Population-Based Study of Cesarean Section After In Vitro Fertilization in Australia

Authors

  • Elizabeth A. Sullivan MBBS, MPH, FAFPHM,

    1. Elizabeth A. Sullivan is an Associate Professor and Director of Perinatal and Reproductive Epidemiology Research Unit, School of Women’s and Children’s Health, University of New South Wales, Sydney; Michael G. Chapman is a Professor of Obstetrics and Gynecology, School of Women’s and Children’s Health, University of New South Wales, Sydney, and IVF Australia Southern Sydney, St George Private Hospital, Kogarah, New South Wales; Yueping A. Wang is a Biostatistician in Perinatal and Reproductive Epidemiology Research Unit, School of Women’s and Children’s Health, University of New South Wales, Sydney, Australia; and G. David Adamson is Director, Fertility Physicians of Northern California, Palo Alto and San Jose, California, and is an Adjunct Clinical Professor at Stanford University School of Medicine, Stanford, California, and Associate Clinical Professor at the University of California San Francisco, USA.
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  • Michael G. Chapman MBBS, MD, FRANZCOG,

    1. Elizabeth A. Sullivan is an Associate Professor and Director of Perinatal and Reproductive Epidemiology Research Unit, School of Women’s and Children’s Health, University of New South Wales, Sydney; Michael G. Chapman is a Professor of Obstetrics and Gynecology, School of Women’s and Children’s Health, University of New South Wales, Sydney, and IVF Australia Southern Sydney, St George Private Hospital, Kogarah, New South Wales; Yueping A. Wang is a Biostatistician in Perinatal and Reproductive Epidemiology Research Unit, School of Women’s and Children’s Health, University of New South Wales, Sydney, Australia; and G. David Adamson is Director, Fertility Physicians of Northern California, Palo Alto and San Jose, California, and is an Adjunct Clinical Professor at Stanford University School of Medicine, Stanford, California, and Associate Clinical Professor at the University of California San Francisco, USA.
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  • Yueping A. Wang MPH,

    1. Elizabeth A. Sullivan is an Associate Professor and Director of Perinatal and Reproductive Epidemiology Research Unit, School of Women’s and Children’s Health, University of New South Wales, Sydney; Michael G. Chapman is a Professor of Obstetrics and Gynecology, School of Women’s and Children’s Health, University of New South Wales, Sydney, and IVF Australia Southern Sydney, St George Private Hospital, Kogarah, New South Wales; Yueping A. Wang is a Biostatistician in Perinatal and Reproductive Epidemiology Research Unit, School of Women’s and Children’s Health, University of New South Wales, Sydney, Australia; and G. David Adamson is Director, Fertility Physicians of Northern California, Palo Alto and San Jose, California, and is an Adjunct Clinical Professor at Stanford University School of Medicine, Stanford, California, and Associate Clinical Professor at the University of California San Francisco, USA.
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  • G. David Adamson MD, FACOG, FACS

    1. Elizabeth A. Sullivan is an Associate Professor and Director of Perinatal and Reproductive Epidemiology Research Unit, School of Women’s and Children’s Health, University of New South Wales, Sydney; Michael G. Chapman is a Professor of Obstetrics and Gynecology, School of Women’s and Children’s Health, University of New South Wales, Sydney, and IVF Australia Southern Sydney, St George Private Hospital, Kogarah, New South Wales; Yueping A. Wang is a Biostatistician in Perinatal and Reproductive Epidemiology Research Unit, School of Women’s and Children’s Health, University of New South Wales, Sydney, Australia; and G. David Adamson is Director, Fertility Physicians of Northern California, Palo Alto and San Jose, California, and is an Adjunct Clinical Professor at Stanford University School of Medicine, Stanford, California, and Associate Clinical Professor at the University of California San Francisco, USA.
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  • The Fertility Society of Australia is the funding body for the Australian and New Zealand Assisted Reproduction Database. The authors acknowledge the contribution of fertility clinics in Australia and New Zealand in the provision of data to the Australian and New Zealand Assisted Reproduction Database. This article is based on data made available by the Australian Institute of Health and Welfare. The authors are responsible for the data used in this article.

Address correspondence to Elizabeth Sullivan, MBBS, MPH, Perinatal and Reproductive Epidemiology Research Unit, Level 2, McNevin Dickson Building, Randwick Hospitals Campus, Randwick, NSW 2031, Australia.

Abstract

Abstract:  Background:  Decisions about method of birth should be evidence based. In Australia, the rising rate of cesarean section has not been limited to births after spontaneous conception. This study aimed to investigate cesarean section among women giving birth after in vitro fertilization (IVF).

Methods:  Retrospective population-based study was conducted using national registry data on IVF treatment. The study included 17,019 women who underwent IVF treatment during 2003 to 2005 and a national comparison population of women who gave birth in Australia. The outcome measure was cesarean section.

Results:  Crude rate of cesarean section was 50.1 percent versus 28.9 percent for all other births. Single embryo transfer was associated with the lowest (40.7%) rate of cesarean section. Donor status and twin gestation were associated with significantly higher rates of cesarean section (autologous, 49.0% vs donor, 74.9%; AOR: 2.20, 95% CI: 1.80, 2.69) and (singleton, 45.0% vs twin gestations, 75.7%; AOR: 3.81, 95% CI: 3.46, 4.20). The gestation-specific rate (60.1%) of cesarean section peaked at 38 weeks for singleton term pregnancies. Compared with other women, cesarean section rates for assisted reproductive technology term singletons (27.8% vs 43.8%, OR: 2.02 [95% CI: 1.95–2.10]) and twins (62.0% vs 75.7%, OR: 1.92 [95% CI: 1.74–2.11]) were significantly higher.

Conclusions:  Rates for cesarean section appear to be disproportionately high in term singleton births after assisted reproductive technology. Vaginal birth should be supported and the indications for cesarean section evidence based. (BIRTH 37:3 September 2010)

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