1

Complications of In-Vitro Fertilization

Bianca Chaser, Julia Hum, Sarah Leonard, Emily Testa

Youngstown State University

NURS 3749: Nursing Research

Randi Heasley

April 9, 2023
COMPLICATIONS OF IN-VITRO FERTILIZATION 2

Complications of In-Vitro Fertilization

Throughout the years, natural conception has become an issue for a multitude of women.

The impact has affected the hope of sustaining a pregnancy and creating a family. Thought to be

a common and instinctive phenomenon, pregnancy is a very intricate, delicate, and complex

process. Due to groundbreaking discoveries in scientific-based practice and technological

findings, the use of artificial insemination has been able to aid a plethora of couples to achieve

the goal of an expanded family. Techniques that involve the manipulation of an oocyte

externally, in retrospect to the body, are defined as assisted reproductive technology, with in-

vitro fertilization (IVF) being the most common form. With all surgical and non-surgical

procedures, there runs a risk of both fetal and maternal detriments that are often discouraging to

all parties involved. Physically, IVF can have several maternal effects on the body such as

bloating, cramping, and breast tenderness, as well as a myriad of fetal complications consisting

of birth defects. Psychologically, IVF can be challenging for couples. The emotional stress of

undergoing fertility treatments can be significant, and the uncertainty of success can be difficult

to manage.

As mentioned before, IVF is a medical procedure that involves manually fertilizing an

egg with sperm outside of the body and then implanting the fertilized embryo into the uterus.

The oocyte, or developing egg, is fertilized in a petri dish where it is intended to grow, develop,

and mature into pregnancy. Because this is such a monumental advancement in medical

discovery, IVF now accounts for 1.6% of all live births in the United States and 4.5% of live

births in Europe (citation). Treatment has offered couples who are severely struggling with

infertility an alternative method to receive the ultimate desired outcome, a baby. The preparation

for IVF is a convoluted course of action that requires several evaluations before the treatment
COMPLICATIONS OF IN-VITRO FERTILIZATION 3

cycle. There is an importance in recognizing that this choice of fertilization calls for rigorous and

tedious steps that may be exhausting, draining, and dispiriting. Adverse effects can dictate how

well the pregnancy may follow suit.

In comparison to IVF, natural conception appears to occur in a much smoother and easier

fashion than multi-step implantation. To fully understand both concepts of IVF and natural

conception, it is essential to be aware of what fertility denotes. Fertility, by definition, is the

capacity to produce a child. Mothers who can conceive naturally do not necessitate the fact that

there were no complications with conception, but it does mean that they were able to produce a

fetus with no simulated medical assistance. Natural insemination takes place between a male and

female through sexual intercourse where the sperm of the male internally fertilizes the egg

released by the female. Difficulties arise in this population when there is an intent to get

pregnant, but the time window is not working in the favor of the couple, meaning they are doing

everything correctly to get pregnant, but not getting the favored ramification. There are fertility-

aware methods that can be utilized such as the “fertile window,” which is best explained as the 6-

day interval ending on the day of ovulation where, in theory, the viability of both the sperm and

oocyte is maximal and the chance of getting pregnant is high. However, this does not ensure that

pregnancy will be the outcome which can be disheartening to the trying couple.

Now that there is a clear idea of the two processes, one can better grasp the objective of

what complications can arise with IVF. To name just a few, complications may include the risk

of infection, preterm labor, fetal abnormalities, and continuity of infertility. Microbial

contamination refers to the presence of microorganisms such as bacteria, fungi, viruses, and

protozoans in a sterile environment. Despite the best efforts of laboratories and clinics to keep

their premises and equipment free from microbes, contamination can still occur due to various
COMPLICATIONS OF IN-VITRO FERTILIZATION 4

reasons including human error, poor maintenance of equipment, environmental factors, and

cross-contamination. Laboratories and clinics rely on human resources to carry out various tasks,

including sterilization procedures. However, even a minor mistake can compromise the sterility

of equipment and surfaces, leading to microbial contamination.

Automated equipment such as autoclaves and incubators require regular maintenance

checks to ensure that they are functioning optimally. If not properly maintained, such equipment

can harbor microbes that may contaminate other surfaces or samples.Various environmental

factors such as humidity and temperature affect the growth and survival of microorganisms.

Failure to control these factors may lead to the proliferation of unwanted microbes in the

laboratory or clinic. Cross-contamination is the transfer of microorganisms from one sample or

surface to another. This can occur if proper precautions such as disinfecting equipment and using

separate workspaces are not observed.

