Adverse Perinatal Events Associated With ART
Since the advent of ART, much research has focused on the potential adverse for resultant harm. Prematurity, low birth-weight, PIH, congenital malformations, and CP are closely tied to multiple gestation. With the increase in elective single embryo transfer, there will be a reduction in adversity related to multiple birth. It is understood that underlying causes of infertility, including advanced maternal age, PCOS, thyroid disease, and uterine fibroids, predispose to adverse outcomes. However, imprinting abnormalities do not appear to stem from multiple births, and thus the need to consider the association between fertility treatment and methylation disorders remains essential. These, as well as risks of multi-fetal gestation, must be discussed with patients when considering using assisted reproduction.
With the birth of Louise Brown in 1978, a new field geared for infertile couples came into existence. Societal perceptions of in vitro fertilization (IVF) range from pariah to panacea with context and prejudices helping to determine one's view of the assisted reproductive technologies (ART). Do they violate religious law? Are they contributing to skyrocketing health-care costs? Are they at the root of a multiple birth epidemic? Or are they post–space age medical miracles that permit the elimination of genetic illness and provide barren couples with the opportunity to procreate? From a scientific perspective, there remains little doubt that ART has had an impact on health care. IVF remains fundamental in emerging technologies like gene therapy, stem cell propagation, and somatic nuclear transfer. The most direct impact of IVF on humanity is the 4 million children born in its wake.
With emerging technologies, the need to monitor outcomes becomes paramount. In the last several decades, there has been a growing body of perinatal outcome data on children born after ART. As the percentage of births resulting from ART increases (>1% of total U.S. births), the body of research regarding perinatal outcomes will continue to expand. It is essential that practitioners alert patients to an intervention's potential risks as well as its benefits.
This article delineates the adverse perinatal outcomes associated with ART. In addition, some attention is directed to specific maternal risks. One must keep in mind that an inherent confounder of IVF outcomes is the fact that infertility, being a disease, may confer independent risk, and quantification of such risk can be difficult to assess.
Abstract and Introduction
Abstract
Since the advent of ART, much research has focused on the potential adverse for resultant harm. Prematurity, low birth-weight, PIH, congenital malformations, and CP are closely tied to multiple gestation. With the increase in elective single embryo transfer, there will be a reduction in adversity related to multiple birth. It is understood that underlying causes of infertility, including advanced maternal age, PCOS, thyroid disease, and uterine fibroids, predispose to adverse outcomes. However, imprinting abnormalities do not appear to stem from multiple births, and thus the need to consider the association between fertility treatment and methylation disorders remains essential. These, as well as risks of multi-fetal gestation, must be discussed with patients when considering using assisted reproduction.
Introduction
With the birth of Louise Brown in 1978, a new field geared for infertile couples came into existence. Societal perceptions of in vitro fertilization (IVF) range from pariah to panacea with context and prejudices helping to determine one's view of the assisted reproductive technologies (ART). Do they violate religious law? Are they contributing to skyrocketing health-care costs? Are they at the root of a multiple birth epidemic? Or are they post–space age medical miracles that permit the elimination of genetic illness and provide barren couples with the opportunity to procreate? From a scientific perspective, there remains little doubt that ART has had an impact on health care. IVF remains fundamental in emerging technologies like gene therapy, stem cell propagation, and somatic nuclear transfer. The most direct impact of IVF on humanity is the 4 million children born in its wake.
With emerging technologies, the need to monitor outcomes becomes paramount. In the last several decades, there has been a growing body of perinatal outcome data on children born after ART. As the percentage of births resulting from ART increases (>1% of total U.S. births), the body of research regarding perinatal outcomes will continue to expand. It is essential that practitioners alert patients to an intervention's potential risks as well as its benefits.
This article delineates the adverse perinatal outcomes associated with ART. In addition, some attention is directed to specific maternal risks. One must keep in mind that an inherent confounder of IVF outcomes is the fact that infertility, being a disease, may confer independent risk, and quantification of such risk can be difficult to assess.
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