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What a woman should know before embarking on infertility treatment

Robin Wulffson MD's picture
infertility, pregnancy complications, Clomid, IVF, IUI, assisted reproduction

According to a new study, any type of infertility treatment increases the risk of pregnancy complications. Dr. Hayashi of Nippon Medical School, Tokyo and colleagues published the results of a large study online on July 3 in the journal Fertility and Sterility

The researchers compared obstetric and perinatal outcomes of singleton pregnancies conceived with different types of assisted reproductive technology (ART) procedures with those of naturally conceived pregnancies. They reviewed data on more than 242,000 women; they identified 4,111 who received ovulation stimulation medications such as clomiphene citrate (Clomid), 2,351 who underwent intrauterine insemination (IUI) without ovulation stimulation medications, and 4,570 who underwent in vitro fertilization and embryo transfer (IVF-ET).

The researchers found that patients who conceived through the ART procedures were associated with an increased incidence of the following complications: placenta previa (placenta overlying the cervix), preterm delivery, and delivering low birth weight infant. In addition, these women had a decreased incidence of spontaneous cephalic (head first) delivery; thus, the cesarean section rate was higher. This increased risk held for all types of infertility treatment. For example, compared to women who conceived naturally, the risk of a placenta previa was 1.77 times higher for women who underwent ovarian stimulation; the risk was 1.46 times higher for women who underwent an IUI; and the risk was 2.2 times greater for women who underwent IVF-ET. A spontaneous cephalic delivery was decreased to 0.91 for women who underwent ovarian stimulation; it was 0.87for women who underwent an IUI and 0.75 for women who underwent IFV-ET.

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The researchers noted that the general similarity of pregnancy complications across groups suggest that maternal factors associated with infertility may contribute to the adverse outcomes rather than the ART procedures themselves. They stressed that the results need to be interpreted cautiously because: “The mechanisms leading to these adverse outcomes in infertile women remain unclear and require further study for elucidation.”

Take home message:
The results of this study should not deter a woman from seeking infertility treatment; however, it does point out that embarking on a course of infertility treatment, regardless of type, is associated with a pregnancy complications. This complication risk must be factored in with the cost of the treatment and the need to endure side effects, which may be extremely unpleasant. Side effects from taking Clomid are usually mild and include hot flashes, breast tenderness, nausea, and mood swings. However, other medications that are used for IVF treatment can produce more severe symptoms.

Women who undergo infertility treatment in general have increased risk factors for pregnancy complications. For example, they tend to be older, which increases risk, and they may have suffered from past pelvic infections or have endometriosis, both of which can damage the tubes or uterine lining.

Before embarking on infertility treatment, a woman should evaluate lifestyle factors that impact fertility. For example, she may need to lose or gain weight, or do more or less exercise. Smoking, drinking alcohol, and taking drugs by both the woman and her male partner can impact fertility.

Reference: Fertility and Sterility