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European Society for Human Reproduction and Embryology (ESHRE): Annual Meeting
Letrozole bests clomiphene again in infertile women with PCOS
LISBON – The aromatase inhibitor letrozole was associated with roughly a 42% increase in the pregnancy rate, compared with clomiphene citrate in infertile women with polycystic ovary syndrome in a double-blind, randomized study.
In an intention-to-treat analysis, the pregnancy rate was 61.2% with letrozole (Femara) versus 43% with clomiphene (P = .022). There also was a trend toward more live births with letrozole (48.8% vs. 35.4%; P = .089).
The per-protocol results were similar for pregnancy (61% vs. 43.2%; P = .029) and live births (48.1% vs. 35.1%; P = .108).
“We now have convincing evidence that letrozole is better than clomiphene and we should seriously consider moving on to letrozole,” principle investigator Dr. Saad Amer said at the annual meeting of the European Society of Human Reproduction and Embryology.
The results are consistent with the most recent Cochrane meta-analysis, which called for further research comparing letrozole with clomiphene as a primary ovulation induction agent in polycystic ovary syndrome (PCOS) because of low-quality evidence (Cochrane Database Syst. Rev. 2014 Feb. 24;2:CD010287).
A recent robust U.S. study (N. Engl. J. Med. 2014;371:119-29) showed higher live-birth and ovulation rates with letrozole vs. clomiphene in women with PCOS, but it included a markedly obese population with a mean body mass index (BMI) of 35 kg/m2 and thus does not reflect clinical practice worldwide, Dr. Amer said.
The current results are more generalizable, especially in Europe, because the patients fulfilled the widely accepted Rotterdam diagnostic criteria for PCOS and had a median BMI of 27.7 kg/m2 in the clomiphene group and 27.5 kg/m2 in the letrozole group, said Dr. Amer of the University of Nottingham in Derby, England.
The phase IV study evenly randomized 159 anovulatory women, aged 18-39 years, with a diagnosis of PCOS to one tablet of letrozole 2.5 mg or clomiphene 50 mg daily for 5 days, continuing until pregnancy or up to 6 cycles. If there was no response in the first cycle, the dose was increased to two tablets. If there was still no response, the patient was crossed over to the other treatment arm after a 6-week washout. Cycles were initially monitored with ultrasound follicle tracking, then mid-luteal serum progesterone measurements.
Among the 159 women in the intention-to-treat analysis, four conceived before treatment and four dropped out. The remaining 151 women included 77 given letrozole and 74 given clomiphene.
For the 60 women who crossed over, there was no significant difference in pregnancy and live birth rates between groups in either the intention-to-treat or per-protocol analyses.
Notably, however, 70.1% of women who started treatment with letrozole followed by clomiphene became pregnant vs. only 59.5% when the treatment strategy was reversed, while 56.2% started on letrozole and 49.4% started on clomiphene went on to a live birth.
“This tells us that if you take clomiphene first and then follow it with letrozole, you’re achieving almost the same result as just taking letrozole from the beginning,” Dr. Amer said.
The improved pregnancy rates, however, cannot be attributed to the effect of the endometrial factor, he said. Surprisingly, endometrial thickness was significantly greater in the clomiphene group than in the letrozole group (median, 9.0 mm vs. 8.4 mm; P = .002). Mono-follicular ovulation (83% vs. 85%) and multiple pregnancy (twins 0% vs. 6%) rates were similar.
No significant differences were observed between the clomiphene and letrozole groups in miscarriages (6 events vs. 9 events), ectopic pregnancies (0 vs. 1), or preterm births (2 vs. 4).
“Further research is required to investigate the mechanisms of increased pregnancy rates,” Dr. Amer said.
Serious adverse events included one hemorrhagic cyst in each group and a cholecystitis in the clomiphene group.
There was one fetal anomaly – a dilated left kidney – in the clomiphene group and none in the letrozole group, he said.
During a discussion of the results, reproductive medicine specialist Dr. Roy Homburg of Homerton University Hospital, London, said that it’s time for letrozole to recognized as the superior choice.
“Every study that has been done on the subject, every randomized controlled trial, every meta-analysis, every Cochrane database has shown exactly what you have shown – the superiority of letrozole over clomiphene,” Dr. Homburg said. “All this in addition to the fact that there are many more fetal abnormalities, congenital abnormalities with clomiphene rather than letrozole. I think it’s about time people start believing this and make sure letrozole is on-label rather than off-label.”
Dr. Amer agreed. “It’s now time for clomiphene to retire,” he said, receiving a round of applause from the audience.
The study was sponsored by Derby Hospitals NHS Foundation Trust. Dr. Amer reported having no financial disclosures.
On Twitter @pwendl
LISBON – The aromatase inhibitor letrozole was associated with roughly a 42% increase in the pregnancy rate, compared with clomiphene citrate in infertile women with polycystic ovary syndrome in a double-blind, randomized study.
In an intention-to-treat analysis, the pregnancy rate was 61.2% with letrozole (Femara) versus 43% with clomiphene (P = .022). There also was a trend toward more live births with letrozole (48.8% vs. 35.4%; P = .089).
