Possible health effects of IVF
In the hands of experts, IVF procedures are safe and medical
complications are rare. However, as with all medical procedures,
there are some possible health effects to consider for women and
men undergoing treatment and for children born as a result of treatment.
The purpose of this document
VARTA provides independent information
and support for individuals, couples, and
health professionals on fertility, infertility,
assisted reproductive treatment (ART) and
the best interests of children born from ART.
This brochure provides an overview of the
known possible physical and emotional
health effects of IVF for women and men
and of outcomes for children born as a result
of treatment. Information in this brochure
refers to IVF and intracytoplasmic sperm
injection (ICSI) but does not include ovulation
induction alone.
The information represents the state of
knowledge about health effects of IVF at
the time of publication and is drawn from
studies published in scientic literature. It was
compiled with the assistance of experts in the
eld. It does not take into consideration your
personal circumstances and medical history
and should not be seen as a substitute for
advice from doctors and other health
professionals.
If you have other questions that are not
addressed here, please raise them with
your health care provider.
Why it is difficult to determine if there
are IVF-related health effects
The results of studies examining the health effects of IVF can be
difcult to interpret. For example, some health effects of IVF may
not be related to the procedure itself but to an underlying cause
of infertility or the fact that, on average, those who use IVF are
older than those who conceive spontaneously.
Another potential problem with studies of IVF-related health
effects is the unintentional bias in the way people are selected
and assessed. For example, if babies born through IVF are
examined more thoroughly and reporting to health registers
about them is more complete, then it might seem that health
problems are more common than in spontaneously-conceived
children.
Possible health effects of IVF
Page 1
Possible emotional effects of IVF
IVF treatment is psychologically demanding. For some couples,
the strain of IVF causes relationship problems while others describe
feeling closer and able to support each other through the demands
of treatment.
Women often experience symptoms of depression and anxiety
during IVF treatment, particularly when waiting for results after
embryo transfer and when treatment fails. When IVF fails, people
often feel very disappointed and sad. However, follow-up studies
show that within a few years of ending treatment, there are very
few differences in terms of emotional wellbeing and life satisfaction
between those who had a baby as a result of IVF and those who
did not.
Deciding whether to continue or stop treatment can be difcult for
people. Couples who have frozen embryos they are not intending
to use often nd it hard to decide what to do with these embryos.
In the rst few months after giving birth, women who conceive
with IVF have a higher rate of parenting difculties than women
who conceive spontaneously, including anxiety about caring for
the baby. However, these difculties lessen with time. The rate of
exclusive breastfeeding three months after the birth is lower after
IVF than spontaneous conception and this may be related to worry
about the ability to nourish the baby.
In Australia, counselling services are
available in all IVF clinics. Women who
have IVF treatment and their partners are
encouraged to use these if they experience
emotional difculties.
The rst Australian baby conceived
through in-vitro fertilisation (IVF) was
born in 1980. Since then, more than
ve million babies, conceived using
IVF and other assisted reproductive
technologies have been born worldwide.
In 2013, four per cent of all babies born
in Australia were conceived with the
help of assisted reproductive treatment
(ART), including IVF.
In some infertile men, sperm for intracytoplasmic sperm
injection (ICSI) cannot be obtained from the ejaculate. In such
cases, sperm may be retrieved surgically either by needle
biopsy of the testicles under local anaesthesia, or open biopsy
under general anaesthesia. These procedures are associated
with minor risks related to the operation itself and use of
anaesthetics. Local bleeding or infection occurs in less than
one per cent of open biopsies; needle biopsies carry an even
lower risk of complications. However, in rare cases, severe
bleeding may occur with the risk of losing the testis.
Some men with severely reduced sperm production have low
testosterone levels, or risk developing testosterone deciency
later in life. Biopsies of the testes can, on occasion, further
reduce testosterone production, resulting in the need for
lifelong testosterone replacement therapy.
Page 2
During treatment
Physical complications requiring hospital admission occur
in about one per cent of all stimulated treatment cycles.
The most common complication is ovarian hyperstimulation
syndrome (OHSS). This condition can develop as a result of
the fertility drugs which are used in IVF to stimulate the ovaries
to produce multiple eggs. OHSS is a potentially serious condition
which, in very rare cases, can lead to blood clots, kidney
failure and death. In 2013, 294 women (0.7 per cent of all
stimulated cycles) were hospitalised as a result of OHSS.
All IVF programs monitor patients carefully to minimise the
risk of OHSS. If a patient develops an excessive number of
follicles in response to the fertility drugs, the patient’s doctor
may recommend that the cycle be cancelled or a shorter-
acting ovulation drug be used before an egg collection in
order to avoid OHSS. As OHSS is worsened by pregnancy,
if the doctor has reason to believe that the woman is at risk
of OHSS after the egg collection procedure, the advice may
be to freeze all the embryos and then transfer them, one at a
time, when the ovaries return to normal.
Surgical complications which require hospital admission,
such as bleeding and infection from egg collection, occur
in less than 0.5 per cent of IVF cycles.
