PREGNANCY OUTCOME AFTER ARTIFICIAL-INSEMINATION OR IVF WITH FROZEN-SEMEN DONOR - A COLLABORATIVE STUDY OF THE FRENCH CECOS FEDERATION ON 21597 PREGNANCIES

Objective: To assess pregnancies and conceptus after artificial insemi nation (AID) or IVF with frozen semen donor (IVF-D) on sufficiently la rge study population in order to distinguished minor variations. Study design: From 1987 to 1994, all pregnancies obtained after AID or IVF- D were registered prospectively in the French CECOS Federation data ba se. Different factors were recorded for this study: first menarche 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 foetus, weight, malform ation. Results: 21 597 pregnancies obtained after AID and 3381 after I VF-D were registered. 2% were lost to follow up. Foetal loss rate is 1 8% after AID and 21.5% after IVF-D (p<0.001). The tubal pregnancy rate is 0.9% after AID and 1.7% after IVF-D (p<0.0001). 18 128 children we re born after AID and 3313 after IVF-D. After AID, the twin pregnancy rate is 6.9% and the multiple pregnancy (greater than or equal to 3 fo etus) rate is 0.7%. After IVF-D, these rates are 24.8% and 4.2% respec tively (p<0.0001). After AID the mean weight at delivery, sex ratio, p remature rate, intra uterine growth retardation rate are not different from national rates published in 1995. The foetus malformation rate ( including medical abortions) is 1.9% after AID and 2.7% after IVF-D (p <0.009). After AID the trisomy 21 rate increases with the mother age b ut also with the donors age if the maternal age is equal. The birth de fects rate is not different from those registered in Paris, Strasbourg and Marseille. The birth defects rate observed after IVF-D is not dif ferent from the rate observed after IVF with husband semen. (2.74% ver sus 2.99%; p=0.16). Conclusion: After AID the miscarriage and tubal pr egnancy rate, the children's weight, the premature rate is not differe nt from that of the general French population. Sex ratio is normal as is the global malformation rate. The multiple pregnancy rate (x7 for t win and by 10 for multiple pregnancies more than 3 foetus) is high, sh owing the influence of ovulation induction treatment. The birth chromo somal abnormalities rate is normal and correlated not only to the moth er's age but also to the donor's age. This result without clear biolog ical explanation will require further verification in a greater popula tion. Practically speaking, these observations encourages lowering the age limit for semen donors less than 45 years. IVF-D practice instead of AID doubles the tubal pregnancy rate (0.9% versus 1.7% and increas es the twin pregnancy rate by 2.5% and the multiple pregnancy (greater than or equal to 3 fetus) rate by 3. It is necessary to promote good practice for AID from which the pregnancy rate is very different from one centre to another within the centres with AID low results a too hi gh rate of IVF-D. Finally we can say that pregnancies from IVF-D or IV F with husband semen are not significantly different. In other words p regnancy outcome is not changed after sperm cryopreservation. (C) 1997 Elsevier Science Ireland Ltd.