What should I know about pregnancy through assisted reproductive technology?

What are the differences from a natural pregnancy?

Physiologically, there is no difference between pregnancies conceived through assisted reproductive technology (ART) and those from natural conception.

While there aren't substantial physiological differences, certain considerations are crucial. The emotional component is often heightened in women achieving pregnancy through IVF, as it often represents the culmination of a long journey marked by attempts and setbacks. This emotional aspect significantly impacts pregnancy and delivery management.

Furthermore, women undergoing ART are often older, increasing the risk of complications like hypertension or gestational diabetes. Therefore, monitoring should include not only standard gestational parameters but also the potentially heightened anxiety levels.

Regarding delivery, while cesarean sections were previously more common following ART, the decision now rests with the patient and medical team. Indications for cesarean section remain the same as for natural pregnancies.

Is there a higher risk of miscarriage or malformations than in a natural pregnancy?

Literature suggests a slightly increased risk of malformations in ART births compared to the general population. However, this seems more linked to the underlying infertility factor than the ART techniques themselves. Infertility can affect gamete (oocyte and spermatozoa) quality, influencing the risk of malformations. The slightly higher miscarriage and malformation rates are also often associated with the advanced maternal age common in IVF patients, not the technique itself. Remember, most IVF patients are over 35, an age where miscarriage risk naturally increases.

For both spontaneous and assisted pregnancies, regular medical and ultrasound checkups are essential. Invasive diagnostic tests (chorionic villus sampling and/or amniocentesis) and non-invasive tests (NIPT or fetal DNA testing) can detect genetic and chromosomal abnormalities. Your specialist will recommend the most suitable test based on your individual circumstances. Prior preimplantation genetic diagnosis doesn't negate the need for these confirmatory tests, given their approximately 98% accuracy (variable depending on the laboratory).

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Should I have an amniocentesis?

Many women opt for invasive prenatal diagnosis (chorionic villus sampling or amniocentesis) during ART pregnancies.

Chorionic villus sampling and amniocentesis are invasive techniques analyzing placental or amniotic fluid cells to check the fetal karyotype (chromosomes). The risk of chromosomal abnormalities is primarily linked to maternal age, with older women (particularly over 35) facing increased risk. The risk increases with age, especially for certain trisomies.

Screening tests calculate the risk based on maternal age, blood tests (hormones), and first-trimester ultrasound measurements (nuchal translucency). These tests estimate the risk of trisomy 21 (Down syndrome), trisomy 13 (Patau syndrome), and trisomy 18 (Edwards syndrome). Unlike invasive tests, they don't guarantee disease but provide a risk assessment.

In ART pregnancies, the chromosomal abnormality risk is linked to the donor's age. Even with a 40-year-old carrier, the risk might be low if the donor is young. The donor's age is crucial for accurate screening test interpretation.

The decision regarding invasive diagnosis requires careful consideration, as these techniques carry a 1% miscarriage risk. Classical prenatal screening (ultrasound and biochemical markers) has low predictive value, often leading to unnecessary amniocenteses and increased miscarriages.

Fetal DNA testing in maternal blood offers higher predictive value, reducing the need for amniocenteses and allowing for earlier testing. It's particularly important in ART pregnancies with prior embryo genetic studies.

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