The risk of serious complications from general anaesthesia
and sedation is approximately one in 50,000 treatment cycles.
Long-term
There have been very few studies examining long-term health
effects of IVF for women, other than some studies relating to
cancer. Those undergoing treatment are often concerned that
the use of fertility drugs may increase a woman’s risk of cancer.
A number of large studies have investigated the relationship
between the use of fertility drugs and breast cancer. Combining
these studies, the risk of using fertility drugs has been investigated
in over 45,000 women and no overall increase in the rate of
breast cancer has been found.
Ovarian and uterine cancers are less common and therefore
more difcult to study. Although some reports have implied that
they may increase the risk of ovarian and uterine cancer, there
does not appear to be conclusive evidence that fertility drugs
increase the risk of these cancers.
Some studies have raised questions about whether there is
an increase in cancer risk associated with the duration of fertility
drug use, or use of specic types of fertility drugs among
certain groups of infertile women. To date, there is no conclusive
evidence that these factors increase the risk of any type of
cancer, however new studies are emerging all the time.
Although the ndings of existing studies are reassuring, it is
important to remember that IVF has only been available for
about 35 years and that it is only in the past two decades that
IVF has been used by large numbers of women. Therefore,
questions remain about the long-term risks of using fertility
drugs, particularly for rare forms of cancer. Also, little is known
about the effect of fertility drugs in women with a strong family
history of breast or ovarian cancer, or in women with a personal
history of cancer prior to fertility treatment.
Possible physical effects of IVF for women
Possible physical effects of intracytoplasmic
sperm injection (ICSI) for men
Possible health effects of IVF
The vast majority of babies born as
a result of IVF are healthy and have no
short or long-term problems. It is important
to know that birth outcomes are more
favourable for single babies than for twins
and triplets.
Single babies
Australian data show that compared with spontaneously-
conceived babies, IVF-conceived babies have a higher risk
of certain outcomes. In 2013, 10.5 per cent of single babies
born after IVF were pre-term (born before 37 weeks gestation)
compared with 6.9 per cent of spontaneously conceived
babies. Also, seven per cent of IVF-conceived single babies
were low birth weight (weighed less than 2.5kg) compared
with 4.7 per cent of spontaneously-conceived single babies.
The risk of a baby dying around the time of birth is marginally
higher after IVF than spontaneous conception.
Recent studies have found that the risk of bleeding during
pregnancy, premature birth, and low birth weight is lower
among babies born as a result of transfer of a frozen/thawed
embryo in an unstimulated cycle than among babies born as
a result of a fresh embryo transferred in a stimulated cycle.
A single IVF baby is more likely to be born by caesarean section
than a single baby conceived spontaneously. There are a number
of possible reasons for this but the important implication is that
a mother’s physical and emotional recovery following caesarean
birth may be slower than after a vaginal birth.
Twins and more
Multiple births are about three times more common after
IVF than they are after spontaneous conception. A multiple
pregnancy creates a greater risk for the mother and her
babies than a pregnancy with one baby. A major risk is
pre-term delivery. Other risks include bleeding during
pregnancy and high blood pressure, or pre-eclampsia
1
.
Babies born from a multiple pregnancy are more likely than
those from single pregnancies to have cerebral palsy or to
die close to the time of birth, mainly due to a higher risk of
pre-term birth. Risks for the baby are substantially greater
in a triplet or quadruplet pregnancy than in twin or single
pregnancies.
There are higher rates of psychological distress in mothers
of multiples because caring for more than one baby is more
difcult than caring for a single baby.
Single embryo transfer (SET) is the only way to reduce the
rate of multiple births associated with IVF and to give all
babies born after IVF the best possible start in life. When
several embryos are available after a stimulated cycle, one
can be transferred and the remainder frozen. If the rst
embryo does not result in a pregnancy, frozen embryos can
be thawed and then transferred, one at a time, in subsequent
cycles. This way, the cumulative chance of having a baby is
the same as if two or more embryos are transferred together
but the risk of a multiple birth is substantially eliminated. With
improved pregnancy rates associated with IVF, single embryo
transfer has become more common. The proportion of SET
in Australia and New Zealand increased from 40 per cent in
2004 to 79 per cent in 2013. As a result, the multiple birth
rate for IVF-conceived babies in Australia fell to 5.6 per cent
in 2013, one of the lowest in the world.
1
Pre-eclampsia is a serious disorder of pregnancy characterised by high maternal blood pressure, protein in the urine and severe uid retention. It is the most common serious medical complication of
pregnancy, affecting around 5 to 10 per cent of all pregnancies in Australia. One to two per cent of cases are severe enough to threaten the lives of both the mother and her unborn child.
Source: Better Health Channel Pre-eclampsia www.betterhealth.vic.gov.au at 20 November 2015.
Page 3
The risks of pregnancy loss and adverse birth outcomes after
IVF must be viewed in the context of how often problems
occur in spontaneously-conceived pregnancies in Australia.
