Timing of birth in IVF pregnancy - Good practice point

Aim

The aim of this Good Practice Point is to support clinicians in counselling women with ART-conceived singleton pregnancies regarding timing of birth, in order to reduce preventable term stillbirth while maintaining optimal maternal and neonatal outcomes.

Background

Assisted reproductive technology accounts for approximately 6.5% of births in Australia (Kotevski 2023, AIHW 2025) Systematic reviews and meta-analyses have identified assisted reproductive technology as an independent risk factor for stillbirth in high-income countries (Flenady 2011, Sarmon 2021). The magnitude of increased stillbirth risk for IVF singleton pregnancies (adjusted odds ratio 2.7) is comparable to that reported for pre-existing diabetes (aOR 2.9) and pre-existing hypertension (2.6), which are widely recognised indications for increased antenatal surveillance and consideration of planned birth at term (Flenady 2011). 

The risk of stillbirth increases progressively with advancing gestation at term (Crawford 2025).  Population-based cohort studies demonstrate that delivery at 39 weeks’ gestation is associated with the lowest perinatal mortality in singleton pregnancies conceived with infertility treatment (Hamilton 2023). In otherwise uncomplicated pregnancies, neonatal outcomes are optimal from 39 weeks’ gestation onwards. Planned birth between 39 and 40 weeks therefore represents an appropriate gestational window for risk reduction. 

Clinical practice recommendation  

For women with uncomplicated singleton ART pregnancies, clinicians should discuss and offer planned birth between 39+0 and 40+0 weeks’ gestation. 

Timing of birth should be individualised and based on maternal clinical factors, obstetric history, maternal preferences, cervical status and likelihood of successful induction. This recommendation does not apply to multiple pregnancies or pregnancies with additional medical or obstetric complications, which require individualised management. 

Case vignette  

A 39-year-old primigravid woman conceived using IVF following five years of infertility. Her pregnancy was otherwise uncomplicated, with normal fetal growth and no maternal medical conditions. At 40+6 weeks’ gestation, she presented with reduced fetal movements, and intrauterine fetal death was diagnosed. No cause was identified following comprehensive investigation, and placental histopathology showed features of placental insufficiency. Review of the case identified ART conception as a significant risk factor. Earlier discussion and offer of planned birth at 39 weeks may have reduced the risk of stillbirth. 

Implications for clinical practice

Clinicians should recognise assisted reproductive technology as a risk factor for stillbirth. For women with uncomplicated singleton ART pregnancies, clinicians should: 

• discuss timing of birth during late third trimester care
• offer planned birth between 39+0 and 40+0 weeks’ gestation 
• individualise decision-making based on maternal and clinical factors 
• involve women in shared decision-making 

This approach aligns management of ART pregnancies with other recognised stillbirth risk groups. 

Implications for maternity services 

In 2023, there were 18,575 births following ART in Australia and New Zealand (Kotevski et al. 2025). After excluding multiple pregnancies and preterm births, approximately 10,800 singleton ART pregnancies remain ongoing at 39 weeks’ gestation. Of these, approximately 7,900 women (42% of all ART births) remain pregnant at 39 weeks and are planning vaginal birth. This represents the population most likely to be offered planned birth at 39–40 weeks. At an individual service level, the expected impact is modelled below based on Australian data:  

• A maternity service with approximately 2,500 births per year would expect approximately 68 additional planned births annually (approximately 1–2 per week). 
• A tertiary maternity service with approximately 6,700 births per year would expect approximately 184 additional planned births annually (approximately 3–4 per week). 

References

1. Australian Institute of Health and Welfare (AIHW) 2025. Australia's mothers and babies 2023. Cat. no. PER 101. Canberra: AIHW. Viewed 6 August 2025  
2. Crawford K, Carlo WA, Odibo A, Papageorghiou A, Tarnow-Mordi W, Kumar S. Perinatal mortality and other severe adverse outcomes following planned birth at 39 weeks versus expectant management in low-risk women: a population based cohort study. EClinicalMedicine. 2025;80:103076.  
3. Flenady V, Koopmans L, Middleton P et al. 2011, ‘Major risk factors for stillbirth in high-income countries: a systematic review and meta-analysis’, Lancet, vol. 377, pp. 1331–1340. 
4. Hamilton I, Martin N, Liu J, DeFranco E, Rossi R. Gestational Age and Birth Outcomes in Term Singleton Pregnancies Conceived With Infertility Treatment. JAMA Netw Open. 2023 Aug 1;6(8):e2328335.   
5. Kotevski DP, Newman JE, Chaitarvornkit A, Paul RC, Chambers GM 2025, Assisted reproductive technology in Australia and New Zealand 2023, National Perinatal Epidemiology and Statistics Unit, Sydney. 
6. Sarmon KG, Eliasen T, Knudsen UB, Bay B 2021, ‘Assisted reproductive technologies and the risk of stillbirth in singleton pregnancies: a systematic review and meta-analysis’, Fertility and Sterility, vol. 116, no. 3, pp. 784–792.