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FSA F~EE COMMUNICATIONS-IVF ADMINISTRATION AND OUTCOMESTRENDS AND VARIATIONS IN PERINATAL DEATH RATES AFTER ASSISTEDCONCEPTIONTara L. Hurst and Paul A. L. LancasterAIHW National Perinatal Statistics Unit, The University ofNew South Wales, Sydney NSW 2052AustraliaP~evious s~dies have shown that fetal, neonatal and perinatal death rates after assisted conception are muchhigher than In !he general population. Contributing factors include multiple births, differences in maternal age,~he typ~ ofassIsted conception procedure, maternal medical conditions, and other underlying causes oflllfertIhty. As new proced~res such as ICSI are introduc~d, and the relative use ofother procedures changes, it isnecessary to evaluate the Impact ofthese changes on pennatal outcomes, especially perinatal mortality.We anal~sed fetal, ne?nat.al and pe~natal deaths ofat least 20 weeks' gestation that occurred among all birthsfrom aSSIsted conceptIon In AustralIa and New Zealand. We studied trends in three conception cohorts ofbirths(1979-~8,.1989-94, an~ 1995-97),.variations by type ofpr~cedure, and then compared births occurring inAustralIa III 1993-97 WIth populatIOn data for the same penod, analysing data by maternal age (20-29 years 30-34 years, and 35 years and over). 'A;m0ng 28,884 infants conceived between 1979 and 1997, there were 613 fetal deaths (21.2 per 1,000 totalbIrt~S), 397 neonatal deaths (14.0 per 1,000 live births) and 1,010 perinatal deaths (35.0 per 1,000 total births).Pennatal death rates.we~e 100~er in 1989-94 (34.6 per 1,000) and 1995-97 (30.0 per 1,000) than in 1979-88 (48.9per 1,000). The declIne III pennatal death rates was more pronounced for singleton births than for multiple births.In comparing the outcomes for the various types ofassisted conception among infants born in 1993-97 perinataldeath rates aft~r transfer offresh embryos (other IVF, 34.8 per 1,000; ICSI, 37.0 per 1,000) and GIFT (z9.0 per1,000) were ~Ighe: than the rates after transfer ofthawed embryos (other IVF, 24.9 per 1,000; ICSI, 10.3 per1,000). Mu~tIpl.e bIrths a~counted for at least halfofthe perinatal deaths in each ofthese groups, but perinataldeath rates In smgleton bIrths were also higher after transferring fresh embryos than after transferring thawedembryos. There w~s no consis~ent relationship bet~een mat~mal age and outcome for the various types ofprocedure. In 199,,-9:, the p:nnatal death ~ate ofSIngleton mfants born after assisted conception (17.9 per1:000) was almost twI~e as hIgh as ~or all smgleton births in Australia (9.0 per 1,000). However, there was littledI:fferen~e ~etween aSSIsted concep~IOn and the general population in the perinatal death rates for twins (assistedconcept~on. 44.2 per 1,000; AustralIa: 44.1 per 1,000) and other higher order multiple births (assistedconceptIOn: 104.1 per 1,000; Australia: 101.0 per 1,000).Total perinatal death rates after assisted conception have declined but multiple births still account for more thanhalfofthese deaths. Infants born after tr?Jlsfer ofthawed embryos have lower perinatal death rates than thoseborn aft~r transfer o~fresh embry.os, a~n~ut~ble to better outcomes in singleton births and fewer multiple births.Th: pennatal mortalIty ofICSI bIrths IS SImIlar to that for other IVF births after transfer offresh embryos' ICSIpennatal death rates are lower after transfer ofthawed embryos.'FSA FREE COMMUNICATIONS-IVF ADMINISTRATION AND OUTCOMESHEALTH AND DEVELOPMENTAL OUTCOMES OF IVF CHaDREN DURINGTHE FIRST FIVE YEARSG.I. Leslie, C.A. McMahon, 1. Cohen, F. Gibson, C. Tennant, andD.M. Saunders.Northern Clinical School, University ofSydney at Royal North Shore Hospital, Pacific Highway, St.Leonards, NSW, AustraliaIntroduction: This paper reports preliminary findings for health and child develop~enta~ outcome~ up to ?:eyears from a larger prospective study of health, developmental and psychosocIal adjustment III famIlIesconceiving through IVF.Aim: To compare health and developmental outcomes at one and five years for infants conceived using in-vitrofertilisation (IVF).Methods: Primigravid couples were enrolled at 30wk gestation for this prospective ~dy o~ parental adjustmentand child health and developmental outcomes of singleton and twin children conceIved usmg IVF. At one andfive years ofage children had a compreh~nsive.physical exa~nation and developm~ntal a~ses~ment and par~ntscompleted a range of psychosocial que~tlOnnatres. At ~~e t~me of assessments detatled hISto~~S were obtamedfrom the parents concerning childhood Illnesses and utIlIsatIOn of health care resources. CogmtIve developmentwas assessed using the Bayley Scales of Infant Development (second editi~n) at one year and the WechslerPreschool and Primary Scale of Intelligence (Revised) at five years. Compansons of outcomes at one and fiveyears were performed using the paired t-test.Results: Seventy-one children have been assessed at both one and five years to date. Their mean (ran~~) birthweight was 3106 (1300-4535)g and gestational age was 38.6 (33-42)~k. Mean (range) number of VISItS to ~medical practitioner was significantly less during the fifth year than dunng the ~~st year [4.~ (0-25) '! ~.3 (~-25),P = 0 000] The difference was due mainly to a decrease in the number of VISIts to medIcal specIalIs~S. III thelatter year~ [0.7 (0-10) v 1.9 (0-6); P = 0.000], although there was also a decrease in the number of VISItS to ageneral practitioner [3.5 (0-15) v 5.9 (0-24); P = 0.013].The mean (range) Bayley Mental Development Index (:MDI) at one year was 103 (82-122). At five years themean (range) verbal IQ was lOy (?7-148), th.e performance IQ was 1~2 (81-~41~ and the full scale lQ was lIl r(77-149). The MDI correl.ted Sign'fic.olly WIth both the verbal IQ (r - 0.358, P - 0.002) and the full scale IQ (= 0.381; P = 0.001), but less so with the performance IQ (r =0.309; P = 0.01).Conclusions: These preliminary data suggest a decreasing utilisation of health care resources ?y IVF ~hildrenafter the first year up to the age of school entry. Our findings also suggest that most I': chI~dren ~Ill havenormal cognitive development and should therefore not be at increased risk for learmng dIfficultIes uponcommencing their schooling.140141