The per-protocol results were similar for pregnancy (61% vs. 43.2%; P = .029) and live births (48.1% vs. 35.1%; P = .108).
“We now have convincing evidence that letrozole is better than clomiphene and we should seriously consider moving on to letrozole,” principle investigator Dr. Saad Amer said at the annual meeting of the European Society of Human Reproduction and Embryology.
The results are consistent with the most recent Cochrane meta-analysis, which called for further research comparing letrozole with clomiphene as a primary ovulation induction agent in polycystic ovary syndrome (PCOS) because of low-quality evidence (Cochrane Database Syst. Rev. 2014 Feb. 24;2:CD010287).
A recent robust U.S. study (N. Engl. J. Med. 2014;371:119-29) showed higher live-birth and ovulation rates with letrozole vs. clomiphene in women with PCOS, but it included a markedly obese population with a mean body mass index (BMI) of 35 kg/m2 and thus does not reflect clinical practice worldwide, Dr. Amer said.
The current results are more generalizable, especially in Europe, because the patients fulfilled the widely accepted Rotterdam diagnostic criteria for PCOS and had a median BMI of 27.7 kg/m2 in the clomiphene group and 27.5 kg/m2 in the letrozole group, said Dr. Amer of the University of Nottingham in Derby, England.
The phase IV study evenly randomized 159 anovulatory women, aged 18-39 years, with a diagnosis of PCOS to one tablet of letrozole 2.5 mg or clomiphene 50 mg daily for 5 days, continuing until pregnancy or up to 6 cycles. If there was no response in the first cycle, the dose was increased to two tablets. If there was still no response, the patient was crossed over to the other treatment arm after a 6-week washout. Cycles were initially monitored with ultrasound follicle tracking, then mid-luteal serum progesterone measurements.
Among the 159 women in the intention-to-treat analysis, four conceived before treatment and four dropped out. The remaining 151 women included 77 given letrozole and 74 given clomiphene.
For the 60 women who crossed over, there was no significant difference in pregnancy and live birth rates between groups in either the intention-to-treat or per-protocol analyses.
Notably, however, 70.1% of women who started treatment with letrozole followed by clomiphene became pregnant vs. only 59.5% when the treatment strategy was reversed, while 56.2% started on letrozole and 49.4% started on clomiphene went on to a live birth.
“This tells us that if you take clomiphene first and then follow it with letrozole, you’re achieving almost the same result as just taking letrozole from the beginning,” Dr. Amer said.
The improved pregnancy rates, however, cannot be attributed to the effect of the endometrial factor, he said. Surprisingly, endometrial thickness was significantly greater in the clomiphene group than in the letrozole group (median, 9.0 mm vs. 8.4 mm; P = .002). Mono-follicular ovulation (83% vs. 85%) and multiple pregnancy (twins 0% vs. 6%) rates were similar.
No significant differences were observed between the clomiphene and letrozole groups in miscarriages (6 events vs. 9 events), ectopic pregnancies (0 vs. 1), or preterm births (2 vs. 4).
“Further research is required to investigate the mechanisms of increased pregnancy rates,” Dr. Amer said.
Serious adverse events included one hemorrhagic cyst in each group and a cholecystitis in the clomiphene group.
There was one fetal anomaly – a dilated left kidney – in the clomiphene group and none in the letrozole group, he said.
During a discussion of the results, reproductive medicine specialist Dr. Roy Homburg of Homerton University Hospital, London, said that it’s time for letrozole to recognized as the superior choice.
“Every study that has been done on the subject, every randomized controlled trial, every meta-analysis, every Cochrane database has shown exactly what you have shown – the superiority of letrozole over clomiphene,” Dr. Homburg said. “All this in addition to the fact that there are many more fetal abnormalities, congenital abnormalities with clomiphene rather than letrozole. I think it’s about time people start believing this and make sure letrozole is on-label rather than off-label.”
Dr. Amer agreed. “It’s now time for clomiphene to retire,” he said, receiving a round of applause from the audience.
The study was sponsored by Derby Hospitals NHS Foundation Trust. Dr. Amer reported having no financial disclosures.
On Twitter @pwendl
LISBON – The aromatase inhibitor letrozole was associated with roughly a 42% increase in the pregnancy rate, compared with clomiphene citrate in infertile women with polycystic ovary syndrome in a double-blind, randomized study.
In an intention-to-treat analysis, the pregnancy rate was 61.2% with letrozole (Femara) versus 43% with clomiphene (P = .022). There also was a trend toward more live births with letrozole (48.8% vs. 35.4%; P = .089).
The per-protocol results were similar for pregnancy (61% vs. 43.2%; P = .029) and live births (48.1% vs. 35.1%; P = .108).
“We now have convincing evidence that letrozole is better than clomiphene and we should seriously consider moving on to letrozole,” principle investigator Dr. Saad Amer said at the annual meeting of the European Society of Human Reproduction and Embryology.
The results are consistent with the most recent Cochrane meta-analysis, which called for further research comparing letrozole with clomiphene as a primary ovulation induction agent in polycystic ovary syndrome (PCOS) because of low-quality evidence (Cochrane Database Syst. Rev. 2014 Feb. 24;2:CD010287).
