This article is more than 5 years old. Information may no longer be current.
IVF use may slightly increase risk for maternal death
Click Here to Manage Email Alerts
Women who underwent in vitro fertilization were at a “somewhat higher risk” for severe maternal morbidity or death, according to findings recently published in the Canadian Medical Association Journal.
According to the CDC, 7% of women aged between 15 and 44 in the U.S. years are infertile and 12% of women aged 15 to 44 years have ever used infertility services.
“The effect on maternal health of infertility treatment in general — and in vitro fertilization in particular — is understudied,” Natalie Dayan, MD, MSc, of the general internal medicine and obstetric medicine department at McGill University Health Centre in Montreal, and colleagues wrote.
Researchers matched 11,546 infertility treatment pregnancies (IVF with or without intracytoplasmic sperm injection, ovulation induction, or intrauterine insemination) with 47,553 non-IVF pregnancies from an existing Canadian cohort. The mean age of the women in the infertility treatment cohort was 34 years, compared with 33.6 years in the noninfertility treatment cohort.
Dayan and colleagues found severe maternal morbidity or maternal death occurred 30.8 per 1,000 infertility-related deliveries compared with 22.2 per 1,000 noninfertility related deliveries (RR = 1.39; 95% CI, 1.23-1.56). Those who received invasive fertility treatment had the greatest burden for severe maternal morbidity or maternal death (OR = 2.28; 95% CI, 1.56-3.33), vs. those who received noninvasive infertility treatment (OR = 0.99; 95% CI, 0.57-1.72).
Dayan provided ways to identify which women may be at risk for these complications and the appropriate course of action to take with these women in an interview with Healio Primary Care Today.
“We know that maternal factors like older age, high BMI or multiple pregnancy increase the risk of severe maternal morbidity and perinatal complications. To the extent possible, women’s health should be optimized in the preconception period. Primary care physicians should inquire about reproductive planning in all reproductive-aged women and ensure chronic health conditions are well managed, teratogenic medications are flagged and avoided prepregnancy, proper birth control is used, and that positive lifestyle strategies are used,” she said.
Dayan also noted that infertility can be an "enormous" source of distress for some patients and thus, provided ways to discuss the study's findings with patients.
“It is important to hear the patient’s concerns and desires. Infertility treatment may often be necessary, and it is important that patients know that these treatments are overall safe and effective. The adverse consequences we found are thankfully rare. Patients should simply be informed of the slight increase in the risk, and their health should be optimized prior to pregnancy. Sometimes, if a woman is felt to be very high risk then modified treatments can be offered if this is felt to be safe, and enhanced surveillance can be offered during pregnancy,” she added. - by Janel Miller
Reference: CDC. “Infertility.” https://www.cdc.gov/nchs/fastats/infertility.htm. Accessed Feb. 6, 2019.
Disclosures: The authors’ report no relevant financial disclosures.
Perspective
Back to Top
Meredith Snook, MD
Dayan and colleagues evaluated women who had delivered pregnancies and discovered an association between women who conceived with infertility treatment, particularly in vitro fertilization, and poor pregnancy outcomes in these women during their later pregnancy, delivery, and in the 6 weeks postpartum.
Though these outcomes that Dayan et al noted are severe, it is important to note that they are relatively rare, can be hard to predict during pregnancy, and are often multifactorial (due to other causes). Still, the findings warrant an OB/GYN to ask their patients if they conceived using infertility treatment. The answer, regardless of what it is, may not necessarily change how these women are managed and may not warrant additional monitoring during pregnancy, delivery and postpartum but provides an important component to the patient’s history and clinical picture.
I personally have found that when counseling a couple that is considering using IVF to become pregnant, there is very little that will deter them from this treatment when it is indicated or recommended. For instance, I counsel these couples that babies conceived through IVF are at slightly increased risk of lower birth weight, preterm birth, birth defects and being born via cesarean section. They accept these risks for the treatment that will yield the highest chance of pregnancy. I suspect the findings of Dayan et al will have the same impact on these women — that is, wanting to pursue IVF for pregnancy, regardless of the maternal risk to themselves.
Click Here to Manage Email Alerts