Assisted Reproductive Techniques and Pregnancy

The American Society for Reproductive Medicine estimates that about 6.1 million American women and their partners are infertile—that's 10 percent of the reproductive age population! If you or your partner are a member of this group and are now reading this because you are pregnant, congratulations! No doubt you have been through the ringer of assisted reproductive technologies (ART) that only those who have been there can truly understand.

Perhaps you've used fertility drugs, artificial insemination, or in vitro fertilization. Perhaps you've used frozen embryos, donor sperm or eggs, testicular sperm aspiration, transuterine fallopian transfer, tubal embryo transfer, gamete intrafallopian transfer, zygote intrafallopian transfer, or any of the other possible infertility treatments. By whatever method, here you are pregnant and most likely wavering between euphoria and terror. Because you have been riding the emotional roller coaster of high hopes and disappointments for so long, it's understandable that you want to guard the health of your fetus to assure a full-term pregnancy without complications. Well, here are the facts on your risk of miscarriage:

• If your pregnancy is the result of the use of fertility drugs (such as clomiphene citrate or human menopausal gonadotropin) with no other assisted reproductive procedure, