple is not using contraception (CDC, 2002b). Two percent of women had had an infertility-related medical appointment within the previous year, and an additional 10 percent reported that they had received services for infertility at some point in their lives.

The use of infertility treatments has risen dramatically in the past 20 years and has been associated with the trend to delay childbearing (see Chapter 1). In 2002, 33,000 American women delivered babies as a result of the use of infertility procedures; this is more than twice the number who had done so in 1996 (Meis et al., 1998). More than 50 percent of these women were 35 years of age or older. In recent years, an unintended consequence of the use of these technologies, multiple gestations and the increased risk for preterm delivery, has become a focus of attention. There is also evidence that a portion of the reported association between infertility treatments and preterm birth may be attributable to the underlying biological reasons for infertility and sub-fecundity (long time to becoming pregnant) (Basso and Baird, 2003; Henriksen et al, 1997; Joffe, 1994). Henriksen and colleagues (1997) examined pregnancy outcomes for two cohorts of approximately 13,000 deliveries in Denmark. The analyses excluded women with chronic illness, multiple fetuses, and unplanned pregnancies. Compared to women who took 6 or less months to conceive before becoming pregnant, women who tried for 7 to 12 months to conceive had a higher adjusted risk (1.3 times) for preterm delivery (95% CI: .8-2.1) in both cohorts. Those who tried for 12 months or longer had an adjusted risk of 1.6 (95% CI: 1.1-2.2) in the first cohort and 1.7 in the second (95% CI: 1.1-2.6). Results held after controlling for infertility treatments.

This section provides an overview of infertility treatments, including Assisted Reproductive Technologies (ARTs) and ovulation promotion procedures, trends in their use and the resulting pregnancies, maternal and child outcomes, and current regulations on the use of these treatments.

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