As discussed below, some of these are more common after
IVF. For both IVF and spontaneously-conceived pregnancies,
older maternal age, obesity, and smoking increase the risk of
pregnancy complications and adverse birth outcomes. If you
are proceeding with treatment, you should discuss potential
pregnancy-related risks with your fertility specialist, who can
provide advice relevant to your particular circumstances.
Current Australian data for all pregnancies shows
that approximately:
• one pregnancy in six will miscarry
• one baby in 14 will be premature
• one baby in 25 will have a birth defect
• one baby in 100 will die around the time of birth
• one baby in 400 will have cerebral palsy and be disabled.
Although most pregnancies after IVF proceed without
complications, studies show that women who conceive with
IVF are more likely to:
• experience bleeding during the pregnancy
• develop blood clots in early pregnancy
• develop high blood pressure and diabetes in later pregnancy
• deliver prematurely.
Outcomes of IVF pregnancies
Birth outcomes for babies born as a result of IVF
Possible health effects of IVF
Health and development in children
and adults born after IVF
Studies of the growth, health and development of young
children born after IVF have found few differences between
them and other children. However, as multiple births have
historically been more common after IVF and children from
multiple pregnancies are more likely to be born pre-term and to
have a low birth weight than single children, there is an overall
increased risk of developmental problems and cerebral palsy.
Children who are born very prematurely have more learning
difculties and attention and behavioural problems than those
born at term. In adulthood some health problems such as high
blood pressure and reduced lung function are more common
among extreme pre-term survivors.
Childhood cancer is a rare condition. Most major studies of the
frequency of cancer in children born after IVF have shown that
the incidence is similar to that in the general population. Further
studies are needed to investigate the effects of particular forms
of fertility treatments on specic types of cancer.
The few studies that have followed IVF-conceived children
beyond puberty have not detected major differences between
them and other young people. An Australian study of more
than 700 IVF-conceived young adults aged between 18 and
28 years found that they were more likely to have a respiratory
problem and to have experienced a hospital admission than a
comparison group of young adults who were spontaneously-
conceived. However, the two groups showed no differences
in terms of other aspects of physical health and development,
emotional well-being, and quality of relationship with the
parents. Research is continuing in this area as an increasing
number of IVF-conceived people reach adulthood.
Page 4
The risk of birth defects after IVF
Studies investigating the risk of birth defects in babies born
following IVF suggest there is a small increased risk of birth
defects compared with spontaneously-conceived babies.
Between ve and six per cent of IVF-conceived babies have
a birth defect compared with approximately four per cent of
spontaneously-conceived babies.
Whether children born after ICSI have an added risk of birth
defects compared with those born as a result of IVF is still
not clear.
Many of the defects are minor. The severe birth defects that
appear to be more common occur in the early stages of
fetal development and can often be detected by ultrasound
monitoring of pregnancy. One extremely rare condition that
appears to be more common in children born after IVF is
a growth disorder called Beckwith-Wiedemann Syndrome
(BWS). In several studies, BWS has been shown to occur in
about one in 4,000 IVF babies compared with one in 14,000
to 35,000 spontaneously-conceived babies.
The increased risk of birth defects after IVF may relate to parental
characteristics such as age or cause of infertility rather than the
laboratory handling of sperm, eggs, and embryos. If difculty
conceiving is caused by a genetic or chromosomal disorder,
the baby may be affected by the same disorder.
For example, about three per cent of men with severe
defects of sperm production and low or zero sperm counts
are missing parts of the Y chromosome, where genes
responsible for sperm production are located. Men with so
called ‘Y chromosome microdeletion’ may become fathers
with the aid of ICSI but their sons will have the same genetic
problem and therefore in all likelihood will be infertile.
Also, in men with unexplained severe male infertility,
chromosomal imbalances are much more common than
in men with a normal sperm count. In these cases, a
chromosomal test (karyotype) is performed. If a problem
is found, genetic counselling is offered to inform the couple
about the chance of success with ART, potential risks to the
offspring, and the possibility of using embryo screening to
only transfer unaffected embryos.
It is also possible that the process itself or the fertility drugs
affect the uterine environment at the time of implantation and
impair fetal development.
Possible health effects of IVF
The Victorian Assisted Reproductive Treatment Authority
is an independent statutory authority funded by the Victorian
Department of Health and Human Services.
Phone: +61 3 8601 5250
Email: [email protected]g.au
www.varta.org.au
April 2016
If you have further questions
It is important that you collect information from independent sources and then discuss any questions
regarding treatment with your healthcare provider.
For more information about IVF and other assisted reproductive treatments, visit our website at
www.varta.org.au or call 03 8601 5250
Useful sources of information
Access Australia
Australia’s national infertility network
www.access.org.au
Your Fertility
for information on how to improve your chance
of conceiving and having a healthy baby
www.yourfertility.org.au
Andrology Australia
for information on male infertility
www.andrologyaustralia.org
Better Health Channel
for health and medical information
www.betterhealth.vic.gov.au
