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Victory, Jenna

University of British Columbia

Infertility, the inability to conceive after twelve or more months of regular unprotected sexual intercourse, affects approximately 1 in 6 people globally. Fertility rates are declining worldwide, and use of assisted reproductive technologies like in-vitro fertilization (IVF) to conceive is increasing. Racial/ethnic disparities in SMM among women who conceived via IVF are understudied. In addition, the association between IVF conception and HELLP (haemolysis, elevated liver enzymes, low platelets) syndrome during pregnancy has not been quantified on the population level, distinctively in singleton and twin pregnancy. I conducted a population-based retrospective cohort study of all singleton births between 20-44 weeks in the United States between 2016-2021 using live birth and fetal death certificate data. The objective of this study was to quantify the association between IVF and SMM and to ascertain if the association was modified by race/ethnicity. Women who conceived by IVF had a two-fold higher rate of the SMM composite outcome. This higher risk was observed across all racial/ethnic groups. Racial/ethnic disparities were present in women who conceived spontaneously. Women who conceived by IVF generally had similar racial/ethnic disparities. However, these disparities in uterine rupture/intrapartum hysterectomy were larger for Hispanic women who conceived by IVF than spontaneously, and for NHB women who conceived by IVF than spontaneously. Asian women who used IVF also had greater odds of admission to the ICU than those who conceived spontaneously. I conducted a second population-based retrospective cohort study of all singleton and twin live births and stillbirths between 20-44 weeks in British Columbia, Canada, between 2008/09-2021/22. This study attempted to address whether spontaneous versus IVF conception was associated with HELLP syndrome among singleton/twin pregnancies. Women who conceived twins spontaneously had higher risk of HELLP syndrome than women who conceived twins using IVF. Twin pregnancies regardless of mode of conception had higher risks of HELLP syndrome compared with women with spontaneously conceived singleton pregnancy. In summary, IVF conception modifies the associations between risk factors such as race/ethnicity and plurality, and some components of severe maternal morbidity.

Text

2024-08-01

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/88846

Women+ and Children’s Health Sciences

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nc-nd/4.0/