Preterm delivery in infertile women after reproductive surgery: should
we encourage spontaneous conception?
Abstract
Objective: To evaluate an association between the mode of conception and
preterm delivery in women after reproductive surgery, and to explore an
effect of reproductive surgery on preterm delivery. Design: Prospective
cohort study and historical case-control study. Setting: Division of
Obstetrics and Gynecology, Ljubljana, Slovenia. Population or sample: A
cohort of 761 infertile women after reproductive surgery. Methods: In
infertile women, we evaluated the association between the mode of
conception and preterm delivery using logistic regression adjusted for
relevant co-variables. In a case-control study, we evaluated the effect
of reproductive surgery on preterm delivery using propensity score
method. We calculated the adjusted odds ratios with a 95% confidence
interval with a two-way test. Main Outcome Measure: Preterm delivery.
Results: Among 761 infertile women, 428 (56.2%) conceived
spontaneously, and 333 (43.8%) conceived after IVF/ICSI. The incidence
of twin pregnancies was significantly lower after spontaneous conception
(2.6% vs. 14.1%; p <0.000). Adjusted logistic regression
analysis in singleton pregnancies disclosed no significant association
between the mode of conception and preterm delivery. Compared with
fertile women, the incidences of preterm deliveries < 37, and
< 32 gestational weeks were higher in infertile women (11.2%
vs. 14.2%, and 1.7% vs. 2.6%, respectively). However, the differences
did not reach a statistical significance (p=0.076 and p=0.218,
respectively). Conclusion: In selected infertile women after
reproductive surgery, a high rate of spontaneous conception, a low rate
of multiple pregnancies, and no treatment-related adverse effect on
preterm delivery should be the reasons to encourage spontaneous
conception after reproductive surgery.