A recent robust U.S. study (N. Engl. J. Med. 2014;371:119-29) showed higher live-birth and ovulation rates with letrozole vs. clomiphene in women with PCOS, but it included a markedly obese population with a mean body mass index (BMI) of 35 kg/m2 and thus does not reflect clinical practice worldwide, Dr. Amer said.
The current results are more generalizable, especially in Europe, because the patients fulfilled the widely accepted Rotterdam diagnostic criteria for PCOS and had a median BMI of 27.7 kg/m2 in the clomiphene group and 27.5 kg/m2 in the letrozole group, said Dr. Amer of the University of Nottingham in Derby, England.
The phase IV study evenly randomized 159 anovulatory women, aged 18-39 years, with a diagnosis of PCOS to one tablet of letrozole 2.5 mg or clomiphene 50 mg daily for 5 days, continuing until pregnancy or up to 6 cycles. If there was no response in the first cycle, the dose was increased to two tablets. If there was still no response, the patient was crossed over to the other treatment arm after a 6-week washout. Cycles were initially monitored with ultrasound follicle tracking, then mid-luteal serum progesterone measurements.
Among the 159 women in the intention-to-treat analysis, four conceived before treatment and four dropped out. The remaining 151 women included 77 given letrozole and 74 given clomiphene.
For the 60 women who crossed over, there was no significant difference in pregnancy and live birth rates between groups in either the intention-to-treat or per-protocol analyses.
Notably, however, 70.1% of women who started treatment with letrozole followed by clomiphene became pregnant vs. only 59.5% when the treatment strategy was reversed, while 56.2% started on letrozole and 49.4% started on clomiphene went on to a live birth.
“This tells us that if you take clomiphene first and then follow it with letrozole, you’re achieving almost the same result as just taking letrozole from the beginning,” Dr. Amer said.
The improved pregnancy rates, however, cannot be attributed to the effect of the endometrial factor, he said. Surprisingly, endometrial thickness was significantly greater in the clomiphene group than in the letrozole group (median, 9.0 mm vs. 8.4 mm; P = .002). Mono-follicular ovulation (83% vs. 85%) and multiple pregnancy (twins 0% vs. 6%) rates were similar.
No significant differences were observed between the clomiphene and letrozole groups in miscarriages (6 events vs. 9 events), ectopic pregnancies (0 vs. 1), or preterm births (2 vs. 4).
“Further research is required to investigate the mechanisms of increased pregnancy rates,” Dr. Amer said.
Serious adverse events included one hemorrhagic cyst in each group and a cholecystitis in the clomiphene group.
There was one fetal anomaly – a dilated left kidney – in the clomiphene group and none in the letrozole group, he said.
During a discussion of the results, reproductive medicine specialist Dr. Roy Homburg of Homerton University Hospital, London, said that it’s time for letrozole to recognized as the superior choice.
“Every study that has been done on the subject, every randomized controlled trial, every meta-analysis, every Cochrane database has shown exactly what you have shown – the superiority of letrozole over clomiphene,” Dr. Homburg said. “All this in addition to the fact that there are many more fetal abnormalities, congenital abnormalities with clomiphene rather than letrozole. I think it’s about time people start believing this and make sure letrozole is on-label rather than off-label.”
Dr. Amer agreed. “It’s now time for clomiphene to retire,” he said, receiving a round of applause from the audience.
The study was sponsored by Derby Hospitals NHS Foundation Trust. Dr. Amer reported having no financial disclosures.
On Twitter @pwendl
AT ESHRE 2015
Key clinical point: Letrozole is superior to clomiphene with regard to pregnancy rates in infertile women with PCOS.
Major finding: The pregnancy rate was 61.2% with letrozole versus 43% with clomiphene (P = .022).
Data source: A double-blind, randomized phase IV trial in 159 infertile women with polycystic ovarian syndrome.
Disclosures: The study was sponsored by Derby Hospitals NHS Foundation Trust. Dr. Amer reported having no financial disclosures.
ESHRE: Ectopic pregnancy rate with ART tumbles over time
LISBON – Advances in assisted reproductive technology (ART) have paid off, nearly halving the rate of ectopic pregnancy in the past 12 years.
The rate of ectopic pregnancy (EP) following ART progressively declined from 20 to 12 cases per thousand in a nationwide analysis of all ART pregnancies achieved in the United Kingdom between 2000 and 2012.
This trend appears to be related to a reduction in the incidence of tubal factor infertility, a lower number of embryos being transferred, and extended embryo culture, Dr. Nikolaos Polyzos said at the annual meeting of the European Society of Human Reproduction and Embryology.
Ectopic pregnancy (EP) is a rare event, occurring in only 2% of all spontaneous conceptions. ART has been consistently associated with higher rates of EP, which is the most common cause of mortality during the first trimester of pregnancy in the U.K., said Dr. Polyzos of the Centre for Reproductive Medicine at Vrije University Brussels.
Using the Human Fertilisation and Embryology Authority (HFEA) database, the investigators identified 684,247 ART cycles in the U.K. between 2000-2012, resulting in 212,877 pregnancies. After exclusion for various reasons including surrogacy, unspecified treatment, or missing data, 161,967 pregnancies were included in the analysis. Of these, 153,115 pregnancies occurred following in-vitro fertilization or intracytoplasmic sperm injection and 8,852 following intrauterine insemination.
