In Vitro Fertilization: Risky for Mother and Child

Long Assailed by Church, Procedure Stirs Doctors’ Concerns

VIENNA, Austria, JULY 13, 2002 ( The Catholic Church has long warned about the moral problems of in-vitro fertilization. Now, even doctors are warning couples not to be too hasty in starting IVF treatments. This recommendation came during the proceedings of the European Society of Human Reproduction and Embryology conference held here last week.

Dr. David Dunson, of the National Institute of Environmental Health Sciences in North Carolina, observed that many couples embark on IVF treatment when they could have a baby by natural means, the London Times reported July 4.

Research has shown that most women who fail to conceive after a year of trying to do so — the point at which many doctors recommend IVF therapy — will become pregnant naturally during the next 12 months. Even among women in their late 30s, fewer than one in 10 will not conceive after two years, provided the partner is under age 40.

Dunson contended that many couples were misinterpreting research showing that female fertility began to decline from the late 20s, and fell steeply in the late 30s. This meant only that it would take women longer to conceive, not that it would be impossible without medical assistance, he said.

Doctors should avoid assisted reproductive therapy if possible because of its side effects, he said. “Fertility treatment can result in an increased risk of multiple pregnancies, pregnancy complications, low birth weight, major birth defects and long-term disability among surviving infants,” he warned. “In addition, the chance of success with assisted therapy decreases with age, while the side effects increase in prevalence.”

Embryos at risk

An earlier report from the Vienna conference warned that using multiple embryos during IVF treatment not only is unnecessary, but it also puts the babies at risk, BBC reported July 1.

Most IVF treatments normally implant more than one embryo in the uterus, in order to ensure a pregnancy. But a study carried out by French experts, presented at the Vienna conference, affirmed that just one embryo would yield the same chance of a successful pregnancy as two or more.

The research was based on an analysis of nearly 25,000 pregnancies of women who had undergone assisted reproduction treatment between 1986 and 1998. The pregnancies resulted in the births of 32,389 babies. Of these, 18,235 were singletons, 11,905 twins and 1,772 triplets.

“Multiple pregnancy is a very important risk factor for the babies’ health,” commented lead researcher Emile Papiernik, from Hospital Port Royal in Paris.

At a press conference held in Vienna, Dr. Karl Nygren, associate professor of obstetrics and gynecology at Sofiahemmet Hospital in Stockholm, said the natural rate of multiple births was around 1%, but was between 20% and 40% for women who used assisted reproductive techniques.

In the group studied, nearly nine out of 10 of the triplets, and over four out of 10 of the twins, were born prematurely, compared with just over 8% of single babies. Moreover, 57% of the babies who were small for their gestational age were triplets, nearly 43% were twins and just over 17% were singletons.

Deaths in the period around birth were five times as frequent for triplets as for single babies — a rate of nearly 40 per 1,000 compared with under 8 per 1,000 for single babies. For twins it was just over 20 per 1,000.

Multiple pregnancies don’t endanger only the babies. Women carrying multiple babies conceived with IVF are more likely to suffer from a serious high blood pressure condition than women who conceive a multiple pregnancy naturally, Reuters reported Feb. 28.

The news agency cited a report published in the March issue of Obstetrics & Gynecology. The study examined 528 mothers who had delivered twins, triplets or quadruplets between 1994 and 2000. Among these women, 69 had conceived with assisted reproductive technology, or ART.

The investigators found that women who used ART were more than twice as likely as those who had conceived naturally to suffer from pre-eclampsia, in which blood pressure rises to dangerous levels during pregnancy. And women who used ART were almost five times as likely to have the severe form of pre-eclampsia, which can be life-threatening, the report indicates.

Risk of deformations

A number of other studies point to a higher level of health problems for babies conceived through IVF programs. According to a July 5 report by the Australian Broadcasting Corporation, research in the state of Western Australia has found that there is twice the risk of major birth defects in IVF babies compared to children conceived naturally.

A study, co-authored by Michele Hansen at the Institute for Child Health Research, found that babies conceived through assisted conception had a 9% risk of major birth defects. Researchers will now follow up this finding with a project tracking children through the first six years of life.

Previously, a study published by the New England Journal of Medicine found that IVF babies run about double the risk of birth defects and low birth weight, the Washington Post reported March 7.

The article noted that the methods used by the fertility clinics have not undergone government testing of their safety, as is required of drugs. The study comes at a time when artificially assisted reproduction is increasingly popular in the United States, with about 82,000 procedures (leading to the birth of 29,000 children) in 1998, a 12% increase from the previous year.

Still another study also concluded that IVF was leading to problems in babies, even when it is only a single birth. A Jan. 22 report by Health Scout News cited study author Rebecca Jackson, medical director of the Women’s Health Center at San Francisco General Hospital, who warned that problems could arise during any of the many steps involved in IVF.

Some of the risk factors include “the medicines used to induce ovulation, the process of fertilization and growing of the embryo in vitro, the process of reimplanting the embryo back into the uterus,” said Dr. Jackson, who presented her findings at the annual meeting of the American Society for Reproductive Medicine.

Jackson’s study was a comprehensive analysis of 13 studies that examined more than 10,000 IVF pregnancies and 1.5 million natural conceptions. Her goal was to compare the risks of infant mortality, preterm delivery, low birth weight, and small size for gestational age between the babies of women who conceived naturally and those who became pregnant using IVF.

After taking maternal age into consideration, as well as the number of previous pregnancies, Jackson says the study revealed an overall higher rate of all the complications in the babies of women who conceived via IVF.

Another study, carried out at the University Children’s Hospital in Uppsala, Sweden, found that babies born as a result of IVF are three times more likely to develop neurological disorders, including cerebral palsy, than children conceived naturally, the British daily Independent reported Feb. 8.

The study compared 5,680 IVF children aged between 18 months and 14 years with 11,360 youngsters of the same age who were conceived naturally.

The scientists involved in the study believe the findings could be explained by the complications that often arise when two or more IVF embryos share the same womb, rather than because of the IVF techniques themselves.

The Church has often warned of the moral problems of IVF techniques, which in many cases destroy tiny human lives. Science is now finding there are considerable medical drawbacks as well.

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