Births After a Period of Infertility in Victorian Women 1982–199
Authors: Venn Alison , Epid Grad Dip , Lumley Judith 
Published: February 2008

EDITORIAL COMMENT": We have accepted this paper for publication because it reports that there is a significantly increased perinatal mortality rate in women who have a history of infertility. Comparison is made with the similarly increased perinatal mortality rate in patients with infertility treated with IVF and GIFT although such cases were included in the series reported. This paper was not able to address the question of whether the perinatal mortality rate is different in pregnancies resulting from patients who have had IVF, GIFT or induction of ovulation, in comparison with those where the patients had a history of infertility but where conception was unassisted by reproductive technology. The authors examined the documentation on which this paper was based by comparing the history of infertility in cases of perinatal death reported to the Consultative Council on Obstetric and Paediatric Mortality and Morbidity and found that there were 214 perinatal deaths with a history of infertility and only 28 cases of perinatal mortality (13% of the total) had been included in their survey. The underreporting of a history of infertility in Victorian births to the Victorian Perinatal Data Collection Unit calls into question the validity of the findings so carefully analyzed in this paper. The editorial committee of the journal considers that the take‐away message of this paper is that further data is required on the risk of perinatal death in women who report a history of infertility apart from those who are treated with ovulation induction techniques, IVF or GIFT. It would appear that these women may be at increased risk of perinatal mortality and hence warrant careful fetal surveillance during pregnancy.

Summary: Pregnancies following a period of infertility are often thought to be at increased risk of adverse outcomes. Between 1982–1990, 1465 births were reported to the Victorian Perinatal Data Collection Unit with a history of infertility. We present some characteristics of these births and compare them with all Victorian births in 1986 (n = 61,253) and Australian and New Zealand IVF and GIFT births 1979–1989 (n = 6,675). Women with a history of infertility were older than other Victorian women but younger than the IVF and GIFT group. Multiple births comprised 9% of the infertility group compared with 1.3% in the general Victorian population and 23.7% of IVF and GIFT births. The incidence of low birth‐weight (18.6%) and very low birth‐weight (4.2%) was higher than in other Victorian births (5.8% and 1.1% respectively) but lower than in IVF and GIFT births (34.6% and 8.9%). Perinatal mortality in the infertility group (33.4 per 1,000) was higher than in the general population (11.1 per 1,000) and similar to the IVF and GIFT group (34.9 per 1,000). The Caesarean section rate after infertility (41%) was more than double the rate in the rest of the Victorian population (16%), and showed a different pattern of indications. The relative risks of low and very low birth‐weight, perinatal mortality and Caesarean delivery remained significantly increased for singletons after adjustment for maternal age and parity.