Birth outcomes after in vitro fertilization among cancer survivors.
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OBJECTIVE: To determine if patients with cancer who retrieve oocytes for in vitro fertilization (IVF) before or after cancer treatment have an increased risk of adverse birth outcomes compared with other IVF patients without cancer in the United States. DESIGN: Retrospective cohort study. SUBJECTS: Singleton IVF births during 2004-2018 from women with and without a history of cancer in nine states (California, Colorado, Massachusetts, Maryland, Michigan, North Carolina, New Jersey, New York, and Virginia). EXPOSURE: Women with a cancer history before IVF who had oocyte retrieval before cancer treatment (fertility preservation) or after cancer treatment. MAIN OUTCOME MEASURES: Multivariable relative risks (RR) and 95% confidence intervals (CI) for gestational hypertension, low birthweight [LBW, <2,500 g], preterm birth [PTB, <37 weeks], small for gestational age (SGA), large for gestational age (LGA), and cesarean delivery. RESULTS: Among 135,274 IVF births, 648 were from patients with cancer who retrieved oocytes before (fertility preservation, n=112) or after (n=536) cancer treatment. The IVF births in patients with cancer were compared with noncancer IVF births, which had IVF indications of male factor infertility (n=33,284 births), tubal ligation (n=1,258 births), and all other IVF indications (n=100,084 births). Preterm birth (13%), LBW (10%), SGA (12%), and LGA (10%) in the fertility preservation group were similar to noncancer IVF referent groups, but cesarean section (55% vs. 44%-49%) was more common. In models adjusted for race, education, infant sex, and fresh/frozen embryo state, IVF births with oocyte retrieval after cancer treatment did not consistently differ from noncancer IVF births for gestational hypertension (6%), PTB (13%), LBW (9%), SGA (9%), and cesarean delivery (53%), but had lower risk of LGA (8%) compared with male factor infertility (10%, RR=0.69, 95% CI=0.51-0.93), tubal ligation (13%, RR=0.56, 95% CI=0.40-0.78), and all other noncancer IVF indications (10%, RR=0.71, 95% CI=0.53-0.96). CONCLUSION: With the exception of LGA, we found similar risks of several adverse birth outcomes among IVF births across cancer and noncancer indications for IVF. These findings support the use of evidence from noncancer IVF contexts for counseling of patients with cancer/survivors about birth outcomes after IVF.