What advice do you give about the risk of fetal abnormality and IVF conception?

We will be discussing: Maternal factors and the risk of birth defects after IVF and ICSI: a whole of population cohort study by Davies and colleagues.

Wednesday 31st May 2017, 8pm BST

The hosted discussion will take place on Twitter, with the discussion continuing for up to 7 days. Remember to use #BlueJC in all your Tweets!
Host: @bluejchost

Scenario

A 41-year-old nulliparous woman presents to your clinic wishing to get pregnant. What advice do you give her about her risk of fetal abnormality and IVF conception?

Description of research

Participants: 304 670 birth episodes in South Australia for the period January 1986 to December 2002.
Intervention: Assisted conception with IVF or ICSI.
Comparison: Natural conception.
Outcomes: Odds ratios of major birth defects.
Study design: Retrospective cohort study.

Discussion points

  • How does this study define birth defects? How would you explain this to a patient?
  • This study used linked data. What routine data sets did it link between? Do these data sets exist in your healthcare system?
  • Why is linked data of use? Can you think of other areas where this sort of linkage would be helpful?
  • Does this study attain the standards for reporting studies using linked routine data (the RECORD statement)?
  • Do you agree with the authors’ conclusion that this study refutes the assumption that the known risk between assisted conception and birth defects is linked to age, or is more investigation needed?
  • Can you briefly summarise the results of this study? How would the results of this study influence your counselling of the woman in the scenario?

Suggested reading

Benchimol EI, Smeeth L, Guttmann A, Harron K, Moher D, Petersen I, et al. The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) Statement. PLoS Med 2015;12:e1001885. https://doi.org/10.1371/journal.pmed.1001885