Objective: To determine whether adverse perinatal outcomes are increased in subfertile women.Design: Cohort study.Setting: Two tertiary assisted reproductive technologies (ART) centers; Victorian births register.Patient(s): Records of women who registered with the clinics (1991-2000), but did not have an infant using ART, were linked to the birth register (1991-2004) to identify singleton non-ART births within 5 years of registration (N = 2171). Controls, matched by maternal age and year of infant's birth, were selected randomly from birth records (N = 4363).Interventions: None.Main Outcome Measure(s): Adverse obstetric and perinatal outcomes.Result(s): After adjusting for confounders, compared with controls, subfertile women had increased odds of hypertension or preeclampsia (adjusted odds ratio [OR] 1.29, 1.02-1.61), antepartum hemorrhage (adjusted OR 1.41, 1.05-1.89), perinatal death (adjusted OR 2.19, 1.10-4.36), low birth weight (adjusted OR 1.44, 1.11-1.85), preterm birth <37 weeks (adjusted OR 1.32, 1.05-1.67) or <31 weeks (adjusted OR 2.37, 1.35-4.13), and cesarean delivery (adjusted OR 1.56, 1.37-1.77). There was weak evidence for increased birth defects (adjusted OR 1.30, 0.98-1.72) and gestational diabetes (adjusted OR 1.25, 0.96-1.63). No increased risk was found for prelabor rupture of membranes, small for gestational age, or postpartum hemorrhage.Conclusion(s): Subfertile women with singleton births are at increased risk of several adverse outcomes. These risks should be considered during their antenatal care and when analyzing adverse effects of ART. (Fertil Steril (R) 2010;94:2674-9. (C) 2010 by American Society for Reproductive Medicine.)

BACKGROUND:The reasons for increased birth defect prevalence following in-vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) are largely unknown. Classification of birth defects by pathology rather than organ system, and examination of the role of embryo freezing and thawing may provide clues to the mechanisms involved. This study aimed to investigate these two factors.METHOD:Data on 6946 IVF or ICSI singleton pregnancies were linked to perinatal outcomes obtained from population-based data sets on births and birth defects occurring between 1991 and 2004 in Victoria, Australia. These were compared with 20,838 outcomes for singleton births in the same population, conceived without IVF or ICSI. Birth defects were classified according to pathogenesis.RESULTS:Overall, birth defects were increased after IVF or ICSI [adjusted odds ratio (OR) 1.36; 95% CI: 1.19-1.55] relative to controls. There was no strong evidence of risk differences between IVF and ICSI or between fresh and thawed embryo transfer. However, a specific group, blastogenesis birth defects, were markedly increased [adjusted OR 2.80, 95% CI: 1.63-4.81], with the increase relative to the controls being significant for fresh embryo transfer (adjusted OR 3.65; 95% CI: 2.02-6.59) but not for thawed embryo transfer (adjusted OR 1.60; 95% CI: 0.69-3.69).CONCLUSION:Our findings suggest that there is a specific risk of blastogenesis birth defects arising very early in pregnancy after IVF or ICSI and that this risk may be lower with use of frozen-thawed embryo transfer.

Objective: To report preterm birth and small for gestational age (SGA) rates from assisted reproduction technologies (ART) patients with ovarian endometriomata compared with control groups.Design: Retrospective cohort study.Setting: Tertiary university affiliated ART center and Perinatal Data Collection Unit (PDCU).Patient(s): Every woman who had an ART singleton baby born between 1991 and 2004 had her database record assessed (N = 4382). Control groups included 1201 singleton babies from ART patients without endometriosis and 2400 randomly selected women from the PDCU database of 850,000 births.Intervention(s): There were 95 singleton ART babies from patients with ovarian endometriomata and 535 ART singleton babies from patients who had endometriosis but no ovarian endometriomata.Main Outcome Measure(s): Preterm birth rates and SGA birth rates.Result(s): Preterm birth rate increased only in the ovarian endometriomata group when compared with community birth records (n = 850,000). Furthermore, ART patients with ovarian endometriomata had a statistically significantly increased likelihood of having a SGA baby when compared with other forms of endometriosis.Conclusion(s): Rates of preterm birth and SGA babies doubled in infertility patients with ovarian endometriomata who required ART. (Fertil Steril (R) 2009;91:325-30. (C)2009 by American Society for Reproductive Medicine.)