The incidence of ectopic pregnancy was 1.4% over the 12-year study period.
In adjusted analyses, the most important independent risk factor for an ectopic pregnancy was tubal factor infertility, which more than doubled the risk (odds ratio, 2.23), Dr. Polyzos said.
Also significant was the number of embryos transferred (two vs. one; OR, 1.28; ≥ three vs. one; OR, 1.67) and extended embryo culture (day 3 vs. day 2; OR, 0.85; day 5 vs. day 2; OR, 0.73).
What this means in everyday clinical practice is that the probability of having an ectopic pregnancy is 29% per 1,000 pregnancies in a patient with tubal infertility if more than one embryo is transferred, he said. In contrast, the risk is more than three times lower at only 8.2% per 1,000 pregnancies in a patient who has a partner with male infertility and a single blastocyst transferred.
Details from the HFEA database showed that the proportion of infertile patients with tubal disease having ART progressively declined from 24% in 2000 to 12% in 2012. Tubal factor infertility accounts for about 14% of all infertility and is typically the result of Chlamydia trachomatis infection.
“Future efforts should promote national screening programs like the U.K.’s National Chlamydia Screening Programme. Although there is a discussion on how effective it is, I think it is very important we increase the uptake of these programs,” Dr. Polyzos said.
Efforts to promote widespread introduction of single-embryo transfer, which have been widely adopted in his own country, but less so in the United States, would lower the risk of EP even further, he added.
A recent U.S. analysis looking at the risk of EP associated with ART found that the rate of ectopic pregnancy was 1.6% when one embryo was transferred and 1.7%, 2.2%, and 2.5% when two, three, or four or more embryos were transferred, respectively. Overall, the EP rate declined from 2% in 2001 to 1.6% in 2011 based on 553,577 pregnancies reported during those years to the U.S. National ART Surveillance System (Obstet. Gynecol. 2015;125:70-8).
ESHRE did not require reports of financial disclosures.
On Twitter @pwendl
LISBON – Advances in assisted reproductive technology (ART) have paid off, nearly halving the rate of ectopic pregnancy in the past 12 years.
The rate of ectopic pregnancy (EP) following ART progressively declined from 20 to 12 cases per thousand in a nationwide analysis of all ART pregnancies achieved in the United Kingdom between 2000 and 2012.
This trend appears to be related to a reduction in the incidence of tubal factor infertility, a lower number of embryos being transferred, and extended embryo culture, Dr. Nikolaos Polyzos said at the annual meeting of the European Society of Human Reproduction and Embryology.
Ectopic pregnancy (EP) is a rare event, occurring in only 2% of all spontaneous conceptions. ART has been consistently associated with higher rates of EP, which is the most common cause of mortality during the first trimester of pregnancy in the U.K., said Dr. Polyzos of the Centre for Reproductive Medicine at Vrije University Brussels.
Using the Human Fertilisation and Embryology Authority (HFEA) database, the investigators identified 684,247 ART cycles in the U.K. between 2000-2012, resulting in 212,877 pregnancies. After exclusion for various reasons including surrogacy, unspecified treatment, or missing data, 161,967 pregnancies were included in the analysis. Of these, 153,115 pregnancies occurred following in-vitro fertilization or intracytoplasmic sperm injection and 8,852 following intrauterine insemination.
The incidence of ectopic pregnancy was 1.4% over the 12-year study period.
In adjusted analyses, the most important independent risk factor for an ectopic pregnancy was tubal factor infertility, which more than doubled the risk (odds ratio, 2.23), Dr. Polyzos said.
Also significant was the number of embryos transferred (two vs. one; OR, 1.28; ≥ three vs. one; OR, 1.67) and extended embryo culture (day 3 vs. day 2; OR, 0.85; day 5 vs. day 2; OR, 0.73).
What this means in everyday clinical practice is that the probability of having an ectopic pregnancy is 29% per 1,000 pregnancies in a patient with tubal infertility if more than one embryo is transferred, he said. In contrast, the risk is more than three times lower at only 8.2% per 1,000 pregnancies in a patient who has a partner with male infertility and a single blastocyst transferred.
Details from the HFEA database showed that the proportion of infertile patients with tubal disease having ART progressively declined from 24% in 2000 to 12% in 2012. Tubal factor infertility accounts for about 14% of all infertility and is typically the result of Chlamydia trachomatis infection.
“Future efforts should promote national screening programs like the U.K.’s National Chlamydia Screening Programme. Although there is a discussion on how effective it is, I think it is very important we increase the uptake of these programs,” Dr. Polyzos said.
Efforts to promote widespread introduction of single-embryo transfer, which have been widely adopted in his own country, but less so in the United States, would lower the risk of EP even further, he added.
A recent U.S. analysis looking at the risk of EP associated with ART found that the rate of ectopic pregnancy was 1.6% when one embryo was transferred and 1.7%, 2.2%, and 2.5% when two, three, or four or more embryos were transferred, respectively. Overall, the EP rate declined from 2% in 2001 to 1.6% in 2011 based on 553,577 pregnancies reported during those years to the U.S. National ART Surveillance System (Obstet. Gynecol. 2015;125:70-8).
