Risks to women and babies associated with IVF

POSSIBLE RISK FOR WOMAN

In case of assisted fertilization treatment with homologous oocytes, the use of ovarian stimulation drugs exposes the woman to the risk of onset of severe ovarian hyperstimulation syndrome (OHSS) with an incidence ranging from 0.5% to 5% (Delvigne et al., 2002).

The condition of hyperestrogenism induced by hormonal ovarian stimulation may, in patients genetically predisposed to thrombophilia, increase the risk of thrombotic pathology.

If oocyte retrieval is performed under anaesthesia, there are generic risks of the anaesthesiological procedure adopted, while complications are limited and include pelvic infections (0.6%), bleeding abdominal bleeding complications (0.07%), perforation of iliac vessels (0.04%), corpus luteum rupture and ovarian torsion (incidence of 0.008%).

In case of IVF treatment of homologous and heterologous type, the possibility of infectious complications resulting from intrauterine embryo transfer is not excluded.

The transfer of more than one embryo into the uterus exposes to the risk of multiple pregnancies (twin or trigeminal), with an increased risk of pathologies during pregnancy; although the Genera group adopts single embryo transfer policies aimed at minimizing the risks to the health of the woman and child (Grady et al., 2012), the risk of a twin pregnancy (about 4% of cases; Kawachiya et al, 2011) and very rarely multiple pregnancy cannot be totally excluded.

The risk of an extrauterine pregnancy is 2.1% (Sowter and Farquhar, 2004), while the incidence of miscarriage can be superimposed on that of natural conception.

Recent data in the literature have also reported a slight increase in the risk of pathologies in pregnancy (pre-eclampsia and eclampsia), especially in women over 40 years of age (Pandey et al., 2012,Jeve et al, 2016).

POSSIBLE RISK FOR UNBORN CHILD

 

The risk assessment of abnormalities, malformations, neonatal diseases is mainly related to factors such as advanced maternal age at conception and the possible presence of genetic factors related to infertility. According to the most recent literature data, the risk of malformations has slightly increased in children born from IVF compared to those born in the normal population (Chen et al., 2018). However, an extensive evaluation of the most recent literature data shows the importance of the family background (rather than the technique itself) on the increased risk of congenital malformations in children born from medically assisted reproduction techniques (Pinborg et al. 2013).

 

Most of the literature agrees that there is no statistically significant difference between the percentage of malformations in children born on a fresh or frozen cycle (Pinborg et al., 2013, Maheshwari et al., 2016, Zhao et al. 2016). Finally, data on cognitive and psychomotor development are in agreement on the absence of differences between those conceived spontaneously or following IVF/ICSI (Sanchez-Albisua et al., 2011). There are no data at present that would allow the complete exclusion of long-term health implications for children born with classical in vitro fertilisation (and ICSI).