D.J. Amor1,2,3,4,8, J.X. Xu1,2, J.L. Halliday1,2, I. Francis3, D.L. Healy5,6, S. Breheny5,6, H.W.G. Baker4,7, and A.M. Jaques1 Murdoch Childrens Research Institute, Royal Children’s Hospital, Parkville, Victoria, Australia Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia Victorian Clinical Genetics Services, Royal Children’s Hospital, Parkville, Victoria, Australia Melbourne IVF, East Melbourne, Victoria, Australia Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia Monash IVF, Richmond, Victoria, Australia Department of Obstetrics and Gynaecology, University of Melbourne, Royal Women’s Hospital, Parkville, Victoria, Australia

Obstetric haemorrhages have been reported to be increased after assisted reproduction technologies (ART) but the mechanisms involved are unclear.This retrospective cohort study compared the prevalence of antepartum haemorrhage (APH), placenta praevia (PP), placental abruption (PA) and primary post-partum haemorrhage (PPH) in women with singleton births between 1991 and 2004 in Victoria Australia: 6730 after IVF/ICSI, 24 619 from the general population, 779 after gamete intrafallopian transfer (GIFT) and 2167 non-ART conceptions in infertile patients. Risk factors for haemorrhages in the IVF/ICSI group were examined by logistic regression.The IVF/ICSI group had more APH: 6.7 versus 3.6% (adjusted OR 2.0; 95% CI 1.8-2.3), PP: 2.6 versus 1.1% (2.3; 1.9-2.9), PA: 0.9 versus 0.4% (2.1; 1.4-3.0) and PPH: 11.1 versus 7.9% (1.3; 1.2-1.4) than the general population. APH, PP and PA were as frequent in the GIFT group as in the IVF/ICSI group, but were less frequent in the non-ART group. Within the IVF/ICSI group, fresh compared with frozen thawed embryo transfers (FET) was associated with more frequent APH (1.5; 1.2-1.8) and PA (2.1; 1.2-3.7) and the odds ratio increased with number of oocytes collected (1.02; 1.00-1.04). Endometriosis patients had more PP (1.7; 1.2-2.4) and PPH (1.3; 1.1-1.6) than those without endometriosis. FET in artificial cycles was associated with increased PPH (1.8; 1.3-2.6) compared with FET in natural cycles.Obstetric haemorrhages are more frequent with singleton births after IVF, ICSI and GIFT. The exploratory analysis of factors in the IVF/ICSI group, showing associations with fresh embryo transfers in stimulated cycles, endometriosis and hormone treatments, suggests that events around the time of implantation may be responsible and that suboptimal endometrial function is the critical mechanism.

Jane L. Halliday1,2,7, Obioha C. Ukoumunne1,2, H.W. Gordon Baker3,4, Sue Breheny5, Alice M. Jaques1, Claire Garrett4, David Healy5,6, and David Amor1,2,3 Murdoch Childrens Research Institute, Royal Children’s Hospital, Flemington Rd, Parkville, VIC 3052, Australia Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia Melbourne IVF, East Melbourne, VIC, Australia Department of Obstetrics and Gynaecology, University of Melbourne, Royal Women’s Hospital, Parkville, VIC, Australia Monash IVF, Richmond, VIC, Australia Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia Correspondence address. Tel: þ61-3-8341-6260; Fax: þ61-3-8341-6212; E-mail: janehalliday.h@mcri.edu.au

BACKGROUND First trimester screening (FTS) for Down syndrome combines measurement of nuchal translucency, free beta-human chorionic gonadotrophin and pregnancy-associated plasma protein-A (PAPP-A). The aim of this study was to undertake a detailed analysis of FTS results in singleton pregnancies conceived using assisted reproductive technologies (ART) and non-ART pregnancies. METHODS A record linkage study compared outcomes in 1739 ART-conceived and 50 253 naturally conceived pregnancies. RESULTS Overall, significantly lower PAPP-A levels were detected in ART pregnancies (0.83 multiples of median, MoM) than in controls (1.00 MoM) (t-test P < 0.001). This difference remained after excluding complicated pregnancies. Analysis of factors affecting PAPP-A levels suggested fresh compared with frozen embryo transfers and use of artificial cycles compared with natural cycles for frozen transfers were associated with lower values. The adjusted odds ratio (AdjOR) for receiving a false-positive result was 1.71 (95% CI 1.44-2.04; P < 0.001) for ART pregnancies compared with non-ART pregnancies, and this leads to a higher AdjOR (1.24, 95% CI 1.03-1.49; P = 0.02) for having a chorionic villous sampling (CVS) or amniocentesis. CONCLUSIONS ART pregnancies have reduced FTS PAPP-A levels leading to an increased likelihood of receiving a false-positive result and having a CVS/amniocentesis. Lower PAPP-A may reflect impairment of early implantation with some forms of ART.