ESHRE did not require reports of financial disclosures.
On Twitter @pwendl
LISBON – Advances in assisted reproductive technology (ART) have paid off, nearly halving the rate of ectopic pregnancy in the past 12 years.
The rate of ectopic pregnancy (EP) following ART progressively declined from 20 to 12 cases per thousand in a nationwide analysis of all ART pregnancies achieved in the United Kingdom between 2000 and 2012.
This trend appears to be related to a reduction in the incidence of tubal factor infertility, a lower number of embryos being transferred, and extended embryo culture, Dr. Nikolaos Polyzos said at the annual meeting of the European Society of Human Reproduction and Embryology.
Ectopic pregnancy (EP) is a rare event, occurring in only 2% of all spontaneous conceptions. ART has been consistently associated with higher rates of EP, which is the most common cause of mortality during the first trimester of pregnancy in the U.K., said Dr. Polyzos of the Centre for Reproductive Medicine at Vrije University Brussels.
Using the Human Fertilisation and Embryology Authority (HFEA) database, the investigators identified 684,247 ART cycles in the U.K. between 2000-2012, resulting in 212,877 pregnancies. After exclusion for various reasons including surrogacy, unspecified treatment, or missing data, 161,967 pregnancies were included in the analysis. Of these, 153,115 pregnancies occurred following in-vitro fertilization or intracytoplasmic sperm injection and 8,852 following intrauterine insemination.
The incidence of ectopic pregnancy was 1.4% over the 12-year study period.
In adjusted analyses, the most important independent risk factor for an ectopic pregnancy was tubal factor infertility, which more than doubled the risk (odds ratio, 2.23), Dr. Polyzos said.
Also significant was the number of embryos transferred (two vs. one; OR, 1.28; ≥ three vs. one; OR, 1.67) and extended embryo culture (day 3 vs. day 2; OR, 0.85; day 5 vs. day 2; OR, 0.73).
What this means in everyday clinical practice is that the probability of having an ectopic pregnancy is 29% per 1,000 pregnancies in a patient with tubal infertility if more than one embryo is transferred, he said. In contrast, the risk is more than three times lower at only 8.2% per 1,000 pregnancies in a patient who has a partner with male infertility and a single blastocyst transferred.
Details from the HFEA database showed that the proportion of infertile patients with tubal disease having ART progressively declined from 24% in 2000 to 12% in 2012. Tubal factor infertility accounts for about 14% of all infertility and is typically the result of Chlamydia trachomatis infection.
“Future efforts should promote national screening programs like the U.K.’s National Chlamydia Screening Programme. Although there is a discussion on how effective it is, I think it is very important we increase the uptake of these programs,” Dr. Polyzos said.
Efforts to promote widespread introduction of single-embryo transfer, which have been widely adopted in his own country, but less so in the United States, would lower the risk of EP even further, he added.
A recent U.S. analysis looking at the risk of EP associated with ART found that the rate of ectopic pregnancy was 1.6% when one embryo was transferred and 1.7%, 2.2%, and 2.5% when two, three, or four or more embryos were transferred, respectively. Overall, the EP rate declined from 2% in 2001 to 1.6% in 2011 based on 553,577 pregnancies reported during those years to the U.S. National ART Surveillance System (Obstet. Gynecol. 2015;125:70-8).
ESHRE did not require reports of financial disclosures.
On Twitter @pwendl
AT ESHRE 2015
Key clinical point: The rate of ectopic pregnancy following conception with assisted reproductive technology has almost halved in the past 12 years.
Major finding: The rate of ectopic pregnancy following ART declined from 20 to 12 cases per thousand between 2000 and 2012.
Data source: Registry analysis of 161,967 ART pregnancies.
Disclosures: ESHRE did not require reports of financial disclosures.
ESHRE: ART Does Not Hurt Academic Performance in Teens
LISBON – Conception by assisted reproductive technology is not associated with lower academic performance in adolescence, a large nationwide analysis showed.
In crude analyses, ART singletons had higher academic performance than spontaneously conceived singletons and ART twins performed as well as ART singletons. After adjustment for confounders, academic performance was similar between all singletons and between ART twins and ART singletons.
“These findings are very reassuring for the parents of ART children and for the ART society as a whole,” study author Anne Lærke Spangmose Pedersen said at the annual meeting of the European Society of Human Reproduction and Embryology.
ART children and twins in general have an increased risk of preterm delivery and low birth weight, but only a handful of studies have explored IQ in these children.
A recent study (BJOG 2014;121:1642-51) reported similar IQ, attention, and executive function in ART and non-ART children at age 5 years; however, no previous studies have included ninth-grade test scores in a complete national cohort of adolescents all conceived by ART, noted Ms. Pedersen, a medical student at Copenhagen University Hospital, Hvidovre, Denmark.
