Biomedical subjects

Reija Klemetti

Publications and source records attributed to Reija Klemetti.

8 recordsLinked to original sources

PubMed2006

Health of children born as a result of in vitro fertilization.

OBJECTIVE: The purpose of this study was to use nationwide registries to examine the health of children up to 4 years of age who were born as a result of in vitro fertilization. METHODS: Children born after in vitro fertilization (N = 4559) from 1996 to 1999 were monitored until 2003. Two control groups were selected from the Finnish Medical Birth Register as follows: all other children (excluding children born after ovulation induction) from the same period (N = 190,398, for study of perinatal health and hospitalizations) and a random sample of those children (n = 26,877, for study of health-related benefits). Mortality rates and odds ratios for perinatal outcomes, hospitalizations, health-related benefits, and long-term medication use were calculated. RESULTS: Although the health of most in vitro fertilization children was good, such children had more health problems than other children. A total of 35.7% of in vitro fertilization children and 2.2% of control children were multiple births, and the health of multiple births was worse than that of singletons. Perinatal outcomes of in vitro fertilization children were worse and hospital episodes were more common than among control children. Risks for cerebral palsy and psychological and developmental disorders were increased. Among in vitro fertilization singletons, worse results for perinatal outcomes and hospitalizations, but no increased risk for specific diseases, were found. The health of in vitro fertilization multiple births was comparable to the health of control multiple births. CONCLUSIONS: Reducing the number of transferred embryos would improve the health of in vitro fertilization children. Additional studies are needed to explain the poorer health of in vitro fertilization singletons, as well as follow-up studies to examine the health of in vitro fertilization children from 4 years onward.

Child, Preschool↗

PubMed2006

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Explore the source record for details and available documents.

Journal Article↗

PubMed2005

Complications of IVF and ovulation induction.

BACKGROUND: The frequency and importance of complications of IVF and other ovulation induction (OI) are poorly known. We examined the occurrence of serious complications and miscarriages leading to hospitalization or operation after IVF (including microinjections and frozen embryo transfers) and OI treatment (with or without insemination). METHODS: Women who received IVF (n = 9175) or OI treatment (n = 10 254) 1996-1998 in Finland were followed by a register linkage study until 2000. RESULTS: After the first IVF treatment cycle, 14 per 1000 women had a serious case of OHSS (ovarian hyperstimulation syndrome), with 23 per 1000 throughout the study period (mean of 3.3 treatments). The corresponding values after OI were very low. The rates of registered ectopic pregnancies and miscarriages after IVF were nine and 42 respectively per 1000 women, with corresponding rates after OI of eight and 42. Infections and bleeding were not common after IVF and even rarer after OI. Overall, 15% of IVF and 8% of OI women had at least one hospital episode during the study period. CONCLUSIONS: Though there was a low risk of complications after each IVF treatment cycle, repeated attempts resulted in serious complications for many women, and these occurred much more often than after ovulation induction alone.

Abortion, Spontaneous↗

PubMed2005

Children born after assisted fertilization have an increased rate of major congenital anomalies.

OBJECTIVE: To study the occurrence of major congenital anomalies (CAs) among children born after IVF (IVF, microinjections, and frozen embryo transfers) and after ovulation inductions with or without insemination (other assisted reproductive technologies [ART]). DESIGN: Register-based study. SETTING: Data regarding CAs were obtained from the Register of Congenital Malformations. PATIENT(S): Children from IVF (n = 4,559), children from other ART (n = 4,467), and controls (n = 27,078, a random sample of naturally conceived children) from the Medical Birth Register. INTERVENTION(S): In vitro fertilization and other ART treatment in ordinary practice. MAIN OUTCOME MEASURE(S): Rate of major CAs. Children from IVF and other ART were compared with control children, both overall and by plurality, controlling for confounding factors by logistic regression. RESULT(S): For IVF children, the adjusted odds ratio (OR) was 1.3 (95% confidence interval [CI], 1.1-1.6). Stratifying by gender and plurality showed that the risk was only increased for boys, and the risk was decreased for multiple IVF girls (OR = 0.5, 95% CI 0.2-0.9). The crude OR of major CA for other ART children was 1.3 (95% CI 1.1-1.5), but adjusted differences by gender and plurality were statistically insignificant. CONCLUSION(S): In vitro fertilization was associated with an increased risk for major CAs among singleton boys and a decreased risk among multiple girls. The risk after other ART was only slightly increased.

Abnormalities, Multiple↗

PubMed2004

Monitoring of IVF birth outcomes in Finland: a data quality study.

