Professor Nick Macklon is the Medical Director of the London Women’s Clinic Group and is a world-renowned expert in reproductive medicine. He has held professorships at the University of Utrecht in the Netherlands, the University of Southampton and the University of Copenhagen. Today, Professor Macklon answers questions that many people have surrounding the health and wellbeing of IVF births and babies. Show
Choosing to undergo IVF can be an emotional decision. There are huge amounts of information out there and while we are glad the topic is widely discussed, we understand this can be overwhelming. In recent years, particularly with the growth of social media, myths surrounding IVF and fertility treatment are more common. "Are IVF pregnancies higher risk?"Pregnancies arising from IVF are often thought to be at higher risk than spontaneously conceived pregnancies, but this perception has arisen because of the high rate of multiple pregnancies and associated risks of prematurity that characterized IVF in its early days. Fortunately, modern practice does not require the transfer of multiple embryos and therefore the risk of multiple pregnancy has dropped considerably. We do need to remember that on average women who conceive with IVF are older, and we know that increased age brings with it slightly increased risks in pregnancy. However, in healthy women, these risks remain low even up to age 50. "Are IVF babies 'normal' and healthy?"IVF babies have been very closely followed up, and with now more than 6 million babies born from IVF, we are getting a very reassuring picture of their health. There is some evidence that IVF babies conceived after fresh embryo transfer are born a little smaller than spontaneously conceived babies, and while this may in part reflect parental factors related to infertility, we think that the IVF process itself may be involved. This is supported by the observation that babies born after frozen thaw transfer are if anything slightly larger than spontaneously conceived babies. At this time however, these differences do not appear to have significant long-term consequences and many IVF babies are now healthy parents of naturally conceived children! However, we do need to keep researching the health of IVF babies, and recently it has been suggested that growing embryos in the laboratory environment might have subtle effects on future development. Again, these appear minor but need to be followed up. "Are IVF babies born early?"We often think of IVF babies being born prematurely more often than spontaneously conceived babies. This impression arises from the increased proportion of IVF babies who are twins or even triplets. However, the norm now is to transfer just one embryo and this had greatly reduced this risk. "Are IVF babies born late?"There is no evidence of this. "Are IVF babies sicker?"As long as we can avoid multiple pregnancies and the associated risks of prematurity, IVF does not appear to be associated with sicker babies. "Are IVF babies bigger?"There is some evidence that babies born after frozen thaw transfer may be slightly bigger than spontaneously conceived babies. The reason for this remains unclear. "Are IVF babies born smaller?"See above. "Are IVF babies fertile?"Yes. The incidence of subfertility in adults born as a result of IVF does not seem to be increased. One possible exception to this is men who were conceived after ICSI because their father had very poor sperm quality. These babies are just beginning to become dads now, and while they appear to be fertile in general, a recent study suggests that they have a slightly higher prevalence of low sperm count, suggesting they have inherited this from their father in some cases. We need more data to confirm this initial observation though. "Are IVF twins identical?"Most IVF twins are born as a result of two embryos being transferred into the uterus at the same time and both implanting. These embryos came from different eggs and are not therefore identical. Occasionally, however, a single embryo can ‘split’ into two, resulting identical twins, just as can happen in nature too. So most IVF twins are not identical. "Are IVF babies taller?"IVF babies don’t seem to be taller as a result of having been conceived by IVF. "Are IVF babies induced?"Most IVF pregnancies run the same course as spontaneous pregnancies, and unless a complication develops, or the pregnancy continues beyond the desired term, IVF pregnancies are not routinely induced. Have another question? London Women's Clinic is one of the leading providers of IVF treatment in the UK. We strive to ensure that all patients feel comfortable and confident in their decision to undergo IVF treatment, and so we hope to dispel any IVF myths surrounding the welfare and development of IVF babies. If you have any further questions about the IVF process and the wellbeing of IVF babies, or want to find out how you can start your IVF journey, please get in touch with a member of our team where we can discuss your options with our consultants. Find out more about IVF >