To do this, the investigators used compulsory national registers and the Danish IVF and Medical Birth Registry to identify 10,429 individuals born in Denmark from 1995 to 1998. This included all children conceived by ART (fresh embryo in-vitro fertilization and intracytoplasmic sperm injection), totaling 2,838 singletons and 1,930 twins, and a random sample of 5,661 non-ART singletons.
The primary outcome was the mean test score on the National Test, which is used for university entrance and completed by all ninth-grade students in Denmark at ages 15-16 years. Mandatory subjects include Danish, foreign languages, mathematics, and physics/chemistry, with scores ranging from –3 to +12 (mean 7). Scores were available for 2,544 ART singletons, 4,985 non-ART singletons, and 1,676 ART twins.
The mean test scores were 7.16 in ART singletons, 6.74 in non-ART singletons, and 7.21 in ART twins. The difference was statistically significant between ART and non-ART singletons (P < .001), but not between ART singletons and twins (P = .47), Ms. Pedersen said.
After adjustment for a variety of factors, including maternal age and socioeconomic status, which tend to be higher in ART families, the difference did not persist, she said.
“It’s not the final conclusion, but I think the data at this moment are reassuring,” session comoderator Dr. Willianne Nelenof Radboud University Nijmegen (the Netherlands) Medical Centre said in an interview. Like members of the audience, she said that data should be pooled from studies and that more data are needed from ART children and parents.
During the discussion of the results, Ms. Pedersen noted that preterm birth rates were significantly higher in ART singletons than non-ART singletons (4.6% vs. 2.7%; P < .001) and in ART twins, compared with ART singletons (22.8% vs. 4.6%; P < .001).
Ms. Pedersen reported having no financial disclosures.
LISBON – Conception by assisted reproductive technology is not associated with lower academic performance in adolescence, a large nationwide analysis showed.
In crude analyses, ART singletons had higher academic performance than spontaneously conceived singletons and ART twins performed as well as ART singletons. After adjustment for confounders, academic performance was similar between all singletons and between ART twins and ART singletons.
“These findings are very reassuring for the parents of ART children and for the ART society as a whole,” study author Anne Lærke Spangmose Pedersen said at the annual meeting of the European Society of Human Reproduction and Embryology.
ART children and twins in general have an increased risk of preterm delivery and low birth weight, but only a handful of studies have explored IQ in these children.
A recent study (BJOG 2014;121:1642-51) reported similar IQ, attention, and executive function in ART and non-ART children at age 5 years; however, no previous studies have included ninth-grade test scores in a complete national cohort of adolescents all conceived by ART, noted Ms. Pedersen, a medical student at Copenhagen University Hospital, Hvidovre, Denmark.
To do this, the investigators used compulsory national registers and the Danish IVF and Medical Birth Registry to identify 10,429 individuals born in Denmark from 1995 to 1998. This included all children conceived by ART (fresh embryo in-vitro fertilization and intracytoplasmic sperm injection), totaling 2,838 singletons and 1,930 twins, and a random sample of 5,661 non-ART singletons.
The primary outcome was the mean test score on the National Test, which is used for university entrance and completed by all ninth-grade students in Denmark at ages 15-16 years. Mandatory subjects include Danish, foreign languages, mathematics, and physics/chemistry, with scores ranging from –3 to +12 (mean 7). Scores were available for 2,544 ART singletons, 4,985 non-ART singletons, and 1,676 ART twins.
The mean test scores were 7.16 in ART singletons, 6.74 in non-ART singletons, and 7.21 in ART twins. The difference was statistically significant between ART and non-ART singletons (P < .001), but not between ART singletons and twins (P = .47), Ms. Pedersen said.
After adjustment for a variety of factors, including maternal age and socioeconomic status, which tend to be higher in ART families, the difference did not persist, she said.
“It’s not the final conclusion, but I think the data at this moment are reassuring,” session comoderator Dr. Willianne Nelenof Radboud University Nijmegen (the Netherlands) Medical Centre said in an interview. Like members of the audience, she said that data should be pooled from studies and that more data are needed from ART children and parents.
During the discussion of the results, Ms. Pedersen noted that preterm birth rates were significantly higher in ART singletons than non-ART singletons (4.6% vs. 2.7%; P < .001) and in ART twins, compared with ART singletons (22.8% vs. 4.6%; P < .001).
Ms. Pedersen reported having no financial disclosures.
LISBON – Conception by assisted reproductive technology is not associated with lower academic performance in adolescence, a large nationwide analysis showed.
In crude analyses, ART singletons had higher academic performance than spontaneously conceived singletons and ART twins performed as well as ART singletons. After adjustment for confounders, academic performance was similar between all singletons and between ART twins and ART singletons.
“These findings are very reassuring for the parents of ART children and for the ART society as a whole,” study author Anne Lærke Spangmose Pedersen said at the annual meeting of the European Society of Human Reproduction and Embryology.
ART children and twins in general have an increased risk of preterm delivery and low birth weight, but only a handful of studies have explored IQ in these children.
A recent study (BJOG 2014;121:1642-51) reported similar IQ, attention, and executive function in ART and non-ART children at age 5 years; however, no previous studies have included ninth-grade test scores in a complete national cohort of adolescents all conceived by ART, noted Ms. Pedersen, a medical student at Copenhagen University Hospital, Hvidovre, Denmark.
