The Risks of In Vitro Fertilization (IVF)

We believe it is necessary to understand some aspects of infertility and the research done in this area in order to both understand the potential dangers involved when undergoing IVF and to evaluate the alternative option of having the baby you so desire without jeopardy to either  yours or to your child’s future health and without put your life in danger.

Panagiota Chadla-Skarlatou Biologist, Genetics and Molecular Biology MSc Systemic Biology:"The risks of In-Vitro Fertilization that no one will ever tell you about!"

"Over the past ten years, more than 6% of children in Europe were born through assisted reproduction. In vitro fertilization (IVF) is the most common method of Medically Assisted Reproduction. It was first applied successfully in humans in 1978. In vitro fertilization, as the name suggests, is fertilization outside the body. That is to say, instead of the sperm fertilizing the egg in its natural environment, which is in the woman's fallopian tube, fertilization takes place in the laboratory. It substitutes for that function of the body when, for various reasons, fertilization can’t take place naturally.

IVF commences with a preliminary screening of the couple. For women, this includes a hormonal check, ultrasound of the uterus and ovaries, a virtual test for embryo transfer and hysteroscopy in pathological cases. Men require semen analysis. The second stage involves stimulation of the ovaries to produce multiple mature ova. This requires special hormonal therapy. Ovarian stimulation is monitored by ultrasound and blood testing while the respective hormone levels are identified. The fourth stage is the collection of the ova and their evaluation. There then follows fertilization which is successful in 60-70 % of cases. Embryo transfer comes next (placement of the embryos resulting from in vitro fertilization in the uterine cavity). Two weeks later a blood test determines the levels of beta-human chorionic gonadotropin to determine the success of the process.

What risks dies this method harbour for women and babies? Do we know of potential complications?

Ovarian Hyper Stimulation Syndrome (OHSS): This may occur because, as indicated by the name, the agents given during the process of in vitro fertilization stimulate the ovaries to engage and mature many follicles so as to retrieve many mature ova. OHSS occurs in 5% of all women undergoing IVF treatment. Depending on the severity, the symptoms are categorised as mild, moderate or severe. The severe form of the syndrome has been more often observed in women with polycystic ovaries. The symptoms are abdominal swelling and pain, stomach pain, nausea, weight gain and decreased urination. Rarely, more serious forms can be shortness of breath, fainting and abnormal haematological and biochemical parameters. In such cases hospitalization for observation and treatment is necessary.

Cancer: The medication administered during IVF speed up the development of multiple follicles and thereby the development and maturation of multiple ova. The developing follicles secrete amounts of oestrogen that are more than during a normal cycle. Hypothetically, these raised oestrogen levels could be associated with the emergence or acceleration of oestrogen dependent tumours, such as breast cancer. Few studies have so far tried to explore the correlation between breast cancer and medication causing oestrogen overproduction in women. The analysis of case-controlled studies, including a number of women with breast cancer and healthy women, showed a correlation between fertility medications and potential breast cancer in women with a family history of breast cancer. Also observed, was an increased risk in women who made long-term use of gonadotropins (more than 6 IVF cycles ). But because there are numerous worthy but conflicting studies, it is considered necessary to conduct further research on women in these categories so as to clearly demonstrate that they have increased probabilities of falling ill.

Ectopic pregnancy: Ectopic pregnancy is the installation of the foetus in a position not in the womb (usually in a fallopian tube). The chances of this happening after natural conception are 1-1.5 %, whereas in assisted reproduction programs they are greater  and the situation is remedied with laparoscopic surgery.

Multiple Pregnancies: The methods used in assisted reproduction and IVF programs are accompanied by increased rates of multiple pregnancies. Usually, twin pregnancies don’t pose problems. Problems are more frequent and severe in multiple pregnancies and affect the health of the mother and increase the likelihood of early and premature births. The worst, athough rare, sequelae of premature births are cerebral haemorrhages associated with cerebral palsy.

Cerebral palsy: There is evidence to show that rates of cerebral palsy are higher (about twice as many, according to research by the University of Aarhus in Denmark) among children born from in vitro fertilization (IVF) in relation to those born from natural conception.

Genome changes: the DNA of embryos conceived through in vitro fertilization differs from that of other children (Sapienza Research). Scientists have identified differences in 10% of the genes studied. This, they stress, gives a logical explanation as to why IVF babies tend to face a higher risk of being born considerably underweight, with health problems and rare metabolic disorders. Changes in genes are caused by the mechanism that activates and deactivates them (epigenetic). Other eminent geneticists warn that babies from IVF are at risk of developing debilitating diseases in adulthood (diabetes, hypertension, cancer) and emphasize that until the age of 50, these individuals should be submitted to preventative checks at regular intervals.

The unrestrained development of assisted reproduction and the lack of a regulatory plan from commencement are the main reasons that have not minimized the potential health hazards for ‘test-tube children’ and their mothers. A recent research on this issue showed that there is a higher rate of multiple pregnancies when compared with naturally occurring twin pregnancies that are 1 in 127 births. A doubling of miscarriages was recorded, a tripling of late foetal deaths, a fivefold increase in ectopic pregnancies, more than double the likelihood of underweight infants (<2.500gr), twice as likely for congenital anomalies to appear and 17-fold chances of an ectopic pregnancy by using frozen embryos. Another research (published in the "British Journal of Obstetrics and Gynaecology") supports that IVF increases the probability of male births by 51% to 56%, while in ICSI (Intracytoplasmic Sperm Onjection), the probability of male births is 49 % as opposed to 51 % in natural births. The boy-girl ratio in a population fluctuates over time due to various external factors (natural disasters, wars, standards of living, environmental changes etc). Recent study shows that with the advancement of science and technology, assisted reproduction is an additional factor affecting the ratio of the sexes."