BACKGROUND: The collection of information on infertility treatments is important for the surveillance of potential health consequences and to monitor service provision. STUDY DESIGN: We compared the coverage and outcomes of IVF children reported in aggregated IVF statistics, the Medical Birth Register (subsequently: MBR) and research data based on reimbursements for IVF treatments in Finland in 1996-1998. RESULTS: The number of newborns were nearly equal in the three data sources (N = 4331-4384), but the linkage between the MBR and the research data revealed that almost 40% of the reported IVF children were not the same individuals. The perinatal outcomes in the three data sources were similar, excluding the much lower incidence of major congenital anomalies in the IVF statistics (157/10 000 newborns) compared to other sources (409-422/10 000 newborns). CONCLUSION: The differences in perinatal outcomes in the three data sets were in general minor, which suggests that the observed non-recording in the MBR is most likely unbiased.

Adult↗

PubMed2004

Equity in the use of IVF in Finland in the late 1990s.

AIMS: The purpose of this study was to describe equity in the use of in vitro fertilization (IVF; including micro-injections and frozen-embryo transfers), and compare its use with that of other assisted reproduction technologies (other ARTs; including ovulation inductions with or without inseminations). METHODS: The women who received IVF (n=9, 175) and other ARTs (n=10,254) between 1996 and 1998 were identified from the reimbursement records of the Social Insurance Institution (SII) covering all Finns. Population controls, matched by age and municipality, were selected for IVF women (n=9,175). Information concerning background characteristics came from the Central Population Register and the SII's reimbursement files. The sector (public vs. private) was defined using prescribing physicians' codes. IVF use was studied by the proportions of women treated and the frequency of treatment. RESULTS: The age-standardized IVF incidence per thousand 20-to-49-year-old women was 8.8 in urban and 7.3 in rural areas, but the use of other ARTs did not vary correspondingly (9.2, 9.3). The regional incidence of IVF and other ARTs varied considerably. In the private sector, women in the highest socioeconomic position were over-represented (29% private, 18% public, 16% controls). During the mean 1.5 years of the study period, the IVF women had somewhat more treatment cycles in the private than in the public sector (mean 3.3, 2.7), and those in the highest socioeconomic position had more cycles than others (3.5, 3.2); the frequency was not age-dependent. In the public sector the number of cycles did not differ by socioeconomic group (mean 2.7-2.8 per woman), and women aged 25 to 39 had more cycles than others. CONCLUSION: There were socioeconomic differences in use of IVF services, but they were small because of the equitable use of public services.

Adult↗

PubMed2003

Identifying exposures of in vitro fertilization from drug reimbursement files: a case study from Finland.

OBJECTIVE: This article describes an innovative method to identify infertility interventions from drug reimbursement data, which did not contain diagnoses. METHODS: An algorithm of usual infertility care steps was designed and information on drug prescriptions were retrieved from the Drug Reimbursement Register and linked to a register covering examinations and interventions in private health care. The data were compared to in vitro fertilization (IVF) statistics and the Birth Register. RESULTS: Despite the novelty of the idea, the complexity of the pharmacological details, the use of administrative registers not commonly used for research, and the involvement of two institutions, the identification of the exposed cohorts went well. An estimated 16 work-weeks were used. The numbers of started IVF-cycles with fresh embryos were similar to those in statistics, but our data had more transfers of frozen embryos. The linkage to the Birth Register gave further support that our algorithm worked well. Classification into different IVF-classes was not accurate. CONCLUSION: Even though diagnoses were not recorded in the Finnish drug reimbursement data, the algorithm approach allowed exposure identification.

Algorithms↗

PubMed2002

Comparison of perinatal health of children born from IVF in Finland in the early and late 1990s.

BACKGROUND: The purpose of this study was to investigate whether perinatal health outcomes changed during the 1990s with the increasing use of IVF. METHODS: Data were from the Finnish Medical Birth Register for periods 1991-1993 and 1998-1999. Outcomes of IVF infants and other infants were compared, both overall and separately for singleton and multiple births, by adjusting for mothers' background variables by logistic regression. RESULTS: The IVF multiple birth rate, especially the number of triplets, declined from the first (1991-1993) to the second (1998-1999) time-period. The outcomes for IVF newborns improved, especially for multiple births. After adjusting for mothers' background variables, the odds ratios for preterm birth and low birthweight decreased among singletons from 2.2 [95% confidence interval (CI) 1.8-2.8] to 1.8 (CI 1.5-2.1) and from 2.4 (CI 1.9-3.1) to 1.7 (CI 1.4-2.1) respectively and more among multiples from 2.4 (CI 2.0-2.9) to 1.5 (CI 1.2-1.7) and from 1.9 (CI 1.6-2.3) to 1.1 (CI 1.0-1.3) respectively. Still, overall the outcomes for IVF infants remained poorer than those for other infants. A correlation was found between increased use of antenatal services and improved outcomes, but causality cannot be assumed. CONCLUSION: A trend of improved perinatal health of multiple IVF children was found, mainly due to a decrease in higher order multiple births.

Adult↗