Infertility Treatment Linked to Increased Pregnancy Complication Risk

Natalie Dayan, MD, MSc

A new study shows that infertility therapies and treatments such as in vitro fertilization (IVF) are associated with an increased risk of severe pregnancy complications.

Canadian-based investigators from the Research Institute of the McGill University Health Center (RU-MUHC) and St. Michael’s Hospital have shared new findings showing that women to have received an infertility treatment are at a two- to three-fold risk of severe pregnancy complications compared to those who are not.

Seeing as severe complications are already difficult to track and could result in patient death, the team emphasized the need for improved measures to understand complication factors and markers.

In an interview with MD Magazine®, lead author Natalie Dayan, MD, MSc, a clinician and scientist at RU-MUHC, explained that the use of infertility treatment is on the rise in at least Canada—the site for their observed patient population.

“The use of infertility treatment is rising in Canada as the technology advances and as some provincial government funding programs make these treatments more widely accessible,” Dayan said. “Part of this trend might be due to choices among Canadian couples to delay childbearing to later years.”

Investigators assessed data from 813,719 births recorded in Ontario hospitals from 2006-2012. Among the population, 11,546 (1.4%) were conceived through infertility treatment. They were matched with 47,554 women with similar characteristics and who conceived without assistance.

The team reported that 30.8 per 1000 women to have received an infertility treatment had experienced a severe complication—a 39% increase from the 22.2 untreated women per 1000 to report a severe complication. Their findings also associate greater risks of complications in infertility-treated women over 40 years old, pregnant with their first child, or in those pregnant with twins. Dayan highlighted this last risk factor in her talk with MD Mag, noting that fertility specialists already work around this risk by often implanting a single embryo in at-risk women to avoid an increased chance of complications.

That said, the study was not designed to evaluate mechanisms for such complications, Dayan said.

Investigators also observed that a greater annual income was associated with greater risk of severe pregnancy complication and infertility use. Average maternal age is on the rise in high-income countries, Dayan observed. Though this is more likely correlation than causation, it may influence the choice a women would make to seek out effective infertility treatment options while planning pregnancy—a field which is growing with the advancement of technology.

“As with any effective treatment, it is important to monitor for possible undesirable side effects or complications,” Dayan said. “While our study and others like it have shown slight increases in complication rates, the numbers are small and not cause for alarm.”

Rather, the rates call for more work focused on improving strategies, protocol, and guidelines for women seeking infertility treatment both before and during their pregnancy. A need to improve patient and physician awareness comes with that task.

Seeing as risk scores are already used to help predict a patient’s chance of success following infertility treatment—most notably with IVF—the team is invested in seeking a similar risk score system to establish chance of complication following the same treatments.

“This way, a woman and her doctor would be armed with information not only about how likely it is that she will become pregnant with treatment, but also how risky it is,” Dayan said. “We also would like to see more research about the aspects of IVF that might make it risky, since this is not yet well understood.”

The hope is that such future assessments leads to optimized, personalized infertility care for women.

The study, "Infertility treatment and risk of severe maternal morbidity: a propensity score—matched cohort study," was published online in CMAJ.