Are fertility treatments safe for babies?

None of us can be certain of a healthy pregnancy –it is one of the risks of parenthood.

Unfortunately, some of the very conditions that lead to subfertility (an unusual uterine shape for example, or a known genetic variation in one of the parents) may lead to even more complications in pregnancy.

A recent review of births in South Australia, published in the New England Journal of Medicine, reminds us that when a subfertile couple conceives their chances of having healthy baby will be about 92%…not quite as high as “fertile” patients at 94%.

If you look to specific treatments, the risks are not usually any higher. (For the mathematically inclined: the 95% confidence intervals for adjusted risk ratios for infertility-without-treatment are 1.01-1.56, IVF 0.89-1.33, and ICSI 1.35-2.04 compared to fertile controls. IVF and ICSI do not appear to increase risks above baseline for subfertile patients, and are associated with the rates of fertile controls (0.46-1.34) for frozen embryo transfers ie when embryos are sorted for health).

Our current understanding is that the treatments themselves do not appear to add risk.

But what of subfertility?

I can help you to understand some of the more common issues that affect our patients, and (if any apply to you) what you can do to maximize your chances for a healthy baby. The vast majority of patients who choose fertility treatments will not be putting their babies’ health at risk.

• Mum’s health matters

A healthy mother makes a healthy pregnancy more likely.

What you can do

• Ensure your physical exams remain up to date (pap test, breast exam, BP check, etc) with screens every 6-12 months for hormone disorders relevant to pregnancy like hypothyroidism and diabetes
• Maintain a balanced lifestyle…7h sleep, a healthy weight, moderate exercise, eating well. Sleep means good sleep hygiene. A healthy weight means that  if your BMI >30, try to lose 5%. (If it is under 18.5%, try to gain 5%). I know, not easy, but 5% is a reasonable goal for many of us. Moderate exercise is 2-3x week, or, at the very minimum, wear a pedometer and walk your 10,000 steps a day. Eating well? I like Michael Pollan’s books but weight watchers online is also extremely educational.
• If you have a chronic health condition, confirm that your specialist will know how to manage your care once you are pregnant.
• You know you can’t smoke.
• And I know you know this too, but don’t forget your folate 1mg per day.

• Dad matters too

What you can do

Fibroids, uterine structural variations like a septum, and possibly a thin endometrial lining all get in the way of a good chance for implantation

What you can do

• 3D sono or hysteroscopy for uterine structure
• Further tests of uterine and tubal structure if necessary: HSG, pelvic MRI, and an endometrial biopsy. (Not everybody needs all of these tests, but everyone needs to be confident that the uterine structure is as healthy as possible).
• One or more monitored cycles prior to IVF, to ensure that uterine lining is expected to be 8mm or more at the time of transfer

• Minimize your risks for multiple pregnancy

Complications can happen in any pregnancy, but especially with multiples…and the more babies there are (triplets etc) the greater the risk

This is one decision that is completely within your control. See the ASRM Guide for Patients if you need to know more about this important subject, and why we are trying so very hard to move to elective single embryo transfers

• Not all embryos are the same

It may not be bad for embryos to grow in a lab (research is ongoing on this point) but it isn’t a benefit either…just because you are transferring two “beautiful” embryos doesn’t mean we know that they are going to grow up just fine.

What you can do

• Preimplantation Genetic Screening: trophectoderm biopsy of a day 5 blastocyst, and vitrification or day 6 embryo transfer, may help to select for only your healthiest embryos
• Frozen Embryo Transfers. Some clinicians wonder if frozen, in preference to fresh transfers, can have better outcomes. The New England Journal paper cited above notes that frozen-thawed embryo transfers from both IVF and ICSI cycles presented no increased risks compared with fertile patients.
• Donor Gametes. If you are really, truly worried about the health of your embryos (and the pregnancy that will follow), then donor eggs and/or donor sperm may provide the peace of mind you need.

Summary

So is IVF/ICSI, or any fertility treatment, actually safe for babies?

Success rates in today’s top clinics are so high, the screening tests for health, for uterine structure and function, and for embryos are so strong, and the monitoring of pregnancies so tight, that you can be in control of your risk tolerance at every step.

We cannot eliminate all risk. But the biggest risk of all –the choice in how many embryos you elect to transfer– is entirely in your control.

Tom Hannam

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