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Maternal and Fetal Risk Associated With Assisted Reproductive Technology

Kawwass, Jennifer F., MD; Badell, Martina L., MD

doi: 10.1097/AOG.0000000000002786
Clinical Expert Series: PDF Only

Infertility is a disease that affects up to 15.5% of reproductive-aged couples. Until the birth of the first neonate born from in vitro fertilization (IVF) in 1978, many infertile couples did not have an opportunity to conceive a biological child. Over the past 40 years, access to and effectiveness of IVF have increased; currently 1.7% of births in the United States result from IVF. As with any medical intervention, potential risk exists. In the case of IVF, both maternal risks (ovarian stimulation, oocyte retrieval, and subsequent pregnancy) and fetal risks that vary based on maternal age and fetal number must be considered. Importantly, risk quantification varies by comparison group, which is typically either spontaneous conception in a fertile couple or assisted non-IVF conception in an infertile couple. It must also be considered compared with the alternative of not undergoing IVF, which may mean not having a biological child. Although increased compared with spontaneous conception, absolute maternal–fetal-assisted reproductive technology risks are low and can be minimized by optimizing ovarian stimulation and transferring a single embryo. In this article, we aim to summarize maternal and fetal risk associated with use of assisted reproductive technology. The review focuses on ovarian stimulation and procedural risks as well as adverse perinatal outcomes among resultant singleton and twin pregnancies in young women and women of advanced maternal age.

Although risks are increased compared with spontaneous conception, absolute maternal–fetal-assisted reproductive technology risks are low and can be minimized by optimizing ovarian stimulation and transferring a single embryo.

Division of Reproductive Endocrinology and Infertility, Emory Reproductive Center, and the Division of Maternal-Fetal Medicine, Emory Perinatal Center, Emory Department of Gynecology and Obstetrics, Atlanta, Georgia.

Corresponding author: Jennifer F. Kawwass, MD, Emory Reproductive Center, Division of Reproductive Endocrinology and Infertility, Emory Department of Gynecology and Obstetrics, 550 Peachtree Street, Suite 1800, Atlanta, GA 30308; email: jennifer.kawwass@emory.edu.

Financial Disclosure The authors did not report any potential conflicts of interest.

Continuing medical education for this article is available at http://links.lww.com/AOG/B130.

Each author has indicated that she has met the journal's requirements for authorship.

Received January 29, 2018

Received in revised form March 13, 2018

Accepted April 19, 2018

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.