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IVF series, part V: What are benefits and risks of the IVF process?

IVF series, part V: What are benefits and risks of the IVF process?

Catherine Poslusny | March 3, 2020 | Getting Pregnant

The use of in vitro fertilization (IVF) has grown significantly over the past few decades, allowing many people to get pregnant that wouldn’t have been able to otherwise. A 2018 survey found that 33% of American adults have either used some type of fertility treatment or know somebody who has (1).The process comes with a pretty serious physical, financial, and emotional commitment that shouldn’t be taken lightly. Before you decide whether IVF is right for you, we want to help make sure you’re fully informed about all of the benefits and risks associated with the procedure.

 

Risks of IVF

IVF carries its own set of health risks, in addition to the complications that can happen during any pregnancy. A 2019 study published in the Canadian Medical Association Journal (CMAJ) looked at about 60,000 pregnancies and found that women who received infertility treatment (especially IVF) were 40% more likely to experience a severe pregnancy complication than women who conceived naturally (2).

However, the study’s authors point out that the actual number of women who experience serious complications is still relatively low, and that IVF is still considered a generally safe and effective treatment for infertility (3). 

IVF carries the same risks for miscarriage as conceiving naturally—15 to 20% with an increase as maternal age increases. More research is needed to determine whether IVF carries different risks for congenital anomalies than natural conception (4). The main risks associated with IVF include the following:

 

Side effects of fertility medications

The first step of any IVF cycle is stimulating ovulation. The injectable fertility medications used during this step include follicle-stimulating hormone (FSH), luteinizing hormone (LH), and human chorionic gonadotropin (HCG) (4). These shots come with possible side effects that include bruising, soreness, or skin irritation at the injection site, nausea, breast tenderness, increased vaginal discharge, mood swings, and fatigue (5).

One potentially-severe, but rare, risk of injectable fertility medications is ovarian hyperstimulation syndrome (OHSS), which affects 3 to 6% of women who undergo IVF. Most women only experience mild symptoms, including slight weight gain and abdominal bloating and pain, that typically go away on their own within a few days (6). However, if you become pregnant, these symptoms can stick with you for several weeks (4). Less than 1% of OHSS cases can lead to more severe problems like blood clots or kidney failure (5).

 

Risks associated with egg retrieval and embryo transfer 

After the egg retrieval, women can experience mild to moderate abdominal and pelvic pain that typically goes away within a couple of days. Risks associated with this stage of the IVF process are rare but can include pelvic infection, bleeding, and injury to the organs near the ovaries, such as the bowel and bladder (5, 7).

The embryo transfer comes with mild potential side effects as well, such as cramping, bloating, breast tenderness, constipation, and vaginal spotting. There’s a very slight risk of infection during this stage of IVF, but it can usually be cleared up with antibiotics (5, 7).

 

Potential for multiple births

In some IVF cycles, more than one embryo may be transferred at a time, increasing the likelihood of becoming pregnant with twins (or even triplets). Multiple births have an increased risk of complications for both the fetuses and the mother, including early labor, low birth weight, maternal hemorrhage, pregnancy-related high blood pressure, and gestational diabetes (5, 8, 9).

The risk for multiples, and the accompanying complications, increases with the number of embryos implanted in the uterus. The American Society for Reproductive Medicine (ASRM) recommends transferring the “minimum number of embryos necessary to provide a high likelihood of pregnancy with the lowest risk of multiple pregnancy.” The risk for multiple births can be avoided altogether by only transferring one embryo at a time (5).

 

Ectopic pregnancy

Ectopic pregnancy is a rare but potentially life-threatening condition in which a fertilized egg starts growing outside of the uterus, usually in the fallopian tubes (10). Ectopic pregnancies occur in about 1.4 to 2.1% of patients who get pregnant through IVF. Women who used frozen-thawed embryos or donor oocytes seem to have a lower chance of ectopic pregnancy than women whose embryo transfer directly followed ovarian stimulation and egg retrieval (11, 12).

 

Benefits of IVF

Not only does IVF help couples with infertility get pregnant, but it also makes it possible to have a baby with the help of a surrogate or gestational carrier. Now, same-sex couples, single women, and women who are unable to carry a baby to term can have children genetically related to them, even when they can’t conceive naturally. IVF also allows couples to use donated eggs and sperm when genetic factors or health risks prevent them from using their own.