OBJECTIVE: The aim was to determine which factors affect adverse birth outcomes of singletons after ART including low birthweight (LBW<2.5kg), preterm birth (PTB<37weeks), and perinatal death (PND, stillbirth or neonatal death <28 days). DESIGN: A record linkage study of birth information in the Victorian Perinatal Data Collection Unit linked to all the Melbourne ART centers' patients between 1991-2004 who delivered singletons of 20 or more weeks gestation. MATERIALS AND METHODS: Data were compared for the first singleton births from IVF or ICSI fresh and frozen (FET) embryo transfers with those of two control groups: 1. women seen for infertility but who conceived without ART (non ART) and 2. fertile controls from the general population matched 3:1 by age and year of parturition. Analysis included logistic regression to adjust for covariates. RESULTS: LBW, PTB and PND were significantly more frequent with fresh embryo transfers than in the control general population (Table 1). The higher LBW and PTB rates with FET and non ART were not significant after covariates such as parity were adjusted for by regression analysis but the results with fresh transfers remained highly significant. CONCLUSIONS: These results suggest the adverse birth outcomes of ART are associated with fresh embryo transfers and therefore embryology laboratory procedures affecting the embryos are not the cause because they are not seen with FET. The adverse effects must operate via the woman. If these involve ovarian stimulation or anesthesia for oocyte collection they may be able to be modified to improve birth outcomes. The other implication is that FET should be more widely used.Table 1Frequencies (number and (%)) of low birthweight (LBW), preterm birth (PTB), and perinatal death (PND) in singleton births after fresh (IVF/ICSI) and frozen embryo transfers (FET), non ART conceptions in women seen for infertility (non ART), and natural conceptions in the general population (Control)GroupLBWPTBPNDTotalIVF/ICSI469 (11.0)a527 (12.3)a80 (1.87)a4279FET163 (6.5)b237 (9.4)b29 (1.16)b2510Non ART149 (6.9)b177 (8.2)b27 (1.24)b2169Control1260 (5.1)c1519 (6.2)c224 (0.81)b24646Percentages with different letters are significantly different (p<0.05). Open table in a new tab Percentages with different letters are significantly different (p<0.05).

Introduction: Optimizing outcome in assisted reproduction requires definition of a successful outcome. We suggest delivery of a single term gestation, live baby, per cycle of assisted reproduction initiated is the most relevant standard of success. We have defined this outcome as the birth emphasising a successful singleton at term (BESST). Methods: We have evaluated the BESST outcome in a series of patients requiring controlled ovarian hyperstimulation–intrauterine insemination (COH–IUI) as well as series of patients requiring in vitro fertilisation (IVF). Results: We found that our BESST outcome for COH–IUI was 6%. We also found that our BESST statistic over a large IVF program was 11%. Conclusions: Clinical ART is now established worldwide in both developed and developing nations. Although the science is mature, the outcome of treatment and the reporting of endpoints require emphasis if reducing multiple pregnancy and reducing damage to babies is to occur. We propose the singleton, term gestation, live birth rate of the baby per cycle begun as the BESST measure of ART success.

