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ACOG: Counsel women about risks associated with assisted reproductive technology

The American College of Obstetricians and Gynecologists has published a Committee Opinion outlining the perinatal risks with assisted reproductive technology and ovulation induction.

“Pursuing [assisted reproductive technology] is a deeply personal and significant decision for patients,” Joseph Wax, MD, chair of obstetrics practice at the American College of Obstetricians and Gynecologists (ACOG), said in a press release. “It is our responsibility as providers to ensure patients and their partners are properly informed throughout the process. While we may refer many of our patients seeking [assisted reproductive technology] to an infertility specialist, this process may still require ob-gyns to be capable of talking about the process comprehensively, acknowledging the risks balanced against the external factors that might influence patients’ choices.”

The ACOG published the following recommendations:

• Counsel patients about how [assisted reproductive technology] and ovulation induction have perinatal risks — including multifetal gestations, prematurity, low birth weight, small for gestational age, perinatal mortality, cesarean delivery, placenta previa, abruptio placentae, preeclampsia and birth defects — and how these risks increase in multifetal births;
• Follow professional society guidelines for embryo transfer and should continue to expand use of single-embryo transfer in order to reduce risk for multifetal gestation;
• Complete a medical evaluation to ensure patients are in good health and should address any maternal health problems before initiating ART or ovulation induction;
• Counsel couples at risk of passing on genetic conditions;
• Discuss the option of multifetal reduction in the case of a higher-order multifetal pregnancy. In the case of a continuing higher-order pregnancy, ongoing obstetric care should be with an obstetrician-gynecologist or other obstetric care provider at a facility capable of managing anticipated risks and outcomes.

According to the release, there are several known methods to limit multifetal pregnancies when using assisted reproductive technology, including low-dose stimulation protocols, elective single embryo transfers as well as close monitoring of hormone levels and follicle numbers during superovulation cycles.

“Over the past decades, our understanding and capability around [assisted reproductive technology] have come a long way,” Wax said in the release. “While multifetal pregnancy is a commonly associated risk with [assisted reproductive technology], it is increasingly preventable. Reducing this possibility not only protects mother and fetus, but ultimately increases the likelihood that patients achieve their goal of a healthy and successful pregnancy.” – by Will Offit

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