Fetal growth restriction in IVF pregnancies: outcomes and risk factors: a systematic review

Authors

  • Alhussain Sagr Al Hazmi Consultant, Obstetrics and Gynecology, High-Risk Fetomaternal Medicine, Head of the Maternal-Fetal Medicine Department, Riyadh First Health Cluster, King Saud Medical City, Women’s Health Hospital, Riyadh, Saudi Arabia. Author
  • Shuaa Talal Alamri Saudi Board Resident, Obstetrics and Gynecology Residency Program, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia. Author
  • Saad Khaleel Alonze Obstetrics and Gynecology Registrar, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. ORCID: 0009-0007-0888-3097. Author
  • Saad Khaleel Alonze Obstetrics and Gynecology Registrar, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. ORCID: 0009-0007-0888-3097. Author
  • Muneerah A. Aljumah Saudi Board Resident, Obstetrics and Gynecology Residency Program, Riyadh Second Health Cluster, Riyadh, Saudi Arabia. Author
  • Faisal Talal Alsharif Associate Consultant and Obstetrics and Gynecology Fellow, Maternal-Fetal Medicine, Riyadh First Health Cluster, King Saud Medical City, Women’s Health Hospital, Riyadh, Saudi Arabia. Author
  • Salem Abdulaziz Salem Islam Associate Consultant, Obstetrics and Gynecology Department, Riyadh First Health Cluster, King Saud Medical City, Women’s Health Hospital, Riyadh, Saudi Arabia. Author
  • Fatimah Assari Saudi Board Resident, Obstetrics and Gynecology Residency Program, Riyadh Second Health Cluster, King Fahad Medical City, Riyadh, Saudi Arabia. Author
  • Faya Awad Alshammari Saudi Board Resident, Obstetrics and Gynecology Residency Program, Riyadh First Health Cluster, King Saud Medical City, Riyadh, Saudi Arabia. Author
  • Ghadah Abdulrahman Bukhari Saudi Board Resident, Obstetrics and Gynecology Residency Program, Riyadh First Health Cluster, King Saud Medical City, Riyadh, Saudi Arabia. Author
  • Saeed Tariq Saloom Saudi Board Resident, Obstetrics and Gynecology Residency Program, Riyadh First Health Cluster, King Saud Medical City, Riyadh, Saudi Arabia. Author
  • Ibrahim Sulaiman Alduraywish Saudi Board Resident, Obstetrics and Gynecology Residency Program, Maternity and Children’s Hospital, Al-Jouf, Saudi Arabia. Author

DOI:

https://doi.org/10.65759/k4c8pq27

Keywords:

Fetal growth restriction, in vitro fertilization, intracytoplasmic sperm injection, small for gestational age, frozen embryo transfer

Abstract

Background: Fetal growth restriction (FGR) in in vitro fertilization pregnancies is a clinically important concern because assisted conception linked with altered placentation, singleton low birth weight, small-for-gestational-age birth, hypertensive disorders, and medically indicated preterm delivery. Objective: This systematic review evaluated outcomes and risk factors for FGR or related small-for-gestational-age birth in singleton pregnancies conceived through in vitro fertilization or intracytoplasmic sperm injection. Methods: A PRISMA-guided systematic review designed using PubMed, Scopus, Web of Science, and Cochrane Library searches. Eligible studies were original human studies evaluating FGR, small-for-gestational-age birth, birthweight percentile, or fetal growth trajectory after in vitro fertilization or intracytoplasmic sperm injection. Data synthesized qualitatively because exposure definitions, embryo-transfer protocols, comparator groups, and outcome definitions differed across studies. Results: Ten original studies were included in the results synthesis. Data linked fetal growth impairment with fresh embryo transfer, supraphysiologic estradiol, higher total gonadotrophin dose, vanishing twin syndrome, multiple embryo transfer, female infertility factors, and thin endometrium. Frozen embryo transfer was generally associated with higher birthweight and lower small-for-gestational-age frequency than fresh transfer, although it was linked with larger infants and hypertensive disorders in wider literature. Conclusion: FGR risk in in vitro fertilization pregnancies appears multifactorial. Clinical surveillance needs individualized attention to infertility background, stimulation intensity, embryo-transfer strategy, early multifetal loss, placental disease, and maternal vascular risk.

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Published

2026-08-01

Issue

Vol. 3 No. 3 (2026): Journal of Tazeez for Public Health

Section

Articles