As the number of women seeking IVF continues to rise, it is necessary to evaluate the

potential maternal complications that may increase with the procedure. There have been several

studies conducted investigating the risk of complications associated with IVF compared to

natural conception in women of childbearing age. Research shows that IVF is associated with an

increased risk of maternal complications that in turn increase maternal morbidity and mortality.

One complication that prompted research on how IVF increases the risk of these complications

compared to spontaneous conception was the increased presence of hypertensive disorders of

pregnancy.

A reliable article, Assisted reproductive technology and hypertensive disorders of

pregnancy: systematic review and meta-analysis, evaluated 85 studies in a meta-analysis

including 405,920 IVF pregnancies and 8,122,210 spontaneous conception pregnancies. The
COMPLICATIONS OF IN-VITRO FERTILIZATION 5

studies conducted compared the presence of hypertensive disorders of pregnancy and

preeclampsia between those two methods of conception. Preeclampsia is a complication of

pregnancy in which a woman has a new onset of high blood pressure in addition to either high

levels of protein in the urine or other organ dysfunctions. To analyze the data, they used an odds

ratio. An odds ratio (OR) is a measure of the association between an exposure and an outcome.

The OR represents the odds that an outcome will occur given a particular exposure, compared to

the odds of the outcome occurring in the absence of that exposure. According to the studies

conducted, the results reflected that IVF pregnancies had higher odds of hypertensive disorders

of pregnancy reflecting an odds ratio of 1.70, and preeclampsia reflecting an odds ratio of 1.59 in

comparison to the spontaneous conception group (Chih et al., 2021). Any odds ratio greater than

1 indicates an increased occurrence of the event in the study. Meaning, those who developed a

hypertensive disorder of pregnancy were 1.70 times more likely to have undergone IVF than

those who used spontaneous conception. Those who developed preeclampsia were 1.59 times

more likely to have undergone IVF than those who used spontaneous conception. Therefore, this

meta-analysis confirmed that IVF pregnancies are at higher odds of hypertension disorders of

pregnancy and preeclampsia than spontaneous pregnancies.

A comprehensive review, Complications in pregnancies achieved by assisted production,

addressed obstetric complications in pregnancies that resulted from IVF. In this study, they

analyzed results from thirty-seven articles that examined research over a decade. Their research

reflected a higher rate of complications occurring with IVF in comparison to spontaneous

pregnancies. According to the research, the IVF group had a higher incidence of postpartum

hemorrhage (6.7% vs. 3.6%) and placenta accreta (2.7% vs. 0%) in comparison to spontaneous

conception pregnancies (Madrazo-Cabo et al., 2020). Postpartum hemorrhage occurs when a

COMPLICATIONS OF IN-VITRO FERTILIZATION 6

woman experiences excessive bleeding after giving birth. Placenta accreta is a condition when

the placenta grows deeply in the wall of the uterus and after delivery, parts of it may remain

attached when they should all be expelled. This can cause excessive bleeding after birth as well.

The IVF pregnancy group also had a higher incidence of hypertension with an odds ratio of 1.27,

gestational diabetes with an odds ratio of 3.05, placenta previa with an odds ratio of 2.18, and a

high prevalence of cesarean sections (Madrazo-Caboet al., 2020). These results indicate IVF

increases the odds of women developing these complications in comparison to women who

conceive spontaneously. It is clear that IVF has enabled women to achieve pregnancy that once

seemed impossible as they faced infertility. It is also clear that conception through the process of

IVF can place them at a higher risk for some maternal complications. As this process evolves

and attracts more women battling infertility, research continues to evolve surrounding this topic

as well. If the benefit of this process outweighs the risks for infertile women, it is important to be

aware of this research and the increased risk of maternal complications that has been found for

proper precautions and management to be acknowledged throughout the IVF process.

On top of IVF imposing risks for the mother of the baby, numerous risks are associated

with the fetus, as well. While having to convert to conceiving artificially is a very hard decision

in itself for many parents, understanding the risk factors for the fetus is very important for

parents to be able to make these decisions. According to a reliable article emphasizing these risk

factors, “Emerging evidence has shown that in-vitro fertilization (IVF) is associated with higher

risks of certain placental abnormalities or complications, such as placental abruption,

preeclampsia, and preterm birth” (Fei Kong et al., 2022, p. 2).

