Considering IVF? Here’s what you should know about the risks

In Vitro Fertilization (IVF) does not involve manipulation of genes, and couples should only consider it if they believe that its benefits outweigh its risks, says infertility specialist, gynaecologist and obstetrician Dr. Arockia Virgin Fernando.

It has been more than four decades since the first baby was born from IVF. Since then millions of couples have conceived and given birth, thanks to assisted reproduction techniques (ART). However, there is still research being done on how IVF impacts the health of these children later in life. Various studies say that children conceived using IVF/ Intracytoplasmic Sperm Injection (ICSI) are at a higher risk of congenital heart defects (CHDs), diabetes, preterm birth and obesity.

The procedure in itself can be a difficult process for women, with side effects such as weight gain, migraines, preterm labour, etc. Dr. Fernando (consultant with Practo) talks to us about the impact of IVF on women and children, and the importance of counselling.

• What are the health impacts of IVF treatments on women?
• What about migraines, preterm labour, and the fear of cancer?
• Will you also talk about the risk of cardiovascular diseases from IVF?
• Should couples get counselling before IVF?
• What is the long-term impact of IVF on children?

It has been more than 40 years since the first IVF baby was delivered. Experts say that there hasn’t been enough research on the impact of fertility treatments. Will you talk to us about it?

The hormones that are used during IVF are the same ones which are in the body naturally as well. But they’re given at higher levels. These can cause temporary effects like bloating from increased follicle development. These can also cause abdomen pain as there are more eggs growing in the ovaries, which can cause discomfort. There is also some water collection around the uterus, which causes discomfort. After the eggs are retrieved from the ovaries, women may feel exhausted because of dehydration.  They may have vomiting, nausea for two to three days. It usually settles five days – a week post the procedure. However, it doesn’t happen to everyone. Some women are comfortable throughout the treatment.

We usually give a month’s gap for women to recover post the egg retrieval and before the embryo transfer. They may have water retention in the body and weight gain during this time. It settles down within one to two period cycles. However, they need to be active during this time.

Additionally, women are administered hormonal injections before the embryo transfer. These may cause injection site pain, although it doesn’t happen for everybody. We also use vaginal progesterone capsules for some women (for those who need extra progesterone). They need to maintain good hygiene as the vagina may feel wet because of the discharge from the capsules. It can also cause itching, dryness or fungal infections. Care is very important at this stage. Patients need to keep the area dry, or use a panty liner if they have too much discharge. However, if someone faces an incessant problem, we change the medicine. 

Some IVF pregnancies have a tendency to bleed a lot in the first three months. Although they don’t abort, they will be threatening to abort. Women may have spotting or bleeding, which we call a threatened abortion. We may give them additional hormones and advise bed rest. But after they cross nine-ten weeks, and the pregnancy settles, then it is like any other pregnancy.

Some IVF pregnancies have a tendency to bleed a lot in the first three months. Although they don’t abort, they will be threatening to abort. Women may have spotting or bleeding, which we call a threatened abortion. We may give them additional hormones and advise bed rest.

People have also complained about migraines, preterm labour, and the fear of cancer resulting from IVF treatment.

In some IVF pregnancies, there is a threat of preterm labour. But in many IVF pregnancies, women have delivered at the right time as well. It depends on many factors — the age of the woman, co-morbidities like high blood pressure, diabetes, and infections.

IVF pregnancies do need extra precaution. Ovulation induction medicines or contraceptive pills which we use for fertility can cause headaches, and people with migraines might be affected more.  If somebody has migraine, we reduce the overall dose of hormones and use something like transdermal skin patches instead.

Some people think that fertility medicine will cause ovarian cancer, but that hasn’t been proven yet.

I have also seen some people get IVF treatment five to six times, rather than opting for a donor egg. My advice is that you should not be overdoing anything. If you overdo it, it can cause long-term hormonal imbalances, weight gain, and it exhausts the ovaries. If the IVFs are failing for some reason, there is no point in repeatedly trying, it is better to go in for a donor egg instead.

Will you also talk about the risk of cardiovascular diseases especially preeclampsia? There has been some research which says that the estrogen used during IVF may increase the risk of cardiac diseases.

If patients are being given only estrogen, it may increase the risk cardiovascular diseases. But since we usually treat women in a higher age group, we give them the progesterone hormone as well, which is a protective hormone. It prevents some cancers as well as cardiovascular disease.

Tell us about counselling for couples going in for infertility treatments, how important is it?

Definitely, good counselling is necessary. There are couples who get a lot of wrong or inadequate information, and they avoid treatment. Couples need  counseling so that they are able to understand what IVF is, how it happens, and how they can avoid the side effects. They also need to know about the changes they need to make in their lives, their food habits, everything has to be discussed with them during counselling.

Couples need  counseling so that they are able to understand what IVF is, how it happens, and how they can avoid the side effects. They also need to know about the changes they need to make in their lives, their food habits, everything has to be discussed with them during counselling.

Couples also need to be told in an honest manner about the success rates. They shouldn’t be given false hopes. A lot of times people expect that since they paid money for it, they should get good results, but that isn’t necessarily how it works out. They may get pregnant, but they may abort. Out of a 100 couples undergoing IVF, only 40 will take a baby home.

Out of a 100 couples undergoing IVF, only 40 will take a baby home.

There can be various problems in IVF, like there are in natural pregnancies as well. People have to understand that we are not altering your genes, we are only aiding reproduction, it is only assisted reproduction. All we are doing is combining the egg and the sperm and selecting the good embryos. We are not manipulating anything. IVF is not 100%, you need to understand that. You have to understand the risks and the benefits, and only if you think the benefits overweigh the risks only then should you go for it.

Even things like how many embryos should you put in the uterus. There is a 20% risk of having twins if you transfer two embryos, and couples need to understand that. 

We also wanted to talk about the impact that IVF treatments have on babies, or do they have higher risk of birth defects? Are there any long-term health impacts that have been researched upon. 

If women are in the upper age bracket for pregnancy, or if they have co-morbidities like high blood pressure or diabetes, that baby can land up in a preterm delivery and can have co-morbidities. Even later in life, IVF-born individuals can have diabetes or kidney failures or high blood pressure earlier than usual. This can happen because of the preterm delivery. We have to monitor IVF pregnancies carefully and keep a close check on the medicines that we are administering the patients.

Some studies also talk about the risk of cardiac problems in children who are born from IVF. But we have to understand that women who undergo IVF are usually those with PCOS, or those who are over 35. If they have gestational diabetes, or are already diabetic, there is already a risk of cardiac problems. We have to monitor these pregnancies carefully. The women coming to us are not 22 or 23, they are older. We usually recommend a fetal echo test in the sixth month to confirm there is no problem, and we also monitor them for blood sugar etc to avoid any complications in the pregnancy or pre term delivery.

Sources:

1. Congenital heart defects in IVF/ICSI pregnancy: systematic review and meta-analysis. V Giorgione, F Parazzini, V Fesslova, S Cipriani, M Candiani, A Inversetti, C Sigismondi, F Tiberio, P Cavoretto.

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