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Safety and efficacy of in vitro fertilisation in patients with chronic liver disease and liver transplantation recipients

Published:January 15, 2021DOI:https://doi.org/10.1016/j.jhep.2020.12.022

      Highlights

      • Subfertility is common in women with liver disease and can persist post-LT.
      • Although the complications of IVF are well described in the general population, its effects on women with liver disease are unknown.
      • Women with LRSF can undergo successful pregnancies with IVF therapy.
      • Complications are potentially greater in women with liver disease, so pre-conception counselling is important.

      Background & Aims

      Chronic liver disease and liver transplantation (LT) can delay both timing and ability of women to conceive. With increased awareness and availability of in vitro fertilisation (IVF), the need for accurate counselling is paramount. To date, minimal data exist on outcomes of IVF in patients with chronic liver disease, cirrhosis, or post-LT. We report the largest experience of IVF in women with liver-related subfertility (LRSF).

      Methods

      A retrospective analysis was performed on 42 women with LRSF who had undergone 57 IVF cycles between 1990 and 2019.

      Results

      Forty-two women with LRSF received IVF; 9 cycles in 6 women with cirrhosis, 14 cycles in 11 women post-LT, and 34 cycles in 25 women without cirrhosis. The main aetiologies of liver disease included HBV, HCV, and autoimmune hepatitis (AIH). Of 57 IVF cycles evaluated, 43 (75%) resulted in successful implantation. Eight (2 post-LT, 3 with cirrhosis, 4 without cirrhosis) resulted in miscarriage. The live birth rate (LBR) was 74% (32/43). Two of 9 (22%) patients with cirrhosis, 4/14 (29%) patients who were post-LT, and 6/34 (18%) patients without cirrhosis had unsuccessful IVF attempts. Nine of 57 (16%) IVF cycles resulted in new liver enzyme derangement during therapy, which improved after treatment completion. Six pregnancies (2 in patients who were post-LT, 4 without cirrhosis) were complicated by obstetric cholestasis (OC). Ovarian hyperstimulation syndrome (OHSS) was rare (n = 3, 7%). One patient with AIH-related cirrhosis decompensated after initiating IVF, warranting discontinuation of therapy. There were no maternal deaths. Three women developed a hypertensive disorder of pregnancy. Half the pregnancies resulted in premature deliveries (range 27–36 weeks).

      Conclusions

      In selected cases, IVF in women with LRSF can be successful. However, patients should be counselled on the potential increased risks of OHSS, OC, and prematurity.

      Lay summary

      Women with liver disease or those who have had a liver transplant can experience difficulties getting pregnant. In this study, we look at whether alternative approaches to achieve pregnancy are harmful in these women. Overall, there were no significant issues with the use of in vitro fertilisation in women with liver disease, but they need to be aware of potential risks, such as early delivery of the baby.

      Graphical abstract

      Keywords

      Linked Article

      • The ART of medicine: Counselling women with liver disease about assisted reproductive technology
        Journal of HepatologyVol. 74Issue 6
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          The number of women of reproductive age living with chronic liver disease (CLD), cirrhosis, and post liver-transplantation (LT) is growing along with rising rates of childbirth in women with liver disease documented in Europe,1 Canada,2 and the United States.3 As chronic medical conditions can result in both a delay in conception and infertility, counselling women with liver disease and post-LT regarding the success and safety of assisted reproductive technology (ART) is becoming more frequent. The most common form of ART is in vitro fertilization (IVF), where ovarian stimulation occurs via injectable gonadotropins followed by egg retrieval, fertilization of the egg (either conventional in vitro insemination or intracytoplasmic sperm injection), and embryo transfer.
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