PREGNANCY EVOLUTION AFTER ARTIFICIAL-INSE MINATION OR IVF WITH FROZEN-SEMEN DONOR

Objective : to assess pregnancies and conceptus after artificial insem ination (IAD) or IVF with frozen semen donor (IVFD) on sufficiently la rge study population in order to distinguished minor variations. Study design : From 1987 to 1994 all pregnancies obtained after AID or IVFD where registered prospectively in the French CECOS Federation data ba se. Different factors were recorded for this study : first menarch age of the recipient women, cycle length, insemination date in the concep tion cycle, maternal age at delivery, hormonal treatments, donor age, sperm conservation length and follow up of the pregnancy : miscarriage , tubal pregnancy, time at delivery, sex of the fetus weight, malforma tion. Results : 21597 pregnancies obtained after AID and 3381 after IV FD were registered. 2% where lost of follow up. Fetal loss rate is 18% after AID and 21,5% after AID and 1,7% after IVFD (p <0,0001). 18128 children were born after AID and 3313 after IVFD. After AID the twin p regnancy rate is 6,9% and the multiple pregnancy (greater than or equa l to 3 fetus) rate is 0,7%. After IVDF these rates are respectively 24 ,8% and 4,2% (p <0,0001). After AID the mean weight at delivery, sex r atio, premature rate, intra uterine growth retardation rate are not di fferent from national rates published in 1995. The fetus malformation rate (including medical abortions) is 1,9% after AID and 2,7% after IV FD (p < 0,009). After AID the trisomy PI rate encrease with the mother age but also with the donors age if the maternal age is equal. The bi rth defects rate is not different from those registered in Paris, Stra sbourg and Marseille. The birth defects rate observed after IVDF is no t different from the rate observed after IVF with husband semen (2,74% versus 2,99%, p=0,16). Conclusion : After AID the miscarriage and tub al pregnancy rate, the children weight, the premature rate is not diff erent from the general French population. Sex ratio is normal as the g lobal malformation rate. The multiple pregnancy rate (x 7 for twin and by 10 for multiple pregnancies more than 3 fetus) is high showing the influence of ovulation induction treatment The birth chromosomic abno rmalities rate is normal and correlated to the mother age but also to the donor age. This result without clear biological explanation will r equire further verification in a greater population. Practically speak ing, this observations encourages lowering the age limit for the semen donors less than 45 years. IVFD practice instead of AID double the tu bal pregnancy rate (0,9% versus 1,7% and increase the twin pregnancy r ate by 2,5% and the multiple pregnancy (greater than or equal to 3 fet us) rate by 3. It is necessary to promote AID from which the pregnancy rate is very different from one center to another with in the centers with AID low results a too high rate of IVFD. Finally we can say that pregnancy from IVFD or IVF with husband semen are not significantly d ifferent In other words pregnancy outcome is not changed after sperm c ryopreservation.