Is IVF Safe?

November 8, 2010Carole 1 Comment »

Is IVF safe? Every patient who is considering using IVF probably asks themselves this question before they start treatment. Before you start treatment you will be asked to sign a consent form which outlines the risks, benefits and alternatives of proceeding with IVF. Most consent forms do an adequate job of outlining potential immediate risks to the female patient from the various procedures that make up an ART cycle including ovarian stimulation, egg retrieval and embryo transfer. The American Society for Reproductive Medicine has a good assortment of patient fact sheets and booklets available on-line for free for patients. The booklet “Assisted Reproductive Technology” has an overview of ART for the patient, including complications arising from ART procedures. You owe it yourself to seek out these other sources of information of ART to give yourself a good background to better understand the consent form you will be asked to sign.

More troubling than immediate risks of ART are the possibility of long term risks of ART to mothers and babies. ART is a relatively new field of medicine with the oldest IVF babies less than 35 years old who are only now having their own children. Four million IVF babies have been born at an accelerating rate since the earliest IVF successes in 1978. Who is looking at long term outcomes?

The International Committee Monitoring Assisted Reproductive Technologies (ICMART) is a not-for-profit agency which is dedicated to the “development, collection, and dissemination of worldwide data on assisted reproductive technology (ART). We provide information on availability, efficacy, and safety to health professionals, health authorities, and to the public.” ICMART is responsible for creating a worldwide IVF registry. A recent interview with Professor Karl-Gosta Nygren (Stokholm, Sweden),  Chair of ICMART, looked at the question of whether ART is safe. The answer was a guarded “Yes”, based on your definition of “what safe is” and the information about ART outcomes collected to date.

He points out that  pregnancy and childbirth, the goal of ART, carries certain risks to both mother and fetus. Arguably, pregnancy and childbirth are overall riskier to life and well-being than remaining childless. The one exception to this statement may be the possible greater risk of breast cancer due to nulliparity or never having children.

Another point Professor Karl-Gosta Nygren makes is that patient’s own choices also contribute to the safety of ART. Because IVF produces embryos in vitro and physicians and patients decide how many embryos are transferred, it is theoretically possible to eliminate almost all multiple births and the increased risks associated with those high risk pregnancies, if only one embryo at a time is transferred.

Many patients decide the risks associated with multiples are more acceptable than the risk of not becoming pregnant in that IVF cycle. In her article “IVF women prefer risky pregnancy to no pregnancy”, Alisa Taylor describes the risk-benefit analysis that many couples make when deciding the number of embryos to transfer. In the US, in particular, this decision is influenced by the fact that the financial burden on the patient is so great that many couples feel that they can afford only one ART cycle and thus have only one chance to conceive and must maximize the chances of pregnancy in that one cycle. NPR also looked at factors driving transfer of more than one embryo in their 2009 piece “Embryo Debate Raised In An IVF Treatment”.

Professor Karl-Gosta Nygren goes on to remind us that some studies have shown that IVF patients are at increased risk for pre-eclampsis, neonatal death and some rare birth defects (such as those associated with a rare disease called Beckwith-Wiedemann Syndrome). What is lacking from our understanding is whether the slightly increased risks are due to the technical interventions or use of ovarian medications associated with ART or the greater genetic/illness burden that IVF patients may already carry that caused their infertility or is associated with infertility in the first place. You can read previous study reports about the world-wide safety of ART published by ICMART here.

The World Health Organization also collects data and publishes reports on ART practices. For instance you can download and read the WHO article  “Current practices and controversies in assisted reproduction : report of a WHO meeting on “Medical, Ethical and Social Aspects of Assisted Reproduction”.

The Society for Reproductive Technology (SART) is a not-for-profit professional society for ART health care providers. Its leadership was involved in the development of a US registry to look at longer term ART outcomes.  The Infertility Family Research Registry (IFRR) was funded through a grant from the Eunice Kennedy Shriver National Institutes of Child Health and Human Development (NICHD), a component of the National Institutes of Health (NIH). The grant is titled Development of an Infertility Family Research Registry (IFRR). The grant number is R21 HD60829-01. Some fertility clinics are taking a more active role in recruiting their patients for the registry.

The purpose of this new US registry is to build a database of people, both those who struggled with infertility and those that had no particular problems conceiving children (fertile controls). Persons who were previous egg or sperm donors or those that acted as surrogates are also being recruited for the database. If you want to sign up as a volunteer, the range of your possible involvement is described here. You have the option to become involved with or decline participation in future on-going studies as they arise. You can decline participation at any point.

The registry gives the researchers involved a contact list to reach people who have indicated they might be interested in participating in a clinical research study on fertility. Study participants may be asked to provide medical information and in some cases, specimens (like blood samples) for study. The principle investigators who were awarded the grant to produce the registry are Judy E. Stern, PhD (Dartmouth Medical College) and William Gibbons, MD (Baylor College of Medicine). This registry is apparently very new but represents a start in data collection to answer questions about the long term safety of ART.

The drive to have families is so strong, IVF treatments will continue, even in the face of unanswered questions. Hopefully, the involvement of patients and the public in these registries and studies may eventually give peace of mind to past and future patients and children conceived from ART.

© 2010, Carole. All rights reserved.

One response to this entry

  • C Says:

    Carole, please could you discuss the various stages and the required number of cells the fertilized egg goes through up until it is vitrified on day 6? Also please could you explain the terms “cleaved”, “compacted”, “nonexpanded” blastocysts and possibly give some percentages as to the chance of pregnancy when, e.g. a compacted 6 day blast is transferred.

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