The placenta plays a very important role in every pregnancy. The placenta is responsible

for ensuring that adequate nutrients, blood, gas, and immunity are given to the fetus during
COMPLICATIONS OF IN-VITRO FERTILIZATION 7

pregnancy to develop correctly, and without this, no fetus would develop. Placental abruption

occurs when the placenta detaches from the wall of the uterus, where it naturally resides for the

full term of pregnancy until delivery. This occurring prematurely puts the fetus at risk for many

further complications such as; hemorrhage, fetal death, and decelerations in the fetus’ heart rate

due to not enough oxygen being supplied to the baby while in the womb. Through studies, it was

found that the use of IVF greatly increases the risk of this placental abruption happening, thus

imposing a greater chance of other issues for the fetus occurring, such as preterm labor and birth,

putting the baby at risk for low birth weight.

Preterm birth is defined as any baby born alive too early, specifically before 37 weeks

gestation. Full-term is any baby being born between 39 weeks and 40 weeks. There are many

modifiable and nonmodifiable elements that can contribute to preterm birth, such as the mother's

BMI, low or high maternal age, race, being pregnant with multiples, substance abuse such as

tobacco and alcohol during pregnancy, and the use of assisted reproductive technology, such as

IVF. Babies that are delivered before 37 weeks are at an increased risk of a great number of

health problems, such as low birth weight of the fetus. Low birth weight can put the fetus at risk

for other health complications throughout its entire life. Many health factors can contribute to

preterm birth occurring, and the use of assisted reproductive technology, such as IVF is one of

them.

There is an increased risk for mothers becoming pregnant with multiples when using IVF

because there is usually more than one embryo being transferred during the procedure. What this

means is essentially multiple eggs are harvested from the mother and fertilized, because not

every egg will be successful when using this method of artificial reproductive technologies.

Using this method of harvesting and implanting multiple eggs puts mothers who use IVF at a
COMPLICATIONS OF IN-VITRO FERTILIZATION 8

higher chance to carry twins or triplets. Being pregnant with multiples often puts the babies at

risk of being born prematurely, while also increasing the risk of other placental abnormalities for

the fetus occurring. While this is not the only reason that IVF leads to these issues, it is a

contributing factor.

In 2018, a study conducted in China was used to measure and determine if the use of IVF

contributed to placental abnormalities and complications. 1663 women who used IVF to

conceive and 3326 with spontaneous pregnancies (natural conception) were used in the study.

There was a significantly higher incidence of gestational diabetes, hypertensive disorders, and

placenta previa in mothers who used IVF compared to those who did not (Yang et al., 2019, p.

1). Why IVF leads to health issues for the fetus is not a single, clear answer. Many medications

are used to induce ovulation, and all of these artificial medications can directly harm the gametes

and embryos during development. (Jin et al., 2013, p. 4). This is one reason that the use of IVF

can directly contribute to placental abnormalities.

The final part of the IVF process includes the implantation of one or two fertilized

embryos into the womb. From that point on the pregnancy continues as a natural pregnancy.

Although, IVF pregnancies and spontaneous pregnancies possess specific risks of their own.

Failure to implant the embryos into the uterus lining is the biggest downfall in IVF pregnancies,

the unsuccessful attempt may be due to the embryo or uterus complications.

One specific complication of IVF is ovarian hyperstimulation syndrome (OHSS).

Occurring in women who take injectable hormonal medication that stimulates the development

of eggs in the ovaries, is an overstress response to excess hormones. OHSS has been connected

to a higher abortion rate, in a research article overviewing researchers found, “Another group

studied pregnancy in 104 severe or critical OHSS cases after IVF and observed higher abortion
COMPLICATIONS OF IN-VITRO FERTILIZATION 9

rates in OHSS patients as compared with IVF patients without OHSS during the same 6-year

period” (Delvigne, 2003, p. 86). In spontaneous pregnancies, OHSS is extremely rare but can

occur in women with hypothyroidism. OHSS is associated with increased production of human

chorionic gonadotropin (hCG), which occurs in multiple pregnancies, PCOS, and

hypothyroidism. IVF’s high incidents of multiple pregnancies increase the chances of OHSS,

which leads to higher fetal complications.

In spontaneous pregnancies, high blood pressure, gestational diabetes, infections,

preeclampsia, preterm labor, depression, miscarriage, and stillbirth complications have the

highest instances of occurrence. Due to these complications, the risk of inducing labor and

cesarean section is an increase as well. IVF pregnancies also have higher relative risks of having

induction of labor and cesarean section, both emergency and elective. Cesarean deliveries are

associated with increased maternal and neonatal morbidity and mortality. Our study indicates

that IVF/ICSI pregnancies are associated with higher odds of cesarean section compared to

spontaneous conceptions” (Lodge-Tulloch, 2021, p.1 ). Many natural conception pregnancies

have less of a risk of encountering natural birth. Natural complications arise, but not to the same

degree as IVF births.

