The Dark Side of IVF: Understanding IVF Risks
IVF for Everyone?
With Ontario’s newly introduced funded IVF cycles, thousands of Canadian couples have turned to IVF to start their families. For many couples with infertility, IVF has given them a chance at a family that they otherwise wouldn’t have had. In other cases, however, IVF has been used as a first line treatment for infertility without trying anything else. A recent analysis has suggested that we are overusing IVF, extended IVF use is harmful, and couples should be warned about potential risks before undergoing IVF, particularly if they have a chance of natural conception¹. The truth of the matter is that IVF may carry significant risks, and for some couples with infertility the risks may not outweigh the benefits. When it comes to IVF risks, we should all be able to make a complete and fully informed decision that is best for ourselves and our future families! So with that said, here is a breakdown of IVF’s risks.
IVF Risks to Mom
Risks of Egg Retrieval
For those of you who haven’t been through the IVF process yet, egg retrieval is the procedure in which a woman’s eggs are extracted from the ovaries at timed ovulation. This procedure does carry a number of risks and has been reported to be quite painful. Egg retrieval may cause pelvic bleeding, pelvic infection, pelvic inflammatory disease, appendicitis, and the development of ovarian abscesses that require surgical correction²,³,⁶. If you are about to undergo egg retrieval you can expect to experience vaginal bleeding, and mild to severe pain for 24-72 hours after the procedure⁴. Luckily, the complication rate is 0.5% which is very low².
Ovarian Hyperstimulation Syndrome
Ovarian Hyperstimulation Syndrome (OHSS) is one of the most dangerous and direct side effects of fertility drugs used in IVF procedures. Simply put, OHSS is characterized by enlargement of the ovaries that can lead to a number of symptoms and in severe cases, death⁵. The risk of OHSS is increased in women with PCOS, and in women who have extremely elevated estradiol levels from fertility drugs². Typically, the risk of severe OHSS is approximately 5%². If you suffer from PCOS or feel you are at risk, be sure to bring this to the attention of your Reproductive Endocrinologist.
Ectopic pregnancy rates are 2-3x higher in IVF compared to that of the general population². Ectopic pregnancies are a medical emergency and require immediate medical attention. The risk of ectopic pregnancy tends to be increased in women with endometriosis and tubal disease². At this time, we’re unsure if ectopic pregnancies are increased because women undergoing IVF have higher rates of endometriosis, or if the IVF procedure itself is causing ectopic pregnancies. Typically, 2.2% of pregnancies resulting from IVF are ectopic². If you feel that you are at risk, be sure to speak to your Reproductive Endocrinologist.
We understand that this is a big one; however, it, unfortunately, seems to be the least understood. Sadly, there is research suggesting an association between the use of fertility drugs and cancer² . More specifically, women who have undergone IVF have been found to have less cervical cancer, but more skin cancer, breast cancer, and more invasive ovarian cancer compared to women who have not gone through IVF². In particular, women who began IVF treatment when younger than 24 years old have an increased risk of cancer². Unfortunately, at this time we don’t fully understand the long-term impacts of fertility drugs. More research is needed into the long-term adverse effects of the fertility drugs we use and their propensity to cancers.
Risk of Multiples
This is a fairly obvious one. With IVF and other assisted reproductive technologies comes the risk of having multiple births². Multiple births are riskier pregnancies in themselves and are associated with more maternal and perinatal complications². That said, IVF and assisted reproductive technologies have come a very long way in decreasing this risk!
Complications of Pregnancy
Conceiving with IVF does carry an increased risk of pregnancy complications. In particular, there is an increased risk of preterm birth, low birth weight, hypertension, maternal gestational diabetes, and placental complications⁷.
IVF Risks to Baby
Risk of Multiples
As mentioned above, IVF carries the risk of multiple births. This translates into an increased risk of preterm delivery, low birth weight, intrauterine growth restriction, preeclampsia, gestational diabetes, placental complications, and fetal loss, all of which are detrimental to the health and survival of the babies². Again, IVF technologies have come a long way in mitigating this risk!