To do this, the investigators used compulsory national registers and the Danish IVF and Medical Birth Registry to identify 10,429 individuals born in Denmark from 1995 to 1998. This included all children conceived by ART (fresh embryo in-vitro fertilization and intracytoplasmic sperm injection), totaling 2,838 singletons and 1,930 twins, and a random sample of 5,661 non-ART singletons.
The primary outcome was the mean test score on the National Test, which is used for university entrance and completed by all ninth-grade students in Denmark at ages 15-16 years. Mandatory subjects include Danish, foreign languages, mathematics, and physics/chemistry, with scores ranging from –3 to +12 (mean 7). Scores were available for 2,544 ART singletons, 4,985 non-ART singletons, and 1,676 ART twins.
The mean test scores were 7.16 in ART singletons, 6.74 in non-ART singletons, and 7.21 in ART twins. The difference was statistically significant between ART and non-ART singletons (P < .001), but not between ART singletons and twins (P = .47), Ms. Pedersen said.
After adjustment for a variety of factors, including maternal age and socioeconomic status, which tend to be higher in ART families, the difference did not persist, she said.
“It’s not the final conclusion, but I think the data at this moment are reassuring,” session comoderator Dr. Willianne Nelenof Radboud University Nijmegen (the Netherlands) Medical Centre said in an interview. Like members of the audience, she said that data should be pooled from studies and that more data are needed from ART children and parents.
During the discussion of the results, Ms. Pedersen noted that preterm birth rates were significantly higher in ART singletons than non-ART singletons (4.6% vs. 2.7%; P < .001) and in ART twins, compared with ART singletons (22.8% vs. 4.6%; P < .001).
Ms. Pedersen reported having no financial disclosures.
AT ESHRE 2015
ESHRE: ART does not hurt academic performance in teens
LISBON – Conception by assisted reproductive technology is not associated with lower academic performance in adolescence, a large nationwide analysis showed.
In crude analyses, ART singletons had higher academic performance than spontaneously conceived singletons and ART twins performed as well as ART singletons. After adjustment for confounders, academic performance was similar between all singletons and between ART twins and ART singletons.
“These findings are very reassuring for the parents of ART children and for the ART society as a whole,” study author Anne Lærke Spangmose Pedersen said at the annual meeting of the European Society of Human Reproduction and Embryology.
ART children and twins in general have an increased risk of preterm delivery and low birth weight, but only a handful of studies have explored IQ in these children.
A recent study (BJOG 2014;121:1642-51) reported similar IQ, attention, and executive function in ART and non-ART children at age 5 years; however, no previous studies have included ninth-grade test scores in a complete national cohort of adolescents all conceived by ART, noted Ms. Pedersen, a medical student at Copenhagen University Hospital, Hvidovre, Denmark.
To do this, the investigators used compulsory national registers and the Danish IVF and Medical Birth Registry to identify 10,429 individuals born in Denmark from 1995 to 1998. This included all children conceived by ART (fresh embryo in-vitro fertilization and intracytoplasmic sperm injection), totaling 2,838 singletons and 1,930 twins, and a random sample of 5,661 non-ART singletons.
The primary outcome was the mean test score on the National Test, which is used for university entrance and completed by all ninth-grade students in Denmark at ages 15-16 years. Mandatory subjects include Danish, foreign languages, mathematics, and physics/chemistry, with scores ranging from –3 to +12 (mean 7). Scores were available for 2,544 ART singletons, 4,985 non-ART singletons, and 1,676 ART twins.
The mean test scores were 7.16 in ART singletons, 6.74 in non-ART singletons, and 7.21 in ART twins. The difference was statistically significant between ART and non-ART singletons (P < .001), but not between ART singletons and twins (P = .47), Ms. Pedersen said.
After adjustment for a variety of factors, including maternal age and socioeconomic status, which tend to be higher in ART families, the difference did not persist, she said.
“It’s not the final conclusion, but I think the data at this moment are reassuring,” session comoderator Dr. Willianne Nelenof Radboud University Nijmegen (the Netherlands) Medical Centre said in an interview. Like members of the audience, she said that data should be pooled from studies and that more data are needed from ART children and parents.
During the discussion of the results, Ms. Pedersen noted that preterm birth rates were significantly higher in ART singletons than non-ART singletons (4.6% vs. 2.7%; P < .001) and in ART twins, compared with ART singletons (22.8% vs. 4.6%; P < .001).
Ms. Pedersen reported having no financial disclosures.
On Twitter @pwendl
LISBON – Conception by assisted reproductive technology is not associated with lower academic performance in adolescence, a large nationwide analysis showed.
In crude analyses, ART singletons had higher academic performance than spontaneously conceived singletons and ART twins performed as well as ART singletons. After adjustment for confounders, academic performance was similar between all singletons and between ART twins and ART singletons.
“These findings are very reassuring for the parents of ART children and for the ART society as a whole,” study author Anne Lærke Spangmose Pedersen said at the annual meeting of the European Society of Human Reproduction and Embryology.
ART children and twins in general have an increased risk of preterm delivery and low birth weight, but only a handful of studies have explored IQ in these children.
