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IVF: Long-Term Side Effects on Children

Dr. Sajitha Rajan
BAMS

In the United States, the rate of babies being conceived through In vitro fertilization (IVF) is on the rise as per latest studies and medical reports.

The assisted reproductive technique, in which eggs and sperm are combined in a laboratory and the resultant embryo is placed in a woman's uterus, saw 2,000 more babies born in 2013 than in the previous year.

Around 175,000 In vitro fertilization procedures resulted in the birth of more than 63,000 babies; in 2012 it was slightly fewer than 62,000 babies from 165,000 IVF attempts, as per the analysis of the Society for Assisted Reproductive Technology. The Society also adds that around 1.5 percent of children born each year in the United States are conceived by some form of fertility treatment.

IVF being a complex and expensive procedure that costs around $12,400 in the United States, it is requested by only around 5 percent of infertile couples. But it has still resulted in more than 200,000 babies since its introduction in the U.S. in 1981.

IVF dates back to 1978 when Louise Brown, considered a "test tube baby" was born in England as the first to be conceived outside a mother's womb.

Since the introduction of IVF in the Unites States, many women have chosen to have multiple embryos implanted to increase the chances of a successful full-term pregnancy. But of late, this has become less popular with more women requesting a single embryo to be implanted in an effort to avoid multiple births.

"We are extremely encouraged to see the number of embryos transferred per cycle continue to go down and that more and more patients are choosing single embryo transfer," says society president Dr. James Toner.

The increase in the number of women choosing single embryo implantation was greatest in women under 35, the society said, with 22.5 percent of that age group making that choice compared to around 15 percent in 2012.

"The goal of reducing the incidence of multiple pregnancies is extremely important, and patients can see from the data that fewer embryos transferred do not mean a lower chance of pregnancy," Toner says.

There has been an overall reduction in multiple births; twin births following IVF treatment dropped from 12,436 in 2012 to 12,085 in 2013, while the number of triplets fell from 411 to 376, the society's report shows.


Factors Affecting IVF Success Rate

  • The age of the woman - This gives a clear picture of her ovarian reserve.
  • The status of the uterus – whether it is absolutely normal, the quality of the semen must also be cultured.
  • The success or failure rate of the fertilisation and cleavage in the vitro procedure.
  • The total number, the maturity level and the quality of eggs that are retrieved play a vital role too.
  • The total number of embryos that have been transferred and cyro-preserved.
  • Whether the luteal phase post transfer is adequate or not.
  • The actual cause of infertility is also a major factor that determines the success rate of the IVF.

The success rate of the IVF increases with the increase of the IVF stimulation attempts. It usually ranges for a maximum of 3-4 stimulation cycles.

The success rate also depends on how well the physician or the clinic supports a couple wanting to undergo the IVF procedure. It has been found that when the patients are not preselected, there are maximum chances of the women attaining their dream to become mothers. Female patients who are low responders and those who have a failed IVF cycle in the past should not act as deterrents. But pregnancies are found to happen in many of these ‘negative’ cases as well.


Does IVF carry any risks?

There is no clear evidence that these babies are more at risk from abnormalities than those born through natural conception. Indeed, it seems that certain types of abnormality, such as chromosome problems, are less common with IVF. However, IVF babies tend to have more problems at birth, and stillbirths may be slightly more common. This may not be due to IVF, it is probably because women who conceive through IVF are more likely to be at high-risk in pregnancy.


Is There A Possible Link Between IVF And Neurological Disorders In Children?

Past studies have suggested that IVF is significantly associated with several negative outcomes: congenital birth defects, low birth weight, minor problems in brain development, and premature birth.

Researchers from the University of California, Los Angeles (UCLA) found that among 4,795 babies conceived through IVF in California, 3,463 IVF babies were born with birth defects.

They also compared IVF babies and other babies conceived through other ART techniques with those who were naturally conceived. About 9 percent of IVF children had birth defects compared with 6.6 percent of non-IVF children. This led them to conclude that babies conceived through IVF were 1.25 times more likely to be born with abnormalities.

The catch is, the risk for birth defects was only found to be higher in IVF children than in children born through artificial insemination or ovulation induction.

UCLA researchers said the birth defects are possibly the result of whatever was contributing to infertility in the first place, but the difference between IVF babies and other ART babies somehow show that the procedure done in IVF is the primary culprit, they said.

Meanwhile, in a 2013 study conducted in Swedish children, scientists from the King's College also conducted the same research. They found that 47 children in 100,000 IVF babies had developed cognitive deficiencies.

Lead author Sven Sandin said mental retardation may potentially be added to the list of effects of IVF.

However, researchers said that factors linked to poor fertility may be at play in their findings, and that the development issues in the study were not debilitating and were minor abnormalities.

"Suboptimal neurological condition does not imply overt problems in daily life. It does, however, indicate an increased vulnerability for developmental problems such as learning and behavioral problems," the authors wrote. "This means that our findings do not have significance on the level of the individual child, but that they do have significance for the population at large."