 For women who use in vitro fertilization to get pregnant, particularly those who find success with frozen embryo transfers, recent studies have found they have an increased risk of preeclampsia, a pregnancy complication and serious blood pressure condition. Now, academic researchers may have uncovered why. "Many have reported this higher incidence of preeclampsia in those undergoing frozen embryo transfer, but without any explanation. Now we think we have an explanation – they have no corpus luteum," said Dr. Kirk Conrad, co-senior author of the study published Monday in the American Heart Association journal Hypertension. The corpus luteum is a collection of cells that forms in the ovary after ovulation. It produces multiple hormones that help both maintain pregnancy and the body's adjustment to it. Women who undergo frozen embryo transfer – an increasingly used fertility option – usually do so under a "programmed cycle" involving medical suppression of reproductive hormones, which ultimately prevents the corpus luteum from developing. One way to prevent this from happening is for women to instead undergo a "modified" natural cycle that would allow a corpus luteum to develop, said Conrad, a professor in the University of Florida's departments of physiology and function genomics and obstetrics and gynecology. Researchers found that preeclampsia rates reached 12.8 percent in women receiving frozen embryos under a programmed cycle without a corpus luteum compared with 3.9 percent among women who had frozen embryo transfers under a modified natural cycle with a corpus luteum. Women without a corpus luteum lacked relaxin, one of the hormones it produces during pregnancy. The hormone helps relax blood vessels, among other things, said Dr. Afshan Hameed, a cardiologist and high-risk obstetrician who was not associated with the study. Women who lack relaxin "are at high risk because their blood vessels may remain stiff as shown in the study, particularly the aorta," said Hameed, a professor of cardiology and obstetrics and gynecology at the University of California, Irvine. "The researchers hypothesize that relaxin may play a role in those stiff vessels that are (common) earlier on in pregnancy, and that translates to preeclampsia later on in the pregnancy," she said. "But there are many other hormones present in the system that cause the blood vessels to constrict or dilate, and we don't have any data on those vasoactive type of hormones in this study." Conrad agreed the study only provides an association between a missing corpus luteum, absent relaxin and increased preeclampsia, not a direct link. "The corpus luteum makes a lot of products that we don't know about that may also be important," he said. Even so, Conrad called the findings "compelling." He said the study's co-senior author Dr. Valerie Baker is designing a randomized clinical trial to examine frozen embryo transfers in a natural or modified natural cycle with a corpus luteum versus a programmed cycle with no corpus luteum. Fresh embryo transfers come with a greater risk for babies with low birth weight and who are small for their gestational age, Conrad said. Frozen embryo transfers seem to lessen those risks – but then add a higher risk for preeclampsia. "I think the way to address this whole problem would be to do the frozen embryo transfer in a modified natural cycle or eventually replace the missing corpus luteal factors," he said. "It would be a nice solution but clearly needs (more research) before anything can be done." If you have questions or comments about this story, please email [email protected]. By Robert Preidt HealthDay Reporter MONDAY, Feb. 4, 2019 (HealthDay News) -- Women who've had fertility treatments -- especially in vitro fertilization -- may be at higher risk for serious pregnancy complications, a new study suggests. Still, it's not clear if the treatments cause the hike in risk, and the benefits of IVF far outweigh any obstetric dangers, the study's Canadian authors said. "It is important to remember that the absolute number of women who develop these complications remains quite small, meaning that for most women who cannot conceive naturally, this treatment is a very safe and effective method of becoming pregnant and having a child," said lead researcher Dr. Natalie Dayan. She is director of obstetrical medicine at McGill University Health Center in Montreal. In the study, Dayan and her colleagues tracked data on nearly 814,000 live births and stillbirths at hospitals in the Canadian province of Ontario between 2006 and 2012. They compared more than 11,500 women who conceived through infertility treatment with more than 47,500 women who conceived without such therapies. The women who conceived with infertility treatment were typically older, had higher incomes, were more often first-time moms, and carried multiple fetuses. Rates of severe pregnancy complications -- events such as such as severe bleeding after giving birth, admission to the intensive care unit, and the blood infection sepsis -- were about 31 per 1,000 infertility-treated pregnancies and 22 per 1,000 untreated pregnancies, the research showed. This higher risk was seen among women who had IVF, but not among those who had other forms of infertility treatment, such as intrauterine insemination or ovulation induction with medication, according to the study published Feb. 4 in the Canadian Medical Association Journal. Overall, "we found that the women who received infertility treatment, especially in vitro fertilization, were about 40 percent more likely to experience a severe pregnancy complication compared with women who gave birth without any treatment," Dayan said in a journal news release. Like previous studies, this one found that being older than 40 and being pregnant with twins or triplets is associated with higher rates of serious pregnancy complications, the research team noted. Infertility treatment is common in older women, and pregnancy with multiples is more likely after infertility treatment. So, "whether the increased risk [for IVF recipients] is a reflection of those who require or choose in vitro fertilization, remains to be determined," the authors wrote. One U.S. fertility expert agreed. "It is unclear which the real culprit is," said Dr. Avner Hershlag, who directs reproductive endocrinology at Northwell Health in Manhasset, N.Y. He noted that the study design didn't include information on other medical conditions the women might have had. Without that data, it "seems more plausible" that certain medical issues, such as obesity, might be the real driving force behind the findings, not the use of IVF itself, Hershlag said. "Further studies may allow us to clarify these important issues," he said. |
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