To the Editor: A recent series of observations has suggested a linkbetween in vitro fertilization (IVF) and imprinting disorders, such as Beckwith-Wiedemann syndrome (BWS [MIM 130650]) and Angelman syndrome (MIM 105830). BWS is a model imprinting disorder and is characterized by prenatal and/or postnatal overgrowth, macroglossia, abdominal-wall defects, neonatal hypoglycemia, hemihypertrophy, ear abnormalities, and an increased risk of embryonal tumors (DeBaun et al. DeBaun et al., 2002DeBaun MR Niemitz EL McNeil DE Brandenburg SA Lee MP Feinberg AP Epigenetic alterations of H19 and LIT1 distinguish patients with Beckwith-Wiedemann syndrome with cancer and birth defects.Am J Hum Genet. 2002; 70: 604-611Abstract Full Text Full Text PDF PubMed Scopus (222) Google Scholar). An analysis of BWS registries from three centers has shown the proportion of individuals with BWS conceived using IVF to be 3/65 (DeBaun et al. DeBaun et al., 2003DeBaun MR Niemitz EL Feinberg AP Association of in vitro fertilization with Beckwith-Wiedemann syndrome and epigenetic alterations of LIT1 and H19.Am J Hum Genet. 2003; 72: 156-160Abstract Full Text Full Text PDF PubMed Scopus (769) Google Scholar), 6/149 (Maher et al. Maher et al., 2003Maher ER Brueton LA Bowdin SC Luharia A Cooper W Cole TR Macdonald F Sampson JR Barratt CL Reik W Hawkins MM Beckwith-Wiedemann syndrome and assisted reproduction technology (ART).J Med Genet. 2003; 40: 62-64Crossref PubMed Google Scholar), and 6/149 (Gicquel et al. Gicquel et al., 2003Gicquel C Gaston V Mandelbaum J Siffroi J-P Flahault A Le Bouc Y In vitro fertilization may increase the risk of Beckwith-Wiedemann syndrome related to the abnormal imprinting of the KCNQ1OT gene.Am J Hum Genet. 2003; 72: 1338-1340Abstract Full Text Full Text PDF PubMed Scopus (435) Google Scholar). These data suggest that ∼4% of individuals with BWS are conceived using IVF, a figure greater than the generally accepted usage of IVF in these centers. Further interpretation of these results has been limited because of a reliance by these studies on case records and questionnaire data to determine the method of conception in BWS cases, a lack of the use of appropriate controls, and a statistical significance that was either borderline (Gicquel et al. Gicquel et al., 2003Gicquel C Gaston V Mandelbaum J Siffroi J-P Flahault A Le Bouc Y In vitro fertilization may increase the risk of Beckwith-Wiedemann syndrome related to the abnormal imprinting of the KCNQ1OT gene.Am J Hum Genet. 2003; 72: 1338-1340Abstract Full Text Full Text PDF PubMed Scopus (435) Google Scholar; Maher et al. Maher et al., 2003Maher ER Brueton LA Bowdin SC Luharia A Cooper W Cole TR Macdonald F Sampson JR Barratt CL Reik W Hawkins MM Beckwith-Wiedemann syndrome and assisted reproduction technology (ART).J Med Genet. 2003; 40: 62-64Crossref PubMed Google Scholar) or not mentioned (DeBaun et al. DeBaun et al., 2003DeBaun MR Niemitz EL Feinberg AP Association of in vitro fertilization with Beckwith-Wiedemann syndrome and epigenetic alterations of LIT1 and H19.Am J Hum Genet. 2003; 72: 156-160Abstract Full Text Full Text PDF PubMed Scopus (769) Google Scholar). A recent review of the epidemiology and molecular biology behind these and other related studies has highlighted the need for case-control studies in this area (Niemitz and Feinberg Niemitz and Feinberg, 2004Niemitz EL Feinberg AP Epigenetics and assisted reproductive technology: a call for investigation.Am J Hum Genet. 2004; 74: 599-609Abstract Full Text Full Text PDF PubMed Scopus (266) Google Scholar). We report here the results of what we believe is the first case-control study done to test the null hypothesis that there is no difference between the rate of IVF in BWS cases and that in non-BWS controls, in an Australian population. The present study was possible because the State of Victoria, Australia, is serviced by a single clinical genetics service and laboratory providing molecular tests for BWS. This allowed complete ascertainment of children born in Victoria between 1983 and 2003 and diagnosed with BWS by a clinical geneticist. Only cases meeting the DeBaun criteria (DeBaun and Tucker DeBaun and Tucker, 1998DeBaun MR Tucker MA Risk of cancer during the first four years of life in children from The Beckwith-Wiedemann Syndrome Registry.J Pediatr. 1998; 132: 398-400Abstract Full Text Full Text PDF PubMed Scopus (338) Google Scholar) were included in this study. Appropriate controls were obtained using data from the Victorian Perinatal Data Collection Unit, which registers all births of >19-wk gestation. For each BWS case, four live-born controls were randomly selected from babies born within 1 mo of that case, in which parity was 1 and the maternal age was within 1 year of the risk-set case. Manual record linkage was then used to determine if the BWS cases and the controls were recorded in the databases of the providers of IVF services in Victoria, with the use of maternal names and the dates of birth of mothers and babies. Ethics approval was obtained from all sites providing data. Statistical significance of differences in proportions between groups was assessed using Epi Info, with results expressed as odds ratios (ORs) and as Fisher's-exact-test two-sided P values to account for cell sizes <5. Among ∼1,316,500 live births in Victoria between 1983 and 2003 (2003 data were estimated, as they were known to be very similar to 2002 data), 37 