Conceiving Naturally After IVF: the effect of assisted reproduction on obstetric interventions and child health at birth

A growing share of the world's population is being born via assisted reproductive technology (ART), including in-vitro fertilisation (IVF). However, two concerns persist. First, ART pregnancies correlate with predictors of poor outcomes at birth–and it is unclear whether this relationship is causal. Second, the emotional and financial costs associated with ART-use might exacerbate defensive medical behaviour, where physicians intervene more than necessary to reduce the risk of adverse medical outcomes and litigation. We address the challenge of identifying the pure effect of ART-use on both maternal and infant outcomes at birth by leveraging exogenous variation in the success of ART cycles. We compare the obstetric outcomes for ART-conceived births with those of spontaneously-conceived births after a failed ART treatment. Moreover, we flexibly adjust for key confounders using double machine learning. We do this using clinical registry ART data and administrative maternal and infant data from New South Wales (NSW) between 2009-2017. We find that ART slightly decreases the risk of obstetric interventions, lowering the risk of a caesarean section and increasing the rate of spontaneous labour (+3.5 p.p.). Moreover, we find that ART has a statistically and clinically insignificant effect on infant health outcomes. Keywords: Fertility, Assisted reproduction, IVF, Caesarean Section, Obstetric, Infertility. JEL classification: I10, I12, I19.