Unfortunately, research has confirmed that there is a 30-40% increased risk of birth defects associated with assisted reproductive technologies². Specifically, cardiovascular, musculoskeletal, and urogenital defects are the most common in IVF children². This is mostly due to the fact that couples struggling with infertility are more likely to pass on genetic abnormalities to their children, leading to malformations, rather than from the IVF process itself². That said, intracytoplasmic sperm injection (ICSI), does appear to significantly increase the risk of defects more so than IVF⁸. Children born from ICSI are at a higher risk of being a multiple, congenital defects (especially genitourinary), and epigenetic diseases⁸.
This sounds scary, but before getting into it we want to emphasize that childhood cancers are for the most part incredibly rare! That said, a number of studies have found an association between assisted reproductive technologies and the development of childhood cancers, particularly leukemias². This could be due to the fact that IVF children are more likely to have perinatal complications such as preterm birth, low birth weight, respiratory issues at birth, and low Apgar scores. These perinatal complications on their own are risk factors for cancer in children and young adults². We’re unsure at this time if the IVF process itself predisposes a child to cancer, or if the perinatal complications and/or inheritance of genetic abnormalities are to blame. More research into this area is desperately needed!
Finally some good news! There have been no significant behavioral differences found between children born from IVF, ICSI, and natural conception⁹. All three groups tend to perform equally well in areas of communication, self-dependence, work skills, socialization, and self-management⁹. There is one caveat to this: due to the increased risk of epigenetic disease, the prevalence of autism spectrum disorders is higher in children born from ICSI⁹. More research into assisted reproductive technologies and autism spectrum disorders is also needed.
IVF Risks: A Final Word
Now you that you have all the information, you can make a fully informed choice that is best for yourself and your family. Keep in mind that despite IVF risks, assisted reproductive technologies are making massive advancements as the need for fertility interventions increase. Reproductive Endocrinologists fully understand IVF risks and customize treatment protocols to each patient to ensure safety accordingly.
Even more importantly, there is so much that you can do to manage your own risk and the risk to your baby! Namely, preparing for IVF 3-6 months in advance to ensure you and your partner are healthy going into this process. As mentioned, certain complications are increased with specific conditions such as PCOS and endometriosis. Effectively managing these conditions before starting your IVF process can help decrease these risks. Moreover, ensuring egg and sperm health are at its absolute best helps lessen the risk of passing on genetic abnormalities to your child.
For many of us, IVF is the most promising way to start a family. Before getting started though, do yourselves and your children a favor by adequately preparing. If you would like support before, during, or after your IVF procedure, or if you would like to learn more about managing your risks, I am here and happy to help!
With love and in health,
Priya Prakash, Fertility Health Coach
- Kamphuis E, Bhattacharya S, van der Veen F, Mol B, Templeton A. Are we overusing IVF?. BMJ. 2014;348(jan28 8):g252-g252.
- Strauss J, Barbieri R, Gargiulo A. Yen & Jaffe’s Reproductive Endocrinology. 8th ed. Elsevier; 2018.
- Aragona C, Mohamed M, Espinola M, Linari A, Pecorini F, Micara G et al. Clinical complications after transvaginal oocyte retrieval in 7,098 IVF cycles. Fertility and Sterility. 2011;95(1):293-294.
- Ludwig A, Glawatz M, Griesinger G, Diedrich K, Ludwig M. Perioperative and post-operative complications of transvaginal ultrasound-guided oocyte retrieval: prospective study of >1000 oocyte retrievals. Human Reproduction. 2006;21(12):3235-3240.
- Kumar P, Sharma A, Sait S, Kumar M. Ovarian hyperstimulation syndrome. Journal of Human Reproductive Sciences. 2011;4(2):70.
- Kroes J. The incidence of major clinical complications in a Dutch transport IVF programme. Human Reproduction Update. 1996;2(4):345-353.
- Woo I, Hindoyan R, Landay M, Ho J, Ingles S, McGinnis L et al. Perinatal outcomes after natural conception versus in vitro fertilization (IVF) in gestational surrogates: a model to evaluate IVF treatment versus maternal effects. Fertility and Sterility. 2017;108(6):993-998.
- Alukal J, Lamb D. Intracytoplasmic Sperm Injection (ICSI) – What are the Risks?. Urologic Clinics of North America. 2008;35(2):277-288.
- Lu Y, Wang N, Jin F. Long-term follow-up of children conceived through assisted reproductive technology. Journal of Zhejiang University SCIENCE B. 2013;14(5):359-371.
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