Spontaneous birth is referred to as the reproductive process when sperm enters the

vagina, therefore traveling through the cervix into the uterus and to one of the fallopian tubes.

Fertilization of a mature egg occurs. The resulting embryo then travels to the uterus and attaches

to the uterine wall for pregnancy. For many this process is not always simple, many women have

trouble conceiving naturally due to problems with ovulation, blocked fallopian tubes,

endometriosis, PCOS, premature menopause, fibroids, thyroid problems, and Turner syndrome.
COMPLICATIONS OF IN-VITRO FERTILIZATION 10

The inability of conceiving naturally is frustrating and can be an emotional process for the

family.

Spontaneous births impose risks that differentiate from IVF; many of these complications not

only involve the mother's health but also the fetus's health. These complications may result in a

high-risk pregnancy. In one study about high-risk pregnancies researchers found, “Maternal

mortality remains a major public health issue worldwide, particularly in low-resource countries,

which account for 85% of maternal deaths. About 40%–50% of maternal deaths are deemed

preventable.” (Rajbanshi, et al 2020, p. 12) Many practices and screenings can be used to combat

these maternal deaths in high-risk pregnancies associated with natural conception. Risk

assessment tools can be used if they can prevent adverse effects in both mothers and newborns.

The results of the study show a deeper detail into complications during pregnancy, “About 18%

of high-risk pregnant women developed SMM conditions. While about 5% of low-risk pregnant

women developed SMM conditions, seven had hypertensive disorders, four had hemorrhagic

disorders, and seven were managed for their complications” (Rajbanshi, et al, 2020, p. 23). These

complications impose a variety of issues affecting the whole body. Preventing these

complications comes with early detections and screenings, the best thing for the mother and baby

is to regularly attend doctor appointments.

There are many complications with both natural conception and IVF conception. The

risks with both may be preventable with early detection of the condition and following up with

the patient’s doctor. Some good practices to prevent and maintain these risks include; taking

folic acid supplements, eating well, staying active, and monitoring the infant movement.

Pregnancy involves risks regardless of the type, however the ability to detect and prevent
COMPLICATIONS OF IN-VITRO FERTILIZATION 11

maternal and fetal complications will ensure a safe pregnancy and delivery for the mother and

infant.
COMPLICATIONS OF IN-VITRO FERTILIZATION 12

References

American Society for Reproductive Medicine. (2019). Optimizing Natural Fertility: A committee

opinion . Optimizing natural fertility: a committee opinion. Retrieved March 27, 2023, from

https://www.asrm.org/globalassets/asrm/asrm-content/news-and-publications/practice-

guidelines/for-members/optimizing_natural_fertilitzation.pdf.

Cavoretto, P. (2020). Risk of spontaneous preterm birth in singleton pregnancies conceived after

IVF/ICSI treatment. Retrieved March 26, 2023, from

https://obgyn.onlinelibrary.wiley.com/doi/10.1002/uog.18930

Chih, H. J., Elias, F. T. S., Gaudet, L., & Velez, M. P. (2021). Assisted reproductive technology

and hypertensive disorders of pregnancy: systematic review and meta-analyses. BMC pregnancy

and childbirth, 21(1), 449. https://doi.org/10.1186/s12884-021-03938-8

COMPLICATIONS OF IN-VITRO FERTILIZATION 13

Delvigne, A., & Rozenberg, S. (2003). Review of clinical course and treatment of ovarian

hyperstimulation syndrome (OHSS). Human reproduction update, 9(1), 77–96.

https://doi.org/10.1093/humupd/dmg005

Ganer Herman, H., Farhadian, Y., Shevach Alon, A., Mizrachi, Y., Ariel, D., Raziel, A., Bar, J.,

& Kovo, M. (2021). Complications of the third stage of labor in in vitro fertilization pregnancies:

an additional expression of abnormal placentation. Fertility and sterility, 115(4), 1007–1013.

https://doi.org/10.1016/j.fertnstert.2020.10.004

Ganer Herman, H., Volodarsky-Perel, A., Ton Nu, T. N., Machado-Gedeon, A., Cui, Y., Shaul,

J., & Dahan, M. H. (2022). Pregnancy complications and placental histology in in vitro

fertilization pregnancies with initial low serum β-hCG levels. Fertility and sterility, 118(6),

1058–1065. https://doi.org/10.1016/j.fertnstert.2022.08.852

Kong, F., Fu, Y., Shi, H., Li, R., Zhao, Y., Wang, Y., & Qiao, J. (2022, June 6). Placental

abnormalities and placenta-related complications following in-vitro fertilization. Frontiers.

