Risks of Assisted Reproductive Technologies
What is assisted reproduction?
Assisted Reproductive Technology (ART) is a group of procedures that involve in vitro handling (outside of the body) of human oocytes (eggs), sperm, and/or embryos for the purpose of establishing a pregnancy. It is performed to help infertile couples or single women have children.
How effective has ART been in Australia?
There were 71,516 ART treatment cycles reported from Australia and New Zealand in 2013. Of the 71,516 initiated cycles, 23.8% (17,054) resulted in a clinical pregnancy (positive heart beat on ultrasound) and 18.2% (12,997) in a live birth. (Macaldowie A 2015). Although ART procedures have benefitted many, they also carry certain risks.
What are the risks associated with ART?
The risks of IVF can be divided into ‘maternal risks’ and ‘fetal risks’. Maternal risks can be further subdivided into short-term risks (or risks associated with the IVF cycle itself) and long-term risks (or potential, future risks).
What are the short term maternal risks?
Medication: Hormonal medications used during ART can have mild side effects such as bloating, headaches, nausea, irritability, mood swings and breast tenderness.
Ovarian hyperstimulation syndrome: Ovary enlargement with fluid accumulation in the abdominal and/or chest cavities. This occurs in 1% of women undergoing IVF
Ovarian torsion: Enlarged ovary that rotates, choking off its blood supply, a rare condition requiring emergency surgery.
Complications during egg retrieval: Anesthetic/sedation complications, bleeding, injury to internal organs, which occurs rarely.
Ectopic pregnancy: Implantation of the fertilized egg outside the uterus, typically in the fallopian tubes. This occurs in 2% of ART pregnancies, and 1% of spontaneous pregnancies.
Multiple pregnancy: When only one embryo is transferred the risk of a multiple pregnancy is approximately 1%. Multiple pregnancy can increase the maternal risk of high blood pressure, diabetes, anemia and the need for surgery.
What are the long-term risks associated with ART?
When compared to the general population, there is a slight increase in the risk of uterine or ovarian cancer associated with ART, but this increased risk is also seen in the infertile population that does not undergo ART, therefore ART may not be the cause. Those undergoing ART before the age of 24 have shown a slight increase in the incidence of breast cancer.
What are the fetal risks associated with ART?
Using ART slightly increases the risk of delivering before 37 weeks’ gestation, delivering via caesarean section, having a small for gestational age or growth restricted fetus, or having a stillbirth. Studies have also found that babies born by ART have a slightly higher chance of birth defects, although it is difficult to say if this is due to ART laboratory techniques (ICSI), ovarian stimulation or parental infertility. (Davies 2012, Hansen 2013, Pinborg 2013)
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