cases of BWS were detected, giving an overall BWS prevalence of ∼1/35,580 live births for this period. The average maternal age for BWS cases was 27.0 years. Record linkage of the 37 BWS cases and 148 matched controls identified IVF as the method of conception in 4 BWS cases (10.81%) and in 1 control (0.67%), giving an OR of 17.8 (95% CI 1.8–432.9), and Fisher's-exact-test two-sided P=.006. The clinical and molecular features of the four patients with BWS conceived using IVF are listed in table 1, and the reasons for the use of IVF were varied (two unexplained infertility, one egg donation, and one oligospermia). Our results indicate that if a child has BWS, the odds that the child was conceived using IVF is ∼18 times greater than that for a child without BWS, although the magnitude of this OR should be cautiously interpreted, given the wide CI. During the study period (1983–2003), 14,894 babies were born as a result of an IVF procedure (excluding gamete intrafallopian transfer). Using our population-based data, we can then estimate the absolute risk of having a live-born baby with BWS when IVF is used as the means of conception to be 4/14,894.Table 1Clinical Features of Four Patients Diagnosed with BWS Who Were Conceived Using IVFFinding in PatientClinical Feature1234Intracytoplasmic sperm injectionNoNoNoYesFrozen embryoYesNoYesYesDay of transfer2222SexFemaleMaleMaleFemaleGestation (wk)40333837MacrosomiaYesYesYesNoHypoglycemiaNoYesNoYesMacroglossiaYesYesYesYesEar anomaliesYesNoYesYesAbdominal-wall defectsExomphalosNoExomphalosNoHemihypertrophyNoYesNoNoIsolated loss of methylation at KVDMR1/LIT1YesNot performedYesYes Open table in a new tab This study demonstrates that children conceived by IVF are significantly more likely to have BWS, compared with children conceived naturally. Our study design with a control group matched by maternal age has ensured that the rate of IVF procedures in the control (non-BWS) population is accurate for the entire study period, which encompasses a time from infrequent use of IVF (0.2% of pregnancies in 1983) to more frequent use (3% in 2003). We can quantify, for the first time, the risk of BWS in our IVF population as ∼1/4,000, or 9 times greater than in the general population. The mechanisms underlying this increased risk remain unclear, but this study and previous studies (DeBaun et al. DeBaun et al., 2003DeBaun MR Niemitz EL Feinberg AP Association of in vitro fertilization with Beckwith-Wiedemann syndrome and epigenetic alterations of LIT1 and H19.Am J Hum Genet. 2003; 72: 156-160Abstract Full Text Full Text PDF PubMed Scopus (769) Google Scholar; Gicquel et al. Gicquel et al., 2003Gicquel C Gaston V Mandelbaum J Siffroi J-P Flahault A Le Bouc Y In vitro fertilization may increase the risk of Beckwith-Wiedemann syndrome related to the abnormal imprinting of the KCNQ1OT gene.Am J Hum Genet. 2003; 72: 1338-1340Abstract Full Text Full Text PDF PubMed Scopus (435) Google Scholar; Maher et al. Maher et al., 2003Maher ER Brueton LA Bowdin SC Luharia A Cooper W Cole TR Macdonald F Sampson JR Barratt CL Reik W Hawkins MM Beckwith-Wiedemann syndrome and assisted reproduction technology (ART).J Med Genet. 2003; 40: 62-64Crossref PubMed Google Scholar) have shown that patients with BWS conceived by IVF consistently show isolated hypomethylation at the maternal KVDMR1/LIT1 locus at 11p15.5. By comparison, this molecular mechanism is observed in only 46% of our overall BWS population, with the remainder of BWS cases resulting from uniparental disomy of chromosome 11 (16%), biparental methylation of H19DMR (7%), or an unidentified mutation (31%). The preponderance of BWS cases conceived by IVF that show hypomethylation of maternal KVDMR1/LIT1 suggests that collection of in vitro cultures might disturb methylation in the oocyte or early embryo, predisposing to maternal allele demethylation. The fact that the overall risk of BWS in children conceived using IVF remains low and that BWS is, in most cases, associated with a good long-term outcome makes it unlikely that this finding will deter couples from using IVF. Nor does it seem necessary to offer prenatal diagnosis for BWS to couples undergoing IVF. Questions remain, however, about potential effects of IVF on other regions of the genome that are subject to epigenetic regulation. In this context, the observation of a possible association between IVF and Angelman syndrome, another disorder resulting from hypomethylation of the maternal genome, is of some concern (Cox et al. Cox et al., 2002Cox GF Bürger J Lip V Mau UA Sperling K Wu B-L Horsthemke B Intracytoplasmic sperm injection may increase the risk of imprinting defects.Am J Hum Genet. 2002; 71: 162-164Abstract Full Text Full Text PDF PubMed Scopus (599) Google Scholar; Orstavik et al. Ørstavik et al., 2003Ørstavik KH Eiklid K van der Hagen CB Spetalen S Kierulf K Skjeldal O Buiting K Another case of imprinting defect in a girl with Angelman syndrome who was conceived by intracytoplasmic sperm injection.Am J Hum Genet. 2003; 72: 218-219Abstract Full Text Full Text PDF PubMed Scopus (310) Google Scholar). Although long-term follow-up data of children conceived by IVF are generally reassuring, it remains possible that alterations in genomic imprinting might have other unrecognized health implications for children and adults who were conceived by IVF. Our data reinforce the need for long-term follow-up studies of children conceived by IVF.

