Assisted Reproduction

Risks

Assisted reproduction carries with it some risks. It is important to recognise (as a matter of law, policy and practice) that such risks will be taken into account when

  • determining if regulation is necessary,
  • determining what is permitted or prohibited,
  • determining what laws should be passed regarding oversight, and how oversight should occur,
  • informing patients as to such risks, and the giving of consent, and/or
  • when other legal matters arise (for example alleged negligence or trespass, and/or professional practice and conduct issues).

Some examples of risks associated with ART that have been highlighted in various ways include, but are not limited to:

Infection

There is a small risk of introducing infection into the body via the use of a fine needle to remove eggs from a woman. Antibiotics and surgical hygiene prevent such infection in most cases (i.e. infection is quite rare).

Sperm donation may pass on infection or disease (for example HIV). Screening and washing of sperm in sperm banks or clinics currently reduces this risk (although there is no guarantee that the risk is completely removed).

Non-clinical (private) sperm donation has a higher risk of passing on infection or disease.

Multiple pregnancy

IVF carries with it an increased chance of having multiple pregnancy (eg. twins or triplets).

Such pregnancies pose health risks for the mother and children.

Twins or triplets are more likely to be born prematurely and to be underweight at birth.

Ovarian hyperstimulation syndrome (OHSS)

Drugs used to stimulate the ovaries during IVF can lead to OHSS. 1

OHSS results in the ovaries becoming enlarged and painful, causing abdominal discomfort. Most cases are mild, however, more severe cases can lead to serious illness which may result in hospitalisation.

Symptoms may including shortness of breath, fluid retention in the abdominal cavity, formation of blood clots. In the most severe cases, OHSS may result in death.

Risk of Birth Defects

Infants conceived following IVF and ICSI are more likely to be born preterm, be of low birth weight and to be a twin or higher order multiple than spontaneously conceived infants. 2A number of studies over the past decade have confirmed this.

For example, a systematic review of studies conducted on birth defects as a result of IVF suggests that infants born following ART treatment are at increased risk of birth defects, compared to spontaneously conceived infants. 3  A major U.S. study also found that infants conceived using IVF have a slightly higher rate of major birth defects (6.2% as opposed to 4.4% in naturally conceived children). 4 However, the cause was unknown, and it was concluded that further research was required to determine whether the cause is secondary to problems inherent in the infertile couple and/or factors associated with some aspect of the treatment.

In 2012, a study conducted by the Robinson institute of South Australia found the increase in birth defects associated with IVF was associated with the causes of infertility (such as obesity and age). However, the study also found that ‘the increased risk for a number of other treatments could not readily be explained by patient factors. ICSI, for instance, had a 57% increase in the odds of major defect, although the absolute size of the risk remained relatively small’. 5

Studies continue to investigate the impact of a variety of assisted reproductive treatments on children born as a result of such treatment. 6

Emotional Impacts

There may be emotional impacts upon recipients of ART, as well as impacts upon the children born as a result of donor conception, and donors of eggs, sperm and embryos. When surrogacy is used, long term emotional impacts upon women who relinquish the children, or impacts upon children (both those that live with their mother, and those that are relinquished), are  possible.

Other Ethical and Social Issues

There may also be other ethical and social issues that arise as a consequence of certain practices. These in turn may impact upon the health and well-being of people involved. For example, see sections on the ethical and legal issues raised by surrogacy; and on access to information by donor conceived people.

More information:

A brochure regarding some possible health effects of IVF has been published by the Victorian Assisted Reproductive Treatment Authority (with input from IVF clinics): Possible Health Effects of IVF.

Counselling is also often made available to all people involved in ART in which risks and concerns may be discussed.

People may also seek information via independent support groups and research. Note – links to support groups for those involved in donor conception may be found on this website on the donor conception page.

Find out more

Use the links here or on the right hand side of the page to find out more about

Assisted reproduction

Notes:

  1. Mayo Clinic, Ovarian Hyperstimulation syndrome, at http://www.mayoclinic.org/diseases-conditions/ovarian-hyperstimulation-syndrome-ohss/basics/definition/con-20033777
  2. Helmerhorst FM, Perquin DAM, Donker D and Keirse MJNC (2004) ‘Perinatal outcome of singletons and twins after assisted conception: a systematic review of controlled studies’. Br Med J. doi:10.1136/bmj.37957.560278.EE.; Jackson RA, Gibson KA, Wu YW and Croughan MS (2004) ‘Perinatal out-comes in singletons following in vitro fertilization: a meta-analysis.’ Obstet Gynecol 103,551 – 563.
  3. Hansen M, Bower C, Milne E, de Klerk N, Kurinczuk JJ (2005). ‘Assisted reproductive technologies and the risk of birth defects—a systematic review‘. Hum Reprod 20 (2): 328–38. doi:10.1093/humrep/deh593. PMID 15567881.
  4. Olson CK, Keppler-Noreuil KM, Romitti PA, Budelier WT, Ryan G, Sparks AE, Van Voorhis BJ (2005) ‘In vitro fertilization is associated with an increase in major birth defects.’ Fertil Steril 84(5) 1038-15. doi: http://dx.doi.org/10.1016/j.fertnstert.2005.03.086.
  5. Michael J. Davies, Vivienne M. Moore, Kristyn J. Willson, Phillipa Van Essen, Kevin Priest, Heather Scott, Eric A. Haan, and Annabelle Chan, ‘Reproductive Technologies and the Risk of Birth Defects‘ (2012)  N Engl J Med  366:1803-1813 DOI: 10.1056/NEJMoa1008095.
  6. See for example, Marino JL, Moore VM, Willson KJ, et al. Perinatal outcomes by mode of assisted conception and sub-fertility in an Australian data linkage cohort. PLoS One. 2014;9(1):e80398;Hansen M, Kurinczuk JJ, Milne E, et al. Assisted reproductive technology and birth defects: a systematic review and meta-analysis. Hum Reprod Update. 2013;19(4):330–353; Pinborg A, Wennerholm UB, Romundstad LB, et al. Why do singletons conceived after assisted reproduction technology have adverse perinatal outcome? Systematic review and meta-analysis. Hum Reprod Update. 2013;19(2):87–104.