Assisted reproductive technologies and the risk of stillbirth in singleton pregnancies: a systematic review and meta-analysis

Objective To identify the risk of stillbirth from in vitro types of assisted reproductive technologies compared with spontaneous conception (SC), limited to singleton births. Design Systematic literature search and search chaining on online databases: PubMed, Embase, and Scopus. Setting Not applicable. Patient(s) Singleton pregnancies from in vitro fertilization (IVF) or fertilization by IVF and intracytoplasmic sperm injection (IVF-ICSI). Intervention(s) Not applicable. Main Outcome Measure(s) Adjusted odds ratio for stillbirth or prevalence of stillbirth in case–control groups of IVF/IVF-ICSI singletons and SCs, respectively, in matched studies. Result(s) A total of 19 studies were included, and study quality was mixed. Ten studies qualified for inclusion to the meta-analysis, which revealed a significantly increased risk of stillbirth in IVF/IVF-ICSI compared with that in SC (odds ratio [95% confidence interval]: 1.82 [1.37–2.42]), and there was no evidence of publication bias. Conclusion(s) In vitro fertilization and IVF-ICSI treatment increases the risk of stillbirth compared with natural conception. Clinical Trial Registration Number PROSPERO 216768.