What are the risks of the assisted reproductive technologies (ART) and how can they be minimized?

Abstract

Although assisted reproductive technologies (ART) have become established procedures performed around the world, there are still many unanswered questions regarding safety. Possible risks associated with infertility and ART include (1) those inherent to pregnancy, delivery, and childhood; (2) those associated with the infertility itself and its causes; and (3) risks iatrogenic to ART. Although there are many potential risks associated with ART, it has become clear that the major risk is multiple pregnancy and its consequences. Major efforts are warranted to reduce the risk of multiple gestations with IVF, but it is also clear that single-embryo transfer is not the solution in all cases. Moreover, several studies have now documented that perinatal outcomes are somewhat poorer in IVF singleton infants than in spontaneously conceived singletons, but it is not clear if this increased risk is due to the ART or the infertility. Concerns about the impact of abnormalities in genomic imprinting persist at this time, as do risks associated with the culture conditions and even our environment. Only time will tell if children born following ART are at any increased risk of developing certain chronic diseases as they age. In any case, the risks to IVF children and mothers are likely to remain higher than those for children and mothers conceived spontaneously without medical assistance. However, since there have been over 5 million births after ART worldwide, and the vast majority of pregnancies and children have been essentially ''normal'', it is obvious that any excess risk must be relatively small. The normality of most pregnancies mandates that extreme care be exercised in making any changes to current practice.

Knowledge and attitudes about assisted reproductive technology: Findings from a Hungarian online survey

“…Previous studies (Adashi et al, 2000;Bretherick et al, 2010;Bunting et al, 2013;Daniluk et al, 2012;2013;Hammarberg et al, 2013;Harper et al, 2017;Maheshwari, 2008;Pedro et al, 2018;Peterson, 2012;Utting and Bewley 2011;Wyndham et al, 2012) have reported that there are misconceptions among women about their own fertility, the risks of a pregnancy at an advanced age and the effectiveness of ART. Many women in Hungary wrongly believe that ART will work until menopause (Szalma, 2021;Vicsek, 2018).…”

“…Consequently, its risks are rarely in the focus of public discussions of those who have not participated in ART. However, ART presents various risks to both women and their conceived children ( Hansen et al, 2005 , Rebar, 2013 , Wyndham et al, 2012 ).…”

Moral considerations on infertility and artificial reproductive technics

“…In the same vein, Robar (2013) observes that the moral aspects of the risks associated with reproductive technologies, such as pregnancy, delivery, childhood, infertility, and its causes, risks iatrogenic to ART, multiple pregnancies, singleton infants and abnormalities in genomic imprinting are still facing unanswered questions (Steinbock, 2011). Thus, balancing the positive (what we gain) and the negative aspects (what we sacrifice) of ART, Anderson and Walker (2019) suggest that, “We have to consider and scrutinize the extent to which the Christian moral imagination is formed more by the world’s drive to overcome infertility than by a uniquely Christian response to the absence of children.” The Modified permissive ethics attempts to offer a limited middle ground between Conservative and Permissive views.…”

Protocol of the Fit-For-Fertility study: a multicentre randomised controlled trial assessing a lifestyle programme targeting women with obesity and infertility

“…Unfortunately, these procedures are costly and carry risks for both women and infants. These risks can occur at different stages of ART: ovarian stimulation (ovarian hyperstimulation syndrome, thromboembolism and ovarian torsion), oocyte retrieval (infection and bleeding) and early pregnancy (ectopic or heterotopic pregnancy, and multiple gestations4). Although these risks are rare, they can have significant consequences.…”