A recent study (BJOG 2014;121:1642-51) reported similar IQ, attention, and executive function in ART and non-ART children at age 5 years; however, no previous studies have included ninth-grade test scores in a complete national cohort of adolescents all conceived by ART, noted Ms. Pedersen, a medical student at Copenhagen University Hospital, Hvidovre, Denmark.
To do this, the investigators used compulsory national registers and the Danish IVF and Medical Birth Registry to identify 10,429 individuals born in Denmark from 1995 to 1998. This included all children conceived by ART (fresh embryo in-vitro fertilization and intracytoplasmic sperm injection), totaling 2,838 singletons and 1,930 twins, and a random sample of 5,661 non-ART singletons.
The primary outcome was the mean test score on the National Test, which is used for university entrance and completed by all ninth-grade students in Denmark at ages 15-16 years. Mandatory subjects include Danish, foreign languages, mathematics, and physics/chemistry, with scores ranging from –3 to +12 (mean 7). Scores were available for 2,544 ART singletons, 4,985 non-ART singletons, and 1,676 ART twins.
The mean test scores were 7.16 in ART singletons, 6.74 in non-ART singletons, and 7.21 in ART twins. The difference was statistically significant between ART and non-ART singletons (P < .001), but not between ART singletons and twins (P = .47), Ms. Pedersen said.
After adjustment for a variety of factors, including maternal age and socioeconomic status, which tend to be higher in ART families, the difference did not persist, she said.
“It’s not the final conclusion, but I think the data at this moment are reassuring,” session comoderator Dr. Willianne Nelenof Radboud University Nijmegen (the Netherlands) Medical Centre said in an interview. Like members of the audience, she said that data should be pooled from studies and that more data are needed from ART children and parents.
During the discussion of the results, Ms. Pedersen noted that preterm birth rates were significantly higher in ART singletons than non-ART singletons (4.6% vs. 2.7%; P < .001) and in ART twins, compared with ART singletons (22.8% vs. 4.6%; P < .001).
Ms. Pedersen reported having no financial disclosures.
On Twitter @pwendl
LISBON – Conception by assisted reproductive technology is not associated with lower academic performance in adolescence, a large nationwide analysis showed.
In crude analyses, ART singletons had higher academic performance than spontaneously conceived singletons and ART twins performed as well as ART singletons. After adjustment for confounders, academic performance was similar between all singletons and between ART twins and ART singletons.
“These findings are very reassuring for the parents of ART children and for the ART society as a whole,” study author Anne Lærke Spangmose Pedersen said at the annual meeting of the European Society of Human Reproduction and Embryology.
ART children and twins in general have an increased risk of preterm delivery and low birth weight, but only a handful of studies have explored IQ in these children.
A recent study (BJOG 2014;121:1642-51) reported similar IQ, attention, and executive function in ART and non-ART children at age 5 years; however, no previous studies have included ninth-grade test scores in a complete national cohort of adolescents all conceived by ART, noted Ms. Pedersen, a medical student at Copenhagen University Hospital, Hvidovre, Denmark.
To do this, the investigators used compulsory national registers and the Danish IVF and Medical Birth Registry to identify 10,429 individuals born in Denmark from 1995 to 1998. This included all children conceived by ART (fresh embryo in-vitro fertilization and intracytoplasmic sperm injection), totaling 2,838 singletons and 1,930 twins, and a random sample of 5,661 non-ART singletons.
The primary outcome was the mean test score on the National Test, which is used for university entrance and completed by all ninth-grade students in Denmark at ages 15-16 years. Mandatory subjects include Danish, foreign languages, mathematics, and physics/chemistry, with scores ranging from –3 to +12 (mean 7). Scores were available for 2,544 ART singletons, 4,985 non-ART singletons, and 1,676 ART twins.
The mean test scores were 7.16 in ART singletons, 6.74 in non-ART singletons, and 7.21 in ART twins. The difference was statistically significant between ART and non-ART singletons (P < .001), but not between ART singletons and twins (P = .47), Ms. Pedersen said.
After adjustment for a variety of factors, including maternal age and socioeconomic status, which tend to be higher in ART families, the difference did not persist, she said.
“It’s not the final conclusion, but I think the data at this moment are reassuring,” session comoderator Dr. Willianne Nelenof Radboud University Nijmegen (the Netherlands) Medical Centre said in an interview. Like members of the audience, she said that data should be pooled from studies and that more data are needed from ART children and parents.
During the discussion of the results, Ms. Pedersen noted that preterm birth rates were significantly higher in ART singletons than non-ART singletons (4.6% vs. 2.7%; P < .001) and in ART twins, compared with ART singletons (22.8% vs. 4.6%; P < .001).
Ms. Pedersen reported having no financial disclosures.
On Twitter @pwendl
AT ESHRE 2015
Key clinical point: Conception by assisted reproductive technology is not associated with poorer academic performance in adolescence.
Major finding: Mean test scores were 7.16 for ART singletons, 6.74 for non-ART singletons, and 7.21 for ART twins.
Data source: Danish national cohort study in 10,429 adolescents.
Disclosures: Ms. Pedersen reported having no financial disclosures.
