Did you know that: Infertility treatment may increase the risk of maternal morbidity and mortality in pregnancy

A study published in the Canadian Medical Association Journal (CMAJ) reported that women who became pregnant with infertility treatment (e.g. ovulation induction, intrauterine insemination or in vitro fertilization with or without intracytoplasmic sperm injection) showed an increased risk of maternal morbidity or maternal death (30.8 per 1,000 in infertility treatment women versus 22.2 per 1,000 in women who became pregnant unassisted).

According to this publication:

“Severe maternal morbidity refers to a broad set of conditions that identify women who experience a near-fatal event during, or within 42 days of a pregnancy. The association between assisted reproductive technologies and severe maternal morbidity has been investigated recently in 3 studies in the United States, each reporting an approximate doubling of the risk of severe maternal morbidity among women with pregnancies conceived through assisted reproductive technologies compared to those with pregnancies conceived without.”

Wang ET, Ozimek J, Greene N, et al. Impact of fertility treatment on severe maternal morbidity. Fertil Steril 2016;106:423–6.Google Scholar
Belanoff C, Declercq ER, Diop H, et al. Severe maternal morbidity and the use of assisted reproductive technology in Massachusetts. Obstet Gynecol 2016; 127:527–34.Google Scholar
Vandenbroucke JP, von Elm E, Altman D, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Epidemiology 2007;18:805–35.CrossRefPubMed. Google Scholar


What pregnancy complications result from donated eggs?

A study published in the American Journal of Obstetrics and Gynecology revealed complications associated with pregnancy with a maternal age of 44 and over. The study involved about 80,000 women in which about 175 women aged 45 and over  gave birth, many of these births resulted from the use of egg donors.

These older women had a higher incidence of maternal complications than younger counterparts. About 17% of the older women were diagnosed with gestational diabetes as compared to only 6% of younger women. Higher blood pressure was a problem for 9% of older women but only 3% of younger pregnant participants. The rate of C-section also doubled in the older population.

In addition to complications during pregnancy, older women presented with an increased rate of complications after birth including fever, excessive bleeding, extended stays in the hospital and more occurrences of intensive care. Infants born to older mothers even showed decreased health with metabolic problems reported in 4% of the newborns born to older mothers compared to 2% born to younger mothers.



Considering IVF? First consider the ovarian cancer link

While infertility is on the rise and estimates say that over 80% of couples have trouble getting pregnant, IVF has allowed infertile couples to produce their own biological offspring, yet it is not risk-free, and one of the larger threats is the potential for ovarian cancer.

In a study published in the journal Gynecologic Oncology, women who undergo IVF treatments may be at increased risk of borderline ovarian tumors. The study was completed by researchers from The University of Western Australia. Researchers investigated an entire population of women between 20 and 44 years of age seeking infertility care between 1982 and 2002.

Several factors were taken into account before revealing the final connection, including parity, socio-economic status, age and diagnosis of conditions that could affect fertility.  Based on the number of women diagnosed with borderline ovarian tumors, women undergoing IVF treatment were 2.46 times more likely to develop borderline ovarian tumors than women who did not undergo IVF treatment. Researchers claim the risk factors for borderline ovarian tumors are different than those associated with invasive ovarian cancer.

In another study, IVF treatment may be associated with ovarian tumor growth later in life. According to researchers, women who undergo IVF treatment are four times more likely to develop ovarian tumors and two times more likely to develop malignant tumors.

Researchers used medical records from slightly more than 19,000 women undergoing IVF treatment in the Netherlands. The medical records of women receiving IVF treatment were compared to medical records of 6,000 women who did not receive IVF but sought out fertility help. When the two groups were compared for risk factors and ovarian tumor growth, doctors reported the following results:

  • Women who received IVF treatment were at higher risk of developing ovarian tumors during the follow-up timeframe of just less than 15 years.
  • Ovarian cancer risk increased, but not significantly.
  • Ovarian tumor risk increased 4 times in the IVF group compared to the control group.
  • Ovarian cancer risk increased 2 times in the IVF group compared to the control group.

At the root of the increased risk is ovarian stimulation. During IVF treatment, ovaries are stimulated to mature and release more eggs. This stimulation may cause an increased risk of malignancies, but further research is needed to prove any significant dangers to women undergoing IVF.

Researchers note that doctors should inform patients of the increased risk, but they should not overplay the risks.  If a woman is informed of all potential risks (and every woman should be informed by her doctor), it is ultimately up to her to decide whether she wants to pursue it.