Part One: Assisted reproductive technologies and maternal risk

When women imagine having a baby, most do not envision needing medical assistance to achieve pregnancy.

I, like many women who suffer from infertility, did not really consider this reality until it happened to me. But after months and months of trying unsuccessfully to achieve pregnancy naturally, my husband and I finally went to see an infertility specialist for further evaluation and, ultimately, to pursue additional fertility treatments.

While use of assisted reproductive technologies (ART) and in-vitro fertilization (IVF) may be the best option for a woman suffering from infertility, as it was for me, the use of these technologies is not without risk both during the treatment process and even after successful pregnancy is achieved.

In fact, there are multiple perinatal risks associated with ART, and these can potentially affect both the mother and the developing infant. In this post, I will explain the risks to the mother. Next week, I will follow up with a post detailing risks to the fetus.

Maternal risks associated with ART

Women who become pregnant as a result of ART are at a small but increased risk for developing serious medical conditions compared to traditional pregnancy.

1. Hypertensive disorders of pregnancy and preeclampsia

Women who undergo ART have consistently been shown to have a small but increased risk of pregnancy-related hypertensive disorders, including preeclampsia, despite adjustment for maternal age, inter-pregnancy interval, and presence of a new partner. This risk is further increased in the case of multifetal gestations (being pregnant with more than one child).

2. Placental abnormalities

ART is also associated with a higher risk of placenta previa, a condition in which the placenta covers the maternal cervix, as well as placental abruption, a complication in which the placenta prematurely separates off the uterine wall.

The use of frozen-embryo transfer is associated with a decreased risk of these placental complications compared to pregnancies resulting from a fresh-embryo transfer, suggesting that the uterine environment at the time of embryo implantation is important to the development of these complications.

3. Gestational diabetes

Use of ART increases the risk of gestational diabetes mellitus (GDM) by up to 30 percent compared to naturally conceived pregnancies even after adjusting for confounding factors such as age, body mass index, and family history. However, the prognosis for ART-induced pregnancies, including the complications that can result from gestational diabetes such as birth trauma, is favorable and comparable to natural pregnancies complicated by GDM.

In other words, women who use ART and develop GDM are no more likely to develop GDM-related complications than women who got pregnant and developed GDM without fertility treatments.

4. Cesarean section

Non-randomized trials have shown an increased cesarean section rate in pregnancies conceived via ART. However, this observation is most likely due to the presence of other obstetrical complications that are more likely to occur in ART pregnancies, such as multiple gestations, placental abnormalities, and congenital fetal anomalies. (More on congenital fetal anomalies in next week’s post.)

5. Severe maternal morbidity

In a study of more than 1 million deliveries performed between 2008 and 2012, severe maternal complications were nearly twice as common in pregnancies conceived via ART compared to non-ART pregnancies. However, in most cases, these complications were rare and occurred in less than one in 200 (0.5 percent) of pregnancies, even in those conceived via ART. Additionally, women who used ART had an increased risk of antepartum admission and longer hospitalizations.

Know your risks

While ART does lead to many happy outcomes for women hoping to start a family, the process does carry extra risks. I encourage you to talk to your doctor about these risks and make the decision that makes sense for you and your body.

Be sure to check in with us next week as we talk about the fetal risks associated with ART.

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