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

Abstract：

BACKGROUND: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 exists to inform 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 1990-2019. RESULTS:42 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. Main aetiologies of liver disease included hepatitis B virus (HBV), hepatitis C virus (HCV) and autoimmune hepatitis (AIH). Of 57 IVF cycles evaluated, 43 (75%) resulted in successful implantation. Eight (2 post-LT, 3 cirrhotic, 4 non-cirrhotic) resulted in miscarriage. Live birth rate (LBR) was 74% (32/43). 2/9 (22%) cirrhotics, 4/14 (29%) post-LT and 6/34 (18%) non-cirrhotics had unsuccessful IVF attempts. 9/57 (16%) IVF cycles resulted in new liver enzyme derangement during therapy, which improved after treatment completion. Six pregnancies (2 LT, 4 non-cirrhotic) 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). CONCLUSION:ln 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.

journal_name

J Hepatol

journal_title

Journal of hepatology

authors

Rahim MN,Theocharidou E,Yen Lau KG,Ahmed R,Marattukalam F,Long L,Cannon MD,Heneghan MA

doi

10.1016/j.jhep.2020.12.022

subject

Has Abstract

pub_date

2021-01-15 00:00:00

eissn

0168-8278

issn

1600-0641

pii

S0168-8278(21)00005-2

pub_type

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