Still, no matter what the results are, experts say there is no way to easily reach a conclusion regarding the matter.

However, a new study in New York offers reassurance for couples who rely on assisted reproductive techniques.


Fear Not, There Is No Difference In Development Delays

A team of researchers from the National Institutes of Health, the New York State Health Department and other institutions found that delays in growth and development are not prevalent in children conceived through IVF.

Test-tube children are also not at a greater risk for developing learning disabilities, autism, or speech and language disorders compared with children conceived naturally, they said.

In a study featured in the journal JAMA Pediatrics, the team evaluated year 2008 to 2010 data from 4,824 mothers of 5,841 children in the state of New York, excluding New York City. Of the children, 1,830 were conceived through IVF treatment, and 2,074 were twins.

To see if there were any delays in growth and development, researchers collected data about the children at four, eight, 12, 18, 24, 30, and 36 months.

In the end, the team found that there were no differences between children who were born through IVF and children who weren't. About 13 percent of IVF children had delays, while 18 percent of non-IVF children had delays.


In addition:

Top 15 Risks And Side Effects Associated With IVF Treatment

  • Multiple births: IVF increases your chances of multiple births if more than one embryo is implanted in uterus. This can result in onset of early or preterm labor and low birth weight babies. Not more than three embryos are transferred in the uterus to avoid the probability of multiple pregnancies.
  • Reaction to fertility drugs: Many women experience hot flushes, nausea, breast tenderness, mood swings, insomnia and irritability. Other side effects such as bloating, vomiting or abdominal discomfort are also seen with IVF medications. Ask your doctor for help. Painkillers such as paracetamol can be taken to treat pain and swelling.
  • Pregnancy induced hypertension (PIH): Presence of high blood pressure (above 130/90 mm of Hg) is also seen in mothers with IVF.
  • Heavy bleeding: Heavy uterine bleeding is also seen in women after implantation of IVF embryo.
  • Anemia: This is a consequence of heavy bleeding in some women. Sometimes due to severe anemia blood transfusion becomes essential to save the life of the mother.
  • Need of C-section for childbirth: Generally C-section is done after the completion of term in order to avoid any risk associated with normal delivery
  • Low birth weight and preterm delivery: According to studies, the chances of low birth weight babies and preterm babies are more with IVF.
  • Ovarian hyperstimulation syndrome: In IVF, fertility enhancing drugs such as injectable human chorionic gonadotropins (HCG) are used for promoting ovulation. The HCG results in painful and swollen ovaries (the ovarian hyperstimulation syndrome). The symptoms of hyperstimulation syndrome are nausea, bloating, diarrhea and abdominal pain and discomfort. The worse form is accompanied with breath shortness and sudden weight gain.
  • Miscarriage: Abortions or miscarriages are common with IVF as the embryo is fertilized in laboratory conditions and do not follow the normal course, the uterus often refuses to implant the embryo. The rate and frequency of miscarriages is increased with increasing maternal age and use of frozen embryo.
  • Complications associated with egg-retrieval procedure: Eggs are retrieved from the ovaries with the aid of aspiration needle, this can result in infection, bleeding or damage of the urinary bladder, bowels or blood vessels.
  • Ectopic pregnancy: The implantation of fertilized egg outside uterus-in broad ligament, or in Fallopian tube or in ovaries is termed as ectopic pregnancy. The rate of ectopic with IVF is around 2 to 5 percent. These pregnancies usually do not thrive and result in spontaneous abortion. Ectopic pregnancy is a medical emergency.
  • Birth defects: According to some experts, babies conceived by IVF procedure are more vulnerable to congenital birth defects. However some believe that maternal age is the chief risk factor concerned with birth defects and not IVF.
  • Ovarian cancer: Some experts believe that there is some relation between drugs used for egg stimulation in IVF and formation of some specific tumor in the ovaries, but this point is not supported by the researches.
  • Nausea and diarrhea: Hormonal tablets placed in vagina during IVF procedure can cause nausea and diarrhea. The hormonal injections are quite painful and bruising is common. You can cold compress at the injection site to allay pain and swelling.
  • Stress: IVF is an expensive procedure and affects you emotionally as well as physically. Psychological support from friends, spouse and counselors can allay your tensions and apprehensions regarding the infertility treatment upheaval.

OHSS or ovarian hyperstimulation syndrome is an important side effect of IVF. There are some allergic reactions such as breathing problems, chest tightness, swelling of lips, tongue or mouth are also seen with IVF treatment. Your doctor might even adjust the dosages of hormones according to your condition. Certain side effects are quite alarming and should be immediately reported to the doctor. These include blurred eyesight, flashes or spots and are common with clomiphene citrate medication.

The side effects and risks associated with IVF are quite distressing and might make you overwhelmed. You can talk to your doctor or counselor or even friends to get the much needed emotional support.