CHILDREN CONCEIVED BY IN-VITRO FERTILIZATION AFTER FRESH EMBRYO-TRANSFER

Aims-To compare the outcome in in vitro fertilisation (IVF) children ( after fresh embryo transfer) from multiple and singleton births with o ne another, and with normally conceived control children. Methods-A co hort of 278 children (150 singletons, 100 twins, 24 triplets and four quadruplets), conceived by IVF after three fresh embryos had been tran sferred, born between October 1984 and December 1991, and 278 normally conceived control children (all singletons), were followed up for fou r years after birth. They were assessed for neonatal conditions, minor congenital anomalies, major congenital malformations, cerebral palsy and other disabilities. Control children, all born at term, were match ed for age, sex and social class. Results-The ratio of male:female bir ths was 1.03. Forty six per cent of IVF children were from multiple bi rths; 34.9% were from preterm deliveries; and 43.2% weighed less than 2500 g at birth. The IVF singletons were on average born one week earl ier than the controls, weighed 400 g less, and had a threefold greater chance of being born by caesarean section. The higher percentage of p reterm deliveries was largely due to multiple births and they contribu ted to neonatal conditions in 45.0% of all IVF children. The types of congenital abnormalities varied: 3.6% of IVF children and 2.5% of cont rols had minor congenital anomalies, and 2.5% of NF children and none of the controls had major congenital malformations. The numbers of eac h specific type of congenital abnormality were small and were not sign ificantly related to multiple births. IVF children (2.1%) and 0.4% of the controls had mild/moderate disabilities. They were all from multip le births, including two children with cerebral palsy who were triplet s. Conclusions-The outcome of NF treatment leading to multiple births is less satisfactory than that in singletons because of neonatal condi tions associated with preterm delivery and disabilities in later child hood. A reduction of multiple pregnancies by limiting the transfer of embryos to two instead of three remains a high priority.