Meera Garriga, MD
Credit: LinkedIn
Assisted reproductive technology treatment may help improve pregnancy potential in women of reproductive age, whether or not they have chronic liver disease, results from a recent study show.
Presented at The Liver Meeting 2023 of the American Association for the Study of Liver Diseases (AASLD) in Boston over the weekend, the retrospective analysis compared treatment success rates with assisted reproductive technology between patients with and without chronic liver disease, highlighting similar safety and effectiveness. across both groups.1
“Data on the safety and success of assisted reproductive technology across the spectrum of chronic liver disease are limited, undermining appropriate preconception counseling in women with liver disease,” wrote primary investigator Meera Garriga, MD, a family physician at the University of California, San Francisco, and colleagues.1
According to the Centers for Disease Control and Prevention (CDC), assisted reproductive technology includes all fertility treatments in which either eggs or embryos are manipulated to treat infertility. Its use is still relatively rare, but has more than doubled over the past decade, with approx. 2.3% of all infants born in the United States each year were conceived using assisted reproductive technology. However, data regarding its safety and success in chronic liver disease are limited.2
To evaluate the impact of chronic liver disease on the outcomes of assisted reproductive technology and the rates of liver-related complications and hypertensive disorders of pregnancy, investigators compared electronic health record data of female patients with and without chronic liver disease who underwent assisted reproductive technology treatment at the University of California, San Francisco between 2010 – 2022. Chronic liver disease cases were matched to non-chronic liver disease controls by age and assisted reproductive technology protocol to ensure consistency in hormonal exposure.1
Investigators extracted patient demographics, medical history, liver function tests, hepatitis B or C viral load, and assisted reproductive technology treatment and outcomes from electronic medical records. Chi-square and t tests were used to compare dichotomous and continuous variables, respectively.1
In total, 54 women with chronic liver disease underwent 100 oocyte retrievals and 64 embryo transfers during the study period. The average age at sampling was 39.1 years. Investigators noted etiologies of chronic liver disease included chronic hepatitis B (46%), metabolic dysfunction-associated steatotic liver disease (MASLD; 28%), benign liver lesions (19%), autoimmune hepatitis (4%), and alcohol-associated cirrhosis (2%) .1
On analysis, the following outcomes for assisted reproductive technology were similar between the case and control groups:
- Oocyte count (12.2 for chronic liver disease vs 13.0 for control)
- Embryo fertilization rate (69% for chronic liver disease vs 69% for control)
- Implantation rate (45% for chronic liver disease vs 47% for control)
- Liver birth rate (34% for chronic liver disease vs 33% for control)
For maternal outcomes, researchers noted that liver enzymes increased in 5.6% of chronic liver disease cycles (median peak AST, 121.5 IU/L; ALT, 85 IU/L) and viral load increased in 5% of chronic hepatitis B patients. Gestational hypertension or preeclampsia occurred in 27% of pregnancies in patients with chronic liver disease compared with 5% of those without chronic liver disease. Ovarian hyperstimulation syndrome occurred in 1 non-chronic liver disease control patient and in no chronic liver disease patients. There were no maternal deaths.1
“Assisted reproductive technology success rates with chronic liver disease were similar to those without liver disease, and liver-related complications were uncommon,” the researchers concluded.1 “However, the absolute number of oocytes retrieved may be lower in some patients with chronic liver disease. Routine family planning discussions and early referral to assisted reproductive technology planning may help improve pregnancy potential in women of reproductive age with chronic liver disease.”
References
- Garriga M, Cedars M, Sarkar M. Outcomes in women with chronic liver disease undergoing infertility treatment. Paper presented at: The Liver Meeting 2023 of the American Association for the Study of Liver Diseases. 10-14 November 2023.
- Centers for Disease Control and Prevention. Assisted reproductive technology (ART). March 14, 2023. Accessed November 11, 2023. https://www.cdc.gov/art/index.html