Background: To bring the success rate of in vitro fertilisation (IVF) procedures to an acceptable level, multiple embryos have historically been replaced. This has resulted in an 'epidemic' of multiple births. The pendulum has now swung full circle and the number of embryos transferred is now being limited. Such high numbers of IVF twins will not be produced in the future.Aim: To review retrospectively the outcome of a series of pregnancies achieved by IVF where the 6 week ultrasound showed the presence of two sacs.Methods: Retrospective study in a university IVF programme that produced 746 IVF pregnancies with twins at 6 weeks of gestation (1991-1999).Results: The main outcome measures were perinatal mortality, pregnancy outcome, gestation at delivery and obstetrics complications reported. Interestingly, by 20 weeks gestation, 184 (24.7%) of pregnancies spontaneously reduced to a singleton, whereas 49 (6.6%) lost both twins. Of the 513 (68.8%) viable twin pregnancies (> 20 weeks), 154 (20.6%) went on to term (> 37 weeks), whereas 250 (33.5%) delivered between 33 and 36 weeks gestation. The perinatal mortality per 1000 births was 6.5 over 37 weeks, 8.0 for 33-36 weeks, 41.7 for 29-32 weeks and 500 for under 28 weeks.

OBJECTIVE:To investigate the effect of subserosal, intramural, and submucosal fibroids on the outcome of assisted reproductive technology (ART) treatment.DESIGN:A retrospective comparative study.SETTING:A tertiary referral center for infertility.PATIENT(S):Treatment outcome of 106 ART cycles in 88 patients with uterine fibroids (33 subserosal, 46 intramural without cavity distortion, and 9 submucosal) was compared with that of 318 ART cycles in age-matched patients without fibroids.INTERVENTION(S):Controlled ovarian hyperstimulation and ART.MAIN OUTCOME MEASURE(S):Findings on transvaginal uterine ultrasonography performed before the initiation of treatment and pregnancy and implantation rates.RESULT(S):The pregnancy rates per transfer were 34.1%, 16.4%, 10%, and 30.1% in the patients with subserosal fibroids, intramural fibroids, submucosal fibroids and no fibroids, respectively. The implantation rates were 15.1%, 6.4%, 4.3%, and 15.7%, respectively. Both rates were significantly lower in patients with intramural fibroids than in those with subserosal fibroids or no fibroids.CONCLUSION(S):Pregnancy and implantation rates were significantly lower in the groups of patients with intramural and submucosal fibroids, even when there was no deformation of the uterine cavity. Pregnancy and implantation rates were not influenced by the presence of subserosal fibroids. Surgical or medical treatment should be considered in infertile patients who have intramural and/or submucosal fibroids before resorting to ART treatment.