 

Control the timing of your pregnancy

Another advantage of IVF is that it allows you to have greater control over the timing of your pregnancy. If you don’t want to have kids in your 20s, you can preserve your eggs or fertilized embryos until you need them. Then, when you’re ready, you can proceed with IVF (13).

 

Preimplantation genetic testing 

You may choose to have your embryos genetically screened before they are transferred to your uterus. Preimplantation genetic testing (PGT) allows parents to make sure that the embryos used during the IVF process are free of chromosomal abnormalities or genetic disorders (14).

About 60% of miscarriages occur because an embryo has received an abnormal number of chromosomes during fertilization. PGT helps doctors spot these abnormalities and select embryos for IVF that have the highest likelihood of resulting in healthy, full-term pregnancies (14, 15). You may be a candidate for PGT if you or your partner are carriers of any genetic or chromosomal disorders that can be screened. The process may also be recommended for women who (16):

Since the first IVF baby was born in 1978, the world has seen over 8 million IVF success stories (17). Still, the process is far from a sure thing. If you’re considering IVF, make sure to give yourself the time you need to ask questions, research the potential risks and benefits, and make an informed decision on whether the process is right for you.

 

IVF Series

Part I: The Basics of the IVF Process

Part II: What should I try before IVF?

Part III: When should IVF be done? Why would IVF be recommended? 

Part IV: Will IVF work for me?

Part V: What are the benefits and risks of the IVF process? (you are here)

 

References:

  1. Livingston, G. (2018, July 17). A third of U.S. adults say they have used fertility treatments or know someone who has. 
  2. Dayan, N., Joseph, K. S., Fell, D. B., Laskin, C. A., Basso, O., Park, A. L., Luo, J., Guan, J., & Ray, J. G. (2019, February). Infertility treatment and risk of severe maternal morbidity: a propensity score-matched cohort study. Canadian Medical Association Journal, 191(5), E118–E127.
  3. Canadian Medical Association Journal. (2019, February). Infertility treatment linked with slightly higher risk of pregnancy complications. ScienceDaily. 
  4. Mayo Clinic. (2020). In vitro fertilization (IVF).
  5. American Society for Reproductive Medicine. (2015). In Vitro Fertilization (IVF): What Are the Risks? (booklet).
  6. U.S. National Library of Medicine. (2017, August). Ovarian hyperstimulation syndrome.
  7. American Pregnancy Association. (2019, November). In Vitro Fertilization: IVF
  8. Penzias, A. (2017, April). Guidance on the limits to the number of embryos to transfer: a committee opinion. Fertility and Sterility, 107(4), 901 - 903.
  9. Kamphuis, E. I., Bhattacharya, S., Veen, F. V. D., Mol, B. W. J., & Templeton, A. (2014, January). Are we overusing IVF? BMJ, 348, g252.
  10. American College of Obstetricians and Gynecologists. (2018, February). Ectopic Pregnancy.
  11. Londra, L., Moreau, C., Strobino, D., Garcia, J., Zacur, H., & Zhao, Y. (2015, July). Ectopic pregnancy after in vitro fertilization: differences between fresh and frozen-thawed cycles. Fertility and Sterility, 104(1), 110–118.
  12. Clayton, H., Schieve, L., Peterson, H., Jamieson, D., Reynolds, M., & Wright, V. (2006, March). Ectopic Pregnancy Risk With Assisted Reproductive Technology Procedures. Obstetrics & Gynecology, 107(3), 595–604.
  13. Mayo Clinic (2019). Egg freezing.
  14. American Society for Reproductive Medicine. (2014). Preimplantation Genetic Testing. (booklet).
  15. American College of Obstetricians and Gynecologists. (2016, May). Repeated Miscarriages.
  16. American Pregnancy Association. (2019, November). Preimplantation Genetic Diagnosis: PGD
  17. European Society of Human Reproduction and Embryology. (2018, July). More than 8 million babies born from IVF since the world's first in 1978: European IVF pregnancy rates now steady at around 36 percent, according to ESHRE monitoring. ScienceDaily.