What genetic conditions should be discussed with patients considering to undergo or who have undergone in IVF?
What are the different types of preimplantation genetic testing?
The use of preimplantation genetic testing for aneuploidy (PGT-A): a committee opinion.
Clinical management of mosaic results from preimplantation genetic testing for aneuploidy (PGT-A) of blastocysts: a committee opinion.
What is the accuracy of first-trimester genetic screening tests in pregnancies achieved with in vitro fertilization?
Does multifetal pregnancy reduction reduce the risks associated with multiple gestations?
Are congenital anomalies increased in pregnancies achieved with in vitro fertilization?
|Organ system||IVF with or without ICSI pregnancies||Naturally occurring pregnancies|
|Cleft lip or palate||1.3 (0.9–1.7)||1.2 (1.0–1.6)|
|Eye, ear, face, neck||1.7 (0.8–3.6)||1.5 (0.8–2.8)|
|CNS||1.7 (1.2–2.4)||1.7 (1.2–2.6)|
|Respiratory system||0.8 (0.4–1.6)||0.8 (0.5–1.4)|
|GI||3.8 (2.4–6.0)||2.5 (1.4–4.5)|
|Musculoskeletal||11.0 (6.7–18.1)||8.1 (4.7–13.6)|
|Urogenital||10.9 (6.9–17.2)||6.4 (4.5–9.1)|
|Cardiovascular||5.7 (5.3–11.2)||5.2 (4.5–9.1)|
Are placental anomalies increased in pregnancies achieved with in vitro fertilization?
- Shainker S.A.
- Coleman B.
- Timor-Tritsch I.E.
- et al.
Is the prevalence of spontaneous preterm birth higher in pregnancies achieved with in vitro fertilization?
Is the prevalence of fetal growth restriction higher in pregnancies achieved with in vitro fertilization?
- Maheshwari A.
- Pandey S.
- Shetty A.
- Hamilton M.
- Bhattacharya S.
In pregnancies achieved with in vitro fertilization, does low-dose aspirin prophylaxis reduce the risk for fetal and placental complications?
Is the prevalence of stillbirth increased in pregnancies achieved with in vitro fertilization?
In pregnancies achieved with in vitro fertilization, does delivery at 39 weeks of gestation reduce the risk for adverse perinatal outcomes?
|1||We suggest that genetic counseling be offered to all patients undergoing or who have undergone IVF, with or without ICSI.||2C|
|2||Regardless of whether PGT has been performed, we recommend that all patients who have achieved pregnancy with IVF be offered the options of prenatal genetic screening and diagnostic testing via chorionic villus sampling or amniocentesis.||1C|
|3||We recommend that the accuracy of first-trimester screening tests, including cfDNA for aneuploidy, be discussed with patients undergoing or who have undergone IVF.||1A|
|4||When multifetal pregnancies do occur, we recommend that counseling be offered regarding the option of multifetal pregnancy reduction.||1C|
|5||We recommend that a detailed obstetrical ultrasound examination (CPT 76811) be performed for pregnancies achieved with IVF and ICSI.||1B|
|6||We suggest that fetal echocardiography be offered to patients with pregnancies achieved with IVF and ICSI.||2C|
|7||We recommend that a careful examination of the placental location, placental shape, and cord insertion site be performed at the time of the detailed fetal anatomy ultrasound, including evaluation for vasa previa.||1B|
|8||Although visualization of the cervix at the 18 0/7 to 22 6/7 weeks of gestation anatomy assessment with either a transabdominal or endovaginal approach is recommended, we do not recommend serial cervical length assessment as a routine practice for pregnancies achieved with IVF.||1C|
|9||We suggest that an assessment of fetal growth be performed in the third trimester for pregnancies achieved with IVF; however, serial growth ultrasounds are not recommended for the sole indication of IVF.||2B|
|10||We do not recommend low-dose aspirin for patients with pregnancies achieved with IVF as the sole indication for preeclampsia prophylaxis; however, if one or more additional risk factors are present, low-dose aspirin is recommended.||1B|
|11||Given the increased risk for stillbirth, we suggest weekly antenatal fetal surveillance beginning by 36 0/7 weeks of gestation for pregnancies achieved with IVF.||2C|
|12||In the absence of studies focused specifically on timing of delivery for pregnancies achieved with IVF, we recommend shared decision-making between patients and healthcare providers when considering induction of labor at 39 weeks of gestation.||1C|
- Norton M.E.
- Kuller J.A.
- Metz T.D.
Society for Maternal-Fetal Medicine Special Statement: grading of Recommendations Assessment, Development, and Evaluation (GRADE) update.
|Grade of recommendation||Clarity of risk and benefit||Quality of supporting evidence||Implications|
|1A. Strong recommendation, high-quality evidence||Benefits clearly outweigh risks and burdens, or vice versa.||Consistent evidence from well-performed, randomized controlled trials, or overwhelming evidence of some other form. Further research is unlikely to change confidence in the estimate of benefit and risk.||Strong recommendation that can apply to most patients in most circumstances without reservation. Clinicians should follow a strong recommendation unless a clear and compelling rationale for an alternative approach is present.|
|1B. Strong recommendation, moderate-quality evidence||Benefits clearly outweigh risks and burdens, or vice versa.||Evidence from randomized controlled trials with important limitations (inconsistent results, methodologic flaws, indirect or imprecise), or very strong evidence of some other research design. Further research (if performed) is likely to have an impact on the confidence of the estimate of benefit and risk and may change the estimate.||Strong recommendation that applies to most patients. Clinicians should follow a strong recommendation unless a clear and compelling rationale for an alternative approach is present.|
|1C. Strong recommendation, low-quality evidence||Benefits seem to outweigh risks and burdens, or vice versa.||Evidence from observational studies, unsystematic clinical experience, or randomized controlled trials with serious flaws. Any estimate of effect is uncertain.||Strong recommendation that applies to most patients. Some of the evidence base supporting the recommendation is, however, of low quality.|
|2A. Weak recommendation, high-quality evidence||Benefits closely balanced with risks and burdens.||Consistent evidence from well-performed randomized controlled trials or overwhelming evidence of some other form. Further research is unlikely to change confidence in the estimate of benefit and risk.||Weak recommendation; best action may differ depending on circumstances or patients or societal values.|
|2B. Weak recommendation, moderate-quality evidence||Benefits closely balanced with risks and burdens; some uncertainty in the estimates of benefits, risks, and burdens.||Evidence from randomized controlled trials with important limitations (inconsistent results, methodologic flaws, indirect or imprecise), or very strong evidence of some other research design. Further research (if performed) is likely to have an effect on confidence in the estimate of benefit and risk and may change the estimate.||Weak recommendation; alternative approaches likely to be better for some patients under some circumstances.|
|2C. Weak recommendation, low-quality evidence||Uncertainty in the estimates of benefits, risks, and burdens; benefits may be closely balanced with risks and burdens.||Evidence from observational studies, unsystematic clinical experience, or randomized controlled trials with serious flaws. Any estimate of effect is uncertain.||Very weak recommendation, other alternatives may be equally reasonable.|
|Best practice||Recommendation in which either (1) there is an enormous amount of indirect evidence that clearly justifies strong recommendation (direct evidence would be challenging, and inefficient use of time and resources, to bring together and carefully summarize) or (2) recommendation to the contrary would be unethical.|
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