Assisted Reproductive Technology Safe, Effective for Patients with Chronic Liver Disease

Meera Garriga, MD

Credit: LinkedIn

Assisted reproductive technology treatment may help improve pregnancy potential in reproductive-aged women, regardless of whether or not they have chronic liver disease, findings from a recent study suggest.

Presented at The Liver Meeting 2023 from the American Association for the Study of Liver Diseases (AASLD) in Boston this weekend, the retrospective analysis compared rates of treatment success with assisted reproductive technology between patients with and without chronic liver disease, highlighting similar safety and efficacy across both groups.¹

“Data on the safety and success of assisted reproductive technology across the spectrum of chronic liver diseases are limited, undermining appropriate preconception counseling in women with liver disease,” wrote primary investigator Meera Garriga, MD, resident 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 handled to address infertility. Its use is still relatively rare but has more than doubled over the past decade, with approximately 2.3% of all infants born in the US each year conceived using assisted reproductive technology. However, data regarding its safety and success in chronic liver diseases are limited.²

To evaluate the impact of chronic liver disease on assisted reproductive technology outcomes and the rate of liver-related complications and hypertensive disorders of pregnancy, investigators compared electronic medical record data for 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 tests, hepatitis B or C viral load, and assisted reproductive technology treatment and outcomes from electronic medical records. Chi-squared 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 retrieval was 39.1 years. Investigators pointed out 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

Upon analysis, the following assisted reproductive technology outcomes were similar between the case and control groups:

• Oocyte number (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, investigators noted 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 patients with chronic hepatitis B. Gestational hypertension or preeclampsia occurred in 27% of pregnancies in patients with chronic liver disease, compared to 5% of those without chronic liver disease. Ovarian hyperstimulation syndrome occurred in 1 non-chronic liver disease control patient and in no patients with chronic liver disease. No maternal deaths occurred.¹

“Assisted reproductive technology success rates with chronic liver disease were similar to those without liver diseases, and liver-related complications were uncommon,” investigators 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 for assisted reproductive technology planning may help improve pregnancy potential in reproductive-aged women with chronic liver disease.”

References

1. Garriga M, Cedars M, Sarkar M. Outcomes in Women with Chronic Liver Disease Undergoing Infertility Treatment. Paper Presented at: The Liver Meeting 2023 from the American Association for the Study of Liver Diseases. November 10-14, 2023.
2. Centers for Disease Control and Prevention. Assisted Reproductive Technology (ART). March 14, 2023. Accessed November 11, 2023. https://www.cdc.gov/art/index.html