Perinatal risks after IVF and ICSI

Abstract

Pregnancies that occur after infertility treatment, particularly after assisted reproduction, constitute high-risk pregnancies. Occurrences of conditions such as high blood pressure, preeclampsia, growth retardations and bleeding are higher in comparison with the norm of spontaneously entered pregnancies. The rate of premature births and the frequency of intrauterine deaths are much higher than the average for all pregnancies. Furthermore, pregnancies resulting from in -vitro fertilisation (IVF) have signifi cantly higher rates of requiring induced labour or caesarean section. However, it is to be assumed that these complications and unfortunate developments are not caused by extracorporeal fertilisation itself, but rather are due to the frequency of multiples and to the risk factors of the women involved. These women are, on average, older and there are often more problems with cycle irregularities, uterine anomalies and obesity than in the total collective of all pregnancies. The methods of modern reproductive medicine often bring a higher rate of multiple pregnancies. The clinical problem of multiple pregnancies is, above all, the raised rate of premature births and intrauterine growth retardations that contribute to the signifi cantly higher rate of morbidity and mortality for these children. The slightly higher rate of congenital defects after IVF and intracytoplasmic sperm injection (ICSI) are also attributed more to the risk profi le of the parents and less to the techniques themselves. The most important and easy-to-avoid complication is the multiple pregnancy, and it should be our goal to lower this rate even further.

The influence of infertility and in vitro fertilization treatment on postpartum and long-term mental health in women

“…While the present thesis found that the risk of preeclampsia was increased in the women who had undergone IVF treatment, the regression analyses did not show an association between preeclampsia and PPP nor between IVF pregnancies and PPP. In addition, the results of Study II confirmed the results of previous studies in showing that the risk of most pregnancy and delivery complications, including PTB (8)(9)(10)(11)13) and delivery by caesarean section (8,10,11), which some studied have identified as risk factors for PPP (97,119), was higher in the women who had given birth after IVF treatment compared to those who had conceived spontaneously. However, no associations were found between these complications and PPP in the logistic regression analyses.…”

“…The risk of preeclampsia is increased in IVF pregnancies (8,11,13). While the present thesis found that the risk of preeclampsia was increased in the women who had undergone IVF treatment, the regression analyses did not show an association between preeclampsia and PPP nor between IVF pregnancies and PPP.…”

“…Gonadal hormones have also been implicated in the pathogenesis of PPP (130) However, due to infertility and its treatment, these women have higher prevalence rates of some risk factors for postpartum psychiatric disorders such as a high maternal age (71,143,145,146), obstetric complications (8,11,13) such as delivery by caesarean section (8,10,11,145) and PTB (8,10,11,13) than women who conceive spontaneously. Pregnancy-specific anxiety might be increased (71,75) and expectations of what having a child will bring might also be higher, resulting in increased risks of psychological distress postpartum (71,72,80).…”

“…Compared to women having unstimulated infertility treatment and women undergoing laparoscopic surgery, levels of stress and cortisol were higher in the women who were undergoing IVF treatment (147). In addition, since preeclampsia (8,11,13) is associated with IVF pregnancies as well as PPP, it could be hypothesized that IVF pregnancies and PPP are linked.…”

“…Also, IVF treatment increases the risk of pregnancy and delivery complications such as preeclampsia, bleedings during pregnancy and delivery by caesarean section (8,10,11,13).…”