Is IVF dangerous to your health?

January 31, 2011Carole 1 Comment »

The British Medical Journal published an article (27 January 2011) which shines a light on a rare and largely avoidable complication from IVF, namely death. Although extremely rare, the European study found more maternal deaths occurred in 100,000 IVF pregnancies (42) compared to non-IVF pregnancies (6). The causes of these IVF-related death were related to older maternal age, multiple gestation and increased pre-eclampsia. These causes of death are not due to IVF per se but IVF is able to achieve pregnancy in women who may be poor candidates for pregnancy or creates conditions that carry more risk such as multiple gestation pregnancy. In short, the very success of IVF may be dangerous to your health.

Western countries including the United Kingdom, the US, Denmark, Austria, Canada, and Norway have noted that maternal and fetal deaths from pregnancy have been slowly rising over the last two decades as assisted reproductive technology (ART) becomes more widespread. We tend to think that maternal and fetal mortality from pregnancy is only a problem in poor third world countries where women become pregnant in a malnourished state or too soon after the last birth. The surprising rise in maternal and fetal deaths in pregnancy in the developed world is even more astonishing in that it is linked to what is considered a high tech medical breakthrough. The problem is that as ART becomes more widespread and available to a larger cross section of women, some of the women who are getting pregnant through IVF are older and may have underlying chronic health conditions.

Before undergoing ART treatments, your doctor should evaluate your overall fitness for pregnancy, especially if you are older. If you have a chronic condition like diabetes or hypertension, you should have a doctor other than your ART doctor evaluate your health to make sure these conditions are well controlled. You will want to find out what effect being pregnant will have on your existing chronic conditions. Any cardiac problems should be discussed with your obstetrician or maternal fetal specialist. If you are morbidly obese, it might be worth your health to postpone pregnancy until your weight is closer to normal.

Pregnancy remodels your body in ways large and small. Your cardiovascular volume increases by a third as you develop the cardiovascular support for the placenta and developing fetus which can stress a cardiovascular system that may already be working too hard. The increased mortality rate from IVF reported in these studies was surprising because they overturned the assumption that only the healthiest patients would participate in ART treatments. Obviously, this is less and less true. Getting pregnant is one thing. Staying healthy during pregnancy and having a healthy child are another thing.

Another IVF related factor found to increase pregnancy complications was the use of donor eggs. There are studies in the scientific literature which have shown that egg-donation increases the chance that the recipient will have hypertensive disorders such as pre-eclampsia, a complication of pregnancy which can lead to eclampsia and in some cases, death. Since egg donation is only possible with IVF, it may explain part of the association between IVF pregnancies and an increased risk of pre-eclampsia. The mechanism through which egg donation leads to hypertensive disorders is not well understood but believed to have something to do with the effect of a fetus which is entirely “foreign” to the the mother’s immune system.

You may need to use donor eggs to become pregnant so what can you do to avoid becoming a statistic? Let your obstetrician know that you used donor eggs to become pregnant and that this may place you at higher risk of developing pre-eclampsia. Your doctor can then be more vigilant for the first sign of pre-eclampsia and prevent progression of the condition if it occurs.

Finally, the greatest risk from IVF may be due to the increased frequency of twin and higher order pregnancies which automatically increases the risk of every type of pregnancy complication and increases the health risks to the children. I have posted about the risks of higher order multiples several times before so my regular readers are probably sick of hearing about it. But it makes my head explode when bad things happen that are inherently avoidable. Women with twins or more have a higher risk of either losing their pregnancy outright or having to consider stilling one or more fetal hearts to reduce the pregnancy to twin or singleton to have the best chance of bringing one healthy baby home. Pregnancy complications are more likely with more than one baby in the uterus. These complications can be prevented in many cases if couples elect to transfer only one embryo at a time so if they get pregnant, they are almost assured of a singleton pregnancy (although embryos do split creating identical twins). Your doctor will tell you that your odds of pregnancy are increased if he transfers more embryos to you  and that is true but your risk of pregnancy complications are also greater with the more babies you conceive.

If transferring only one embryo at a time is the medically safest course, why don’t more people do it? Financial pressures, competitiveness among clinics for the highest pregnancy rates and lack of insurance coverage often drive the medical choice to get “more bang for the buck”. It’s appealing to couples because you can do one IVF and complete your whole family. What a bargain. Until you look at the hundreds of thousands of dollars it costs to take care of premature babies in the neonatal intensive care unit. Until you look at the lingering health problems some of these premature kids. Until you look at the expense of raising kids in sets, rather than singly. Until you look at the added stress on the couple and the fact that couple with twins, triplets or more have a higher divorce rate than couples who have kids one at a time.  A study by the Mothers of Super Twins (MOST) organization surveyed over 2500 couples and found that  the divorce rate was 3.6% for twin parents,  5% for triplet parents and 9.2% for parents with quadruplets.

Don’t misunderstand me. I think IVF has done much more good than bad for couples trying to get pregnant. I am proud of the years I spent in the lab helping couples start or expand their families. IVF is safe for women who are healthy enough for pregnancy. IVF is safe for healthy women who use donor eggs if they work with their obstetrician before and during the pregnancy to safeguard against pre-eclampsia or its progression to eclampsia. Pregnancies resulting from IVF can be made safer by having one baby at a time. I want IVF couples to be aware of potential problems so they can avoid them.

© 2011, Carole. All rights reserved.

One response to this entry

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