Retrieved March 26, 2023, from

https://www.frontiersin.org/articles/10.3389/fendo.2022.924070/full.

Lodge-Tulloch, N.A., Elias, F.T.S., Pudwell, J. et al. Caesarean section in pregnancies conceived

by assisted reproductive technology: a systematic review and meta-analysis. BMC Pregnancy

Childbirth 21, 244 (2021). https://doi.org/10.1186/s12884-021-03711-x

COMPLICATIONS OF IN-VITRO FERTILIZATION 14

Madrazo-Cabo, J. M., León-Durán, G. A., Oliveros-Montiel, A., Ledesma-Montes, J. A.,

Morales-González, I. D., & Sedeño-Monge, V. (2020). Complications in pregnancies achieved

by assisted reproduction. Complicaciones en embarazos logrados por reproducción asistida.

Gaceta medica de Mexico, 156(2), 156–163. https://doi.org/10.24875/GMM.M20000352

Niederberger, C., Pellicer, A., Cohen, J., Gardner, D. K., Palermo, G. D., O'Neill, C. L.,

Chow, S., Rosenwaks. (2018). Forty years of IVF. Fertility and sterility, 110(2), 185–

324. https://doi.org/10.101/j.fertnstert.2018.06.005

Shanks, A., & Choe, J. (2022). In Vitro Fertilization. NCBI Bookshelf. Retrieved March 27,

2023, from https://www.ncbi.nlm.nih.gov/books/NBK562266/

COMPLICATIONS OF IN-VITRO FERTILIZATION 15

OLD VERSION

In Vitro Fertilization

Throughout the years, natural conception has become an issue for a multitude of women.

The impact has affected the hope of sustaining a pregnancy and creating a family. Thought to be

a common and instinctive phenomenon, pregnancy is a very intricate, delicate, and complex

process. Due to groundbreaking discoveries in scientific-based practice and technological

findings, the use of artificial insemination has been able to aid a plethora of couples to achieve

the goal of an expanded family. Techniques that involve the manipulation of an oocyte

externally, in retrospect to the body, are defined as assisted reproductive technology, with in

vitro fertilization being the most common form. With all surgical and non-surgical procedures,

there are both fetal and maternal risks that are often discouraging to all parties involved.
COMPLICATIONS OF IN-VITRO FERTILIZATION 16

Physically, IVF can have several maternal effects on the body such as bloating, cramping, and

breast tenderness as well as a myriad of fetal complications consisting of birth defects.

Psychologically, IVF can be challenging for couples. The emotional stress of undergoing fertility

treatments can be significant, and the uncertainty of success can be difficult to manage.

As mentioned before, in vitro fertilization is a medical procedure that involves manually

fertilizing an egg with sperm outside of the body and then implanting the fertilized embryo into

the uterus. The oocyte, or developing egg, is fertilized in a petri dish where it is intended to

grow, develop, and mature into pregnancy. Because this is such a monumental advancement in

medical discovery, IVF now accounts for 1.6% of all live births in the United States and 4.5% of

live births in Europe (citation). Treatment has offered couples who are severely struggling with

infertility an alternative method to receive the ultimate desired outcome, a baby. The preparation

for IVF is a convoluted course of action that requires several evaluations prior to the treatment

cycle. There is an importance in recognizing that this choice of fertilization calls for rigorous and

tedious steps that may be exhausting, draining, and dispiriting. Adverse effects can dictate how

well the pregnancy may progress.

In comparison to IVF, natural conception appears to occur in a much smoother and easier

fashion than the multi-step implantation. To fully understand both concepts of IVF and natural

conception, it is essential to be aware of what fertility denotes. Fertility, in definition, is the

capacity to produce a child. Mothers who are able to conceive naturally do not necessitate the

fact that there were no complications with conception, but it does mean that they were able to

produce a fetus with no simulated medical assistance. Natural insemination takes place between

a male and female through sexual intercourse where the sperm of the male internally fertilizes

the egg released by the female. Difficulty arises in this population when there is an intent to get
COMPLICATIONS OF IN-VITRO FERTILIZATION 17

pregnant, but the time window is not working in the favor of the couple, meaning they are doing

everything correct to get pregnant but not getting the favored ramification. There are fertility-

aware methods that can be utilized, again non-medically, such as the “fertile window” which is

best explained as the 6-day interval ending on the day of ovulation where in theory the viability

of both the sperm and oocyte are maximal and chance of getting pregnant is high. However, this

does not ensure that pregnancy will be the final outcome which can be disheartening to the trying

couple.

