Infertility In Women

Description

Alternative Names

Complications of ART

Since ART procedures have become more widespread since 1980, multiple births have significantly increased. About 35% of all ART births are multiple ones, with 4.3% being triplets or more.

Complications from Multiple Births. Both the child and the mother are endangered by multiple births. The effects of multiple births on children are considerable:

• Higher rates of cesarean sections.
• Low birth weight.
• Higher mortality rates (13 times that of single births).
• Higher risks for later lung and heart problems.
• Higher risk for mental retardation or learning disabilities.

Limiting Birth Numbers. Given these hazards, the parents must make some hard decisions if the treatment produces multiple embryos. The choices are limited:

• Carry all of them to term, which increases health risks for both the mother and the developing fetuses.
• Complete abortion.
• Embryo reduction, in which the physician removes one or more embryos (possibly endangering the remaining embryos).

At this time, the best approach is to limit the number of implanted embryos in the first place. Experts are attempting to develop methods to reduce the risk for multiple births:

• Most centers now implant two to three embryos at a time, and the remainder can be frozen for future use. (To date, frozen eggs do not appear to pose a risk for developmental problems in children conceived using them, but follow-up studies are needed.) This limits the chance for success, but implanting more than three embryos only increases success rates very slightly, whereas the risk for multiple births increases significantly.
• Reducing the dosage of fertility drugs also reduces the risk for multiple births, but not significantly and it too reduces the chance for successful outcome.
• Blastocyst transfer may help reduce the chances for multiple births.

Risks to the Woman

Studies suggest that there is a significantly higher risk for Caesarean sections (41.9% to 71.4%) after ART. In one small 2001 study, nearly 85% of those who had cesareans had no medical problems that warranted them. (This was a small Israeli study, however, and may not have widespread implications.) Of concern was a 2002 study reported a higher risk for pre-eclampsia (dangerously high blood pressure) in women who conceived with ART. More research is needed on this finding. There may also be a higher risk for urinary tract infections before delivery. It should be noted that infertile women in general have a poorer than average chance for full-term pregnancies regardless of whether they conceive spontaneously or with fertility treatments. In women using donor sperm from sperm banks, rare cases of AIDS, hepatitis, and other sexually transmitted diseases from infected sperm have been reported. Semen should be acquired only from a sperm bank licensed by either the state health department or the American Association of Tissue Banks.

Risk for Birth and Genetic Defects in Children

Several major studies have now reported a higher risk for low birth weight and birth defects in children born from assisted reproductive technologies. Low birth weight, in any case, is a well-known complication of multiple births, which are common with ART. However, even for single newborns delivered at term, 6.5% were underweight, compared to 2.5% in the general population. Another study found that 9% of children conceived with ART had major birth defects, including cleft lip or palate or problems with the feeding tube or windpipe, compared to 4.2% of babies conceived naturally. Birth defect rates were higher for single or multiple births as well as for births that reached term.

Still, ART remains a good option for many infertile couples. The likelihood of having a healthy single child of normal birth weight using ART is about 94%, and of having a child free of major birth defects 91%. In these studies, birth defect rates were similarly increased whether a child was conceived using Standard IVF or ICSI techniques. (There has been some concern that ICSI specifically increased the risk for genetic problems.) To date, frozen eggs do not appear to pose any higher risk for developmental problems in children conceived using them, but follow-up studies are needed.

Couples undergoing ART may have other factors, such as older age or genetic predispositions, which make complications more likely. If such procedures are found to be responsible, however, it is important that couples who undergo ART are aware of these issues.

Preimplantation genetic diagnosis (PGD) is now available in a few fertility centers. It can help identify genetic defects in the offspring and may help parents determine future problems. Such testing, however, also raises significant emotional issues that should be addressed beforehand.