Author Name: Dr. Sasmita Naik || Mentor Name: Dr. Shyam N Gupta on April 27, 2020
In vitro fertilization (IVF) – in which the mother’s egg is fertilized outside of her body and then transferred to her womb – has been available to the childless couples for more than four decades.The first IVF baby was born in 1978, and in 2012 it was estimated that 5 million children had been born worldwide following IVF treatments. Every year more that 60000 lives born as a consequence of amazing technique of IVF according to the society for Assisted Reproductive Technology (SART)”
Despite the joy that IVF can bring, most of the people has common concern that whether birth defects are more prevalent in IVF babies. Some reports have surfaced over the years touching on the potential risks associated with the procedure. It’s important to find out whether it is the IVF procedure or the underlying infertility itself or any other hidden causes that increases the risk for birth defects.
Studies have shown that prospective parents with fertility issues face a higher risk for birth defects in their children regardless of whether or not they pursue IVF. In a study done by Paolo Paolo Emanuele Levi Setti et al, which was published in Journal of Assisted Reproduction and Genetics, where a total of 2414 assisted reproductive technology (ART) pregnancies were compared to 582 spontaneous pregnancies as a control group. Among 2306 successful deliveries, it was found during the comprehensive antenatal and neonatal follow up that there were no significantly different in congenital malformation after ART.
Moreover It is important to understand that couples who are experiencing infertility have a higher risk of having a child with an abnormality even if they conceive on their own. This’s because that even infertile couple with unexplained reason probably have some reason in respect of quality and functionality of eggs and sperms to some extent. Thus, this in future can result in increased risk of fetal abnormality even though they conceived naturally with due course of time. Moreover, a recent study done in Japan by Jwa et al also suggested that male sub-fertility even with low sperm count is associated with higher chance of chromosomal abnormality to passed on offspring.
A study published in the New England Journal of Medicine, tests the similar school of thought by evaluating 310,000 births happened in the following ways:
• Pregnancies in women who received ART
• Spontaneous pregnancies in women who had a child with ART
• Pregnancies in women with history of infertility but no ART
• Spontaneous Pregnancies with no complain of infertility
The researcher emphasized that “the increased risk of birth defect associated with IVF was no longer statistically significant” after eliminating parental factor.
However, the considerable risk of multiple pregnancies ( twin, triplet and more) from IVF technique while transferring more that one embryo, is also a important factor to consider in terms of birth defects.
Multiple pregnancy lead to various medical and pregnancy related complications. The risk of high order multiple pregnancies can be reduced by limiting number of embryos to be transferred. So a good quality single embryo transfer should be opted for embryo transfer. A blastocyst is the embryonic stage about five days after fertilization .According to studies blastocysts are considered better in quality as compared to day 2/3 cleavage stage embryos.A good quality one blastocyst chosen for transfer inside uterus depending on your age.
Drilling down further, it’s important for parents to know researches which suggests the risk of birth defects in multiple gestation pregnancies can be decreased by opting for frozen IVF embryos rather than fresh embryo transfer.
In recent advances genetic problems can be addressed using preimplantation genetic screening (PGS). This can be done in the IVF process to detect many chromosomal abnormalities. In this process one cell of the blastocyst is taken out and sent for genetic testing. In Case of known genetic and chromosomal defects, pre-implantation genetic diagnosis stands a boom for detection in embryo before transfer.
Thus, with PGS and PGD, we can identify the genetically abnormal IVF embryos that would mostly result in birth defects, or failed pregnancy, and decide not to implant those embryos in the woman uterus.
After a successful pregnancy in which genetic testing was not used, other types of early screening and diagnostic procedures are available and used to perform during early pregnancy, such as Scan, biochemical test, CVS, amniocentesis etc, that can detect the majority of IVF babies who do have ongoing birth defects.
Several researches and expert reports suggest that increased risk of birth defects after ART are associated with limitation of methodological and statistical difficulties. Mostly either of couple undergoing ART procedure are aged than the general fertile population and of course, many literature speak that risk of genetic and chromosomal malformations are strongly linked with female age.
Congenital abnormalities in IVF are rare occurrence and it requires large number of scientific studies to see if there is any association. In fact, 3-5% birth defects are noted in general fertile population and with current scenario, defect rate increases by 1% in IVF cycle. Recent studies suggest that if the sperm count, mortality and morphology is well and healthy, there is no increase in birth defects after ICSI manipulation in embryo laboratory.
It is also possible that embryo formed after ICSI (intracytoplasmic sperm injection) may be at a slightly higher risk for having a child with an congenital abnormality than couples undergoing routine IVF procedure. This is likely because of the increased events of male infertility which is always under diagnosed and associated with chromosome abnormalities.
The couple undergoing ART are often older and therefore at a plausible increased risk of developing abnormal gametes responsible for poorer outcomes. Likewise, older age of woman is also one of the important cause associated with poorer outcomes of IVF process.
“Women aged 40 or over are less likely to have babies with birth defects if they conceive by IVF,” the Daily Mail reports, while The Daily Telegraph says: “Older mothers have healthier babies if they conceive using IVF”.
Furthermore, Researchers wanted to see which maternal factors were precisely linked to the risk of birth defects, and how this risk compared between women who conceived naturally and IVF-ICSI. They found that there were three lifestyle factors linked to birth defects: maternal age, whether the mother was a smoker, and how many children she had before.
Among the smaller proportion of women who had IVF or ICSI, increasing age was not linked with birth defects with either of these individual fertility methods. However, while studying both the group of IVF and ICSI together the incidence of birth defects after 40 years found to be fairly reduced. These risks of pregnancy complications are supposed to decrease further by taking antioxidants, vitamin D and folic acid supplements and of course avoiding smoking, alcohol and illegal drugs.
Overall, as it stands, the effect of IVF on the health of children born using IVF technique is yet to be fully understood and many studies suggest that infertility in itself is a risk factor for congenital anomalies compared to rate of anomalies recorded in infertile patients conceiving naturally.
The Advancements in genetic and chromosomal testings to detect abnormalities early have now proved to be a biggest modalities for prevention birth defects. Couples considering IVF should discuss genetic testing options with their doctor to determine if this service is appropriate for them.
IVF is a boon to:
• women with blocked tubes
• Older women have a better chance with IVF
• Couples experiencing male infertility
• Patients with medical and surgical conditions like endometriosis, PCOS or premature ovarian failure
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