Now that there is a meeting of minds concerning the two processes, one can better grasp

the idea of what complications can arise with in vitro fertilization. To name a just a few,

complications may include the risk of infection, preterm labor, fetal abnormalities, and

continuity of infertility. Microbial contamination refers to the presence of microorganisms such

as bacteria, fungi, viruses, and protozoans in a sterile environment. Despite the best efforts of

laboratories and clinics to keep their premises and equipment free from microbes, contamination

can still occur due to various reasons including: human error, poor maintenance of equipment,

environmental factors, and cross contamination. Laboratories and clinics rely on human

resources to carry out various tasks, including sterilization procedures. However, even a minor

mistake can compromise the sterility of equipment and surfaces, leading to microbial

contamination.

Automated equipment such as autoclaves and incubators require regular maintenance

checks to ensure that they are functioning optimally. If not properly maintained, such equipment

can harbor microbes that may contaminate other surfaces or samples.Various environmental

factors such as humidity and temperature affect the growth and survival of microorganisms.

Failure to control these factors may lead to the proliferation of unwanted microbes in the
COMPLICATIONS OF IN-VITRO FERTILIZATION 18

laboratory or clinic. Cross-contamination is the transfer of microorganisms from one sample or

surface to another. This can occur if proper precautions such as disinfecting equipment and using

separate workspaces are not observed.

As the number of women seeking in vitro fertilization continues to rise, it is necessary to

evaluate the potential maternal complications that may increase with the procedure. There have

been several studies conducted investigating the risk of complications associated with in vitro

fertilization compared to natural conception in women of childbearing age. Research shows that

IVF is associated with an increased risk of maternal complications that in turn increase maternal

morbidity and mortality. One complication that prompted research on how IVF increases the risk

of these complications compared to spontaneous conception was the increased presence of

hypertensive disorders of pregnancy. A reliable article evaluated 85 studies in a meta-analysis

including 405,920 IVF pregnancies and 8,122,210 spontaneous conception pregnancies. The

studies conducted compared the presence of hypertensive disorders of pregnancy and

preeclampsia between those two methods of conception. Preeclampsia is a complication of

pregnancy in which a woman has a new onset of high blood pressure in addition to either high

levels of protein in the urine or other organ dysfunctions. To analyze the data, they used an odds

ratio. An odds ratio (OR) is a measure of association between an exposure and an outcome. The

OR represents the odds that an outcome will occur given a particular exposure, compared to the

odds of the outcome occurring in the absence of that exposure. According to the studies

conducted, the results reflected that IVF pregnancies had higher odds of hypertensive disorders

of pregnancy reflecting an odds ratio of 1.70 and preeclampsia reflecting an odds ratio of 1.59 in

comparison to the spontaneous conception group (Chih, 2021, pg.4). Any odds ratio greater than

1 indicates an increased occurrence of the event in the study. Meaning, those who developed a
COMPLICATIONS OF IN-VITRO FERTILIZATION 19

hypertensive disorder of pregnancy were 1.70 times more likely to have undergone IVF than

those who used spontaneous conception. Those who developed preeclampsia were 1.59 times

more likely to have undergone IVF than those who used spontaneous 7conception. Therefore,

this meta-analysis confirmed that IVF pregnancies are at higher odds of hypertension disorders

of pregnancy and preeclampsia than spontaneous pregnancies.

A comprehensive review addressed obstetric complications in pregnancies that resulted

from IVF. In this study, they analyzed results from thirty seven articles that examined research

over a decade. Their research reflected a higher rate of complications occurring in relation to IVF

in comparison to spontaneous pregnancies. According to the research, the IVF group had a

higher incidence of postpartum hemorrhage (6.7% vs. 3.6%) and placenta accreta ( 2.7% vs. 0%)

in comparison to spontaneous conception pregnancies (Madrazo-Cabo, 2020, p. 158).

Postpartum hemorrhage occurs when a woman experiences excessive bleeding after giving birth.

