IUI with donor sperm may increase risk for preeclampsia and hypertensive disorders of pregnancy: EJOG
Intrauterine insemination with donor sperm (IUI-D) became widely used and socially acceptable. In some cases, treatment using donor sperm is the only alternative for severe male factor infertility. New and growing patient groups for IUI-D are same sex female couples and single women seeking infertility treatment. Unlike couples with infertility, these women are usually fertile and have good reproductive health. The trend for all patient groups is delayed parenthood (to an older age). This inevitably leads to increased maternal risks in pregnancy because of the age factor per se and because of underlying chronic diseases, such as chronic hypertension. In vitro fertilization (IVF) using donor sperm (IVF-D) is a treatment option for couples with male factor infertility when IUI-D treatment fails, or when there is a female factor present, e.g. a tubal factor, severe endometriosis, or increased age of the woman.
Over the years, increasing evidence of a higher risk of preeclampsia (PE) in pregnancies after use of donor sperm has arisen. Hypertensive disorders of pregnancy (HDP) and PE are not only associated with adverse maternal and fetal short-term outcomes but also with increased morbidity and mortality in later life of the mother and the child.
The systematic review and meta-analysis by E.-M. Pohjonen et al aimed to assess the risk of HDP and, PE, as well as perinatal outcomes in both IUI-D and IVF-D cycles compared with IUI-H, IVF/ICSI-H and SC pregnancies.
The main outcomes were HDP (including PE, gestational hypertension or pregnancy induced hypertension (PIH)), low birth weight (LBW, defined as birth weight < 2500 g), preterm birth (PTB, defined as birth before 37 gestational weeks + 0 days), fetal sex ratio and birth defects. Separate analyses were made comparing IUI-D with either IUIH or SC pregnancies as well as IVF-D with IVF-H.
No increased risk for HDP after IVF-D treatment was. IUI-D is probably associated with a moderately increased risk of PE and HDP, moderate certainty of evidence. There may be little or no difference in the risk of HDP between IVF/ ICSI-D and IVF/ICSI-H, low certainty of evidence.
There may be little or no difference in risk of LBW between children born after IUI-D and IUI-H, low certainty of evidence or after IUI-D and SC pregnancies, low certainty of evidence. Use of IVF/ICSI-D may be associated with slightly lower risk for children to be born with LBW compared to IVF/ ICSI-H.
There may be little or no difference in risk of PTB between children born after IUI-D compared both with IUI-H and SC, low certainty of evidence or between children born after IVF/ICSI-D compared with IVF/ICSI-H, respectively.
In this systematic review and meta-analysis, a moderately increased risk was observed for PE and HDP after IUI-D compared both with IUI-H and SC pregnancies. However, no increased risk of either HDP or PE was seen when using IVF-D. The frequency of children with LBW or PTB was similar between IUI-D and IUI-H as well as between IUI-D and SC, respectively. The risk for LBW was, however, lower for children born after IVF-D compared with IVF-H.
Generally, IVF pregnancies are known to be associated with higher risk of PTB and LBW compared to SC pregnancies. An interesting finding in this study was that children born after IVF-D had a lower risk for LBW than children born after IVF-H.
The reason for the lower risk of LBW observed in IVF-D vs. IVF-H may be related to the difference in the patient populations as women receiving IVF-H may have more severe infertility diagnoses, such as tubal pathology, endometriosis, uterine pathology, endocrine disorders compared with those treated with IVF-D. On the other hand, the sperm used in IVF-D treatment is usually from healthy donors with top quality semen which is not the case in ICSI-H group.
"Our systematic review and meta-analyses showed that there is a moderately increased risk of PE and HDP in IUI-D pregnancies while the risk of LBW and PTB in children born after IUI-D are comparable to IUI-H and SC. Risks for HDP and PTB after IVF-D are comparable to IVF-H, and there is a slightly lower risk for LBW after IVF-D. From a clinical point of view, the increased risk of HDP after IUI-D treatment identifies a new risk group and calls for case-by-case consideration of prophylactic treatment (e.g. low-dose aspirin) and/or intensified surveillance of these women during pregnancy. In addition, this information should be used for patient counselling."
Source: E.-M. Pohjonen et al.; European Journal of Obstetrics & Gynecology and Reproductive Biology 274 (2022) 210–228
