Infertility affects roughly 1 in 7 couples in the UK at some stage. IVF is now routine practice in the management of infertility and births following IVF account for over 1% of all births in the UK.
But for couples who go through IVF what are the pregnancy and early childhood outcomes?
The paper, produced by the RCOG’s Scientific Advisory Committee, looks at procedures including intra-cytoplasmic sperm injection (ICSI), blastocyst culture, assisted hatching and genetic diagnosis.
Pregnancy risks associated with IVF include multiple births. At present, about 1 in 4 of all IVF pregnancies result in a multiple birth in the UK due to the common practice of replacing two or three embryos.
In addition, multiple pregnancy is a risk factor for premature birth, however, there is an additional 23% increase in the chances of premature birth in IVF twins compared with natural twins. In singletons there is about a two-fold increased risk of premature birth following IVF, however, in both cases the contribution of spontaneous preterm labour is unknown.
Despite prematurity in multiple pregnancy being a risk factor for low birth weight singleton IVF pregnancies also have an increased risk of low birth weight as compared to naturally conceived singletons, states the paper.
Moreover, the review looks at congenital anomalies, which affect between 3-5% of all infants. IVF is associated with an increased risk of major congenital anomalies as compared to natural conceptions however the absolute risk is still low. The authors also noted that the increased risk of congenital anomalies is partly attributable to the underlying infertility as couples who took longer than 12 months to conceive also were at an increased risk of anomalies.
The paper also highlights that IVF is increasingly used by older women who are already at risk of pregnancy and birth complications. However, even when comparing age matched controls there appears to be an increased risk of complications for women with infertility who have a higher rate of caesarean section delivery, pre-eclampsia, pregnancy-induced hypertension and gestational diabetes, all noted in older women having IVF.
The long term outcomes for children are also discussed in the paper. It states that overall the IQ, language development and behaviour of children born following IVF appear similar to children conceived naturally.
The only consistent adverse finding has been an increased risk of cerebral palsy which is partly explained by the increased risk of premature birth.
The paper also explores egg donation which is increasingly popular. There appears to be an increase in early pregnancy and birth complications, with the risk of pregnancy-induced hypertension in particular ranging from 16 to 40% of cases, with the greatest risk observed in women having their first baby. However there is little information on the long-term outcomes of egg donation pregnancies for the mother and her child.
Professor Jenny Kurinczuk, Director of the National Perinatal Epidemiology Unit and co-author of the paper said:
“IVF pregnancies carry an increased risk of poor birth outcomes and complications nevertheless the majority of the children born following IVF will have a good outcome just like any other children.
“The poor birth outcomes and complications may be a combination of treatment and underlying features of the couple such as older maternal age. However, treatment strategies can be altered to improve outcomes such as the adoption of elective single embryo transfer.
“As more couples opt for IVF and new technical processes are introduced, continued follow-up is required for both birth outcomes and longer term childhood outcomes.”
The 10th RCOG International Scientific Congress takes place in Kuching, Malaysia between 5-8 June 2012. It is held in partnership with the Obstetrical and Gynaecological Society of Malaysia (OGSM).
For more information please visit: www.rcog2012.com
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To read the full Scientific Impact Paper please click here.
About New RCOG Scientific Impact Papers
RCOG Scientific Impact Papers (formerly SAC Opinion papers) are produced by the Scientific Advisory Committee. They are up to date reviews of emerging or controversial scientific issues of relevance to obstetrics and gynaecology, together with the implications for future practice. These documents have been rebranded to raise awareness of the issues in obstetrics and gynaecology discussed in the documents and to more accurately reflect their content and remit of the Committee.
This new brand of RCOG documents have been launched on 6 June 2012 at the 10th RCOG International Scientific Congress in Malaysia.
The first two papers are:
Scientific Impact Paper No.8 IVF: Perinatal Risks and Early Childhood Outcomes
Scientific Impact Paper No.32 Management of Endometrial Cancer in Obese and Morbidly Obese Women