Placenta accreta is a condition when the placenta grows deeply in the wall of the uterus and after

delivery, parts of it may remain attached when they should all be expelled. This can cause

excessive bleeding after birth as well. The IVF pregnancy group also had a higher incidence of

hypertension with an odds ratio of 1.27, gestational diabetes with an odds ratio of 3.05, placenta

previa with an odds ratio of 2.18, and a high prevalence of cesarean sections (Madrazo-Cabo,

2020, p. 159-160). These results indicate IVF increases the odds of women developing these

complications in comparison to women who conceive spontaneously. It is clear that IVF has

enabled women to achieve pregnancy that once seemed impossible as they faced infertility. It is

also clear that conception through the process of IVF can place them at a higher risk for some

maternal complications. As this process evolves and attracts more women battling infertility,

research continues to evolve surrounding this topic as well. If the benefit of this process
COMPLICATIONS OF IN-VITRO FERTILIZATION 20

outweighs the risks for infertile women, it is important to be aware of this research and the

increased risk of maternal complications that has been found in order for proper precautions and

management to be acknowledged throughout the IVF process.

On top of In Vitro Fertilization imposing risks for the mother of the baby, there are

numerous risks that are associated with the fetus, as well. While having to convert to conceiving

artificially is a very hard decision in itself for many parents, understanding the risk factors to the

fetus is very important in order for parents to be able to make these decisions. According to a

reliable article emphasizing these risk factors, “Emerging evidence has shown that in-vitro

fertilization (IVF) is associated with higher risks of certain placental abnormalities or

complications, such as placental abruption, preeclampsia, and preterm birth.” (Fei Kong et all,

2022, pg. 2).

The placenta plays a very important role in every pregnancy. The placenta is responsible

for ensuring that adequate nutrients, blood, gas, and immunity are given to the fetus during

pregnancy in order to develop correctly, and without this, no fetus would develop. Placental

abruption occurs when the placenta detaches from the wall of the uterus, where it naturally

resides for the full term of pregnancy until delivery. This occurring prematurely puts the fetus at

risk for many further complications such as; hemorrhage, fetal death, and decelerations in the

fetus’ heart rate due to not enough oxygen being supplied to the baby while in the womb.

Through studies, it was found that the use of IVF greatly increases the risk of this placental

abruption happening, thus imposing a greater chance of other issues for the fetus occuring, such

as preterm labor and birth, putting the baby at risk for a low birth weight.

Preterm birth is defined as any baby born alive too early, specifically before 37 weeks

gestation. Full term is any baby being born between 39 weeks and 40 weeks. There are many
COMPLICATIONS OF IN-VITRO FERTILIZATION 21

modifiable and nonmodifiable elements that can contribute to preterm birth, such as mothers

BMI, low or high maternal age, race, being pregnant with multiples, substance abuse such as

tobacco and alcohol during pregnancy, and the use of assisted reproductive technology, such as

in vitro fertilization. Babies that are delivered before 37 weeks are at an increased risk of a great

amount of health problems, and one of them is low birth weight of the fetus. Low birth weight

can put the fetus at risk for other health complications throughout its entire life. There are many

health factors that can contribute to preterm birth occurring, and the use of assisted reproductive

technology, such as in vitro fertilization is one of them.

There is an increased risk for mothers becoming pregnant with multiples when using in

vitro fertilization because there is usually more than one embryo being transferred during the

procedure. What this means is essentially multiple eggs are harvested from the mother and

fertilized, because of the fact that not every egg will be successful when using this method of

artificial reproductive technologies. Using this method of harvesting and implanting multiple

eggs puts mothers who use IVF at a higher chance to carry twins or triplets. Being pregnant with

multiples often puts the babies at risk of being born prematurely, while also increasing the risk of

other placental abnormalities for the fetus occuring. While this is not the only reason that IVF

leads to these issues, it is a contributing factor.

In 2018 a study conducted in China was used to measure and determine if the use of IVF

contributed to placental abnormalities and complications. 1663 women who used IVF to

conceive, and 3326 with spontaneous pregnancies (natural conception) were used in the study.

There was a significantly higher incidence of gestational diabetes, hypertensive disorders, and

placenta previa in mothers who used IVF compared to those who did not. (Yang et all, 2019,

page 1) Why IVF leads to health issues of the fetus is not a single, clear answer. Many
COMPLICATIONS OF IN-VITRO FERTILIZATION 22

medications are used to induce ovulation, and all of these artificial medications can directly harm

the gametes and embryos during development. (Jin et all, 2013, page 4). This is one reason that

the use of IVF can directly contribute to placental abnormalities.

In vitro fertilization is the process of suppressing the natural menstrual cycle with

medicine to encourage the ovaries to produce more multiple embryos. Through the process the

eggs are mixed with the sperm for a few days to allow them to be fertilized transferring the

embryo. The final part of the IVF process includes the implantation of one or two fertilized

embryos into the womb. From that point on the pregnancy continues as a natural pregnancy.

Although, IVF pregnancies carry different risks compared to natural conception pregnancy.

In vitro fertilization conception increases the chances of having multiple fetuses in one

pregnancy. Due to the process of in vitro fertilization, doctors transfer more than one embryo to

increase the chances of conception. Carrying twins or triplets is considered a higher risk with

both natural or ivf contraception since it increases the chances of premature labor and low birth

weight. According to “It has been estimated that births resulting from infertility treatments

account for about 1% to 3% of all single live births, 30% to 50% of twin births, and for more

than 75% of higher order multiple births.” (Medical Advisory Secretariat, 2006, Page 18) Caring

multiples imposes many risks on the mother and baby. These risks include gestational

hypertension, anemia, and miscarriages. IVF pregnancies also have higher relative risks of

having induction of labor and Cesarean section, both emergency and elective. A research study

conducted by (Kathpalia, S. K., 2016, page 211) states “Many studies of children born after IVF

have found a prevalence of congenital malformations similar to that in normal population (2–

3%) but one Australian study observed a 2-fold increased risk of major birth defects among

children conceived via conventional IVF or ICSI, compared to that in a matched population of
COMPLICATIONS OF IN-VITRO FERTILIZATION 23

children who were naturally conceived.” These complications are solely due to in vitro

fertilization that many natural conception pregnancies have less of a risk encountering in natural

birth. Natural complications arise but not at the same degree as in vitro births.

Natural conception is referred to as the reproductive process when sperm enters

the vagina, therefore traveling through the cervix into the uterus and to one of the fallopian tubes.

Fertilization of a mature egg occurs. The resulting embryo then travels to the uterus and attaches

to the uterine wall for pregnancy. For many this process is not always simple, many women have

trouble conceiving naturally due to problems with ovulation, blocked fallopian tubes,

endometriosis, polycystic ovarian syndrome, premature menopause, fibroids, thyroid problems

and Turner syndrome. The inability of conceiving naturally is frustrating and can be an

emotional process for the family.

Natural conception has many risks as well as in vitro fertilization; many of these

complications can not only involve the mother's health but also the fetus's health, or both.

Women who were healthy before getting pregnant may experience complications. These

complications may result in a high-risk pregnancy. In one study about high risk pregnancies they

found “Maternal mortality remains a major public health issue worldwide, particularly in low

resource countries, which account for 85% of maternal deaths. About 40%–50% of maternal

deaths are deemed preventable.” (Rajbanshi, S., Norhayati, M. N., & Nik Hazlina, N. H., 2020,

page 12) Many practices and screenings can be used to combat these maternal deaths in high risk

pregnancies associated with natural conception. Risk assessment tools can be used if it can

prevent adverse effects in both mother and newborns. The results of the study show a deeper

detail into complications during pregnancy, “About 18% of high-risk pregnant

women developed SMM conditions. While about 5% of low-risk

COMPLICATIONS OF IN-VITRO FERTILIZATION 24

pregnant women developed SMM conditions in which seven (4.5%) had

hypertensive disorders, four (3.3%) had haemorrhagic disorders, and

seven (4.5%) were managed for their complications. In the present

study, the majority of the `women color-coded red visited the

hospital with the complaint of premature contractions of the uterus

(4.0%), Prelabor rupture of membrane (2.6%), prolonged fever ≥five

days (1.1%), and severe hypertension (1.1%).” (Rajbanshi, S., Norhayati, M. N., &

Nik Hazlina, N. H., 2020, page 23) The complications due to natural conception pose a wide

variety of different systems of the body. Preventing these complications comes with early

detections and screenings, the best thing for the mother and baby is to regularly attend doctor

appointments.

There are many complications with both natural conception and in vitro fertilization

conception. The risks with both may be preventable with early detection of the condition and

following up with their doctor. Some good practices to combat these risks include; taking folic

acid supplements, eating well, staying active, and monitoring babies movement. With any type

of pregnancy it involves risks but being able to detect and prevent will ensure a safe pregnancy

and delivery for mom and baby.

COMPLICATIONS OF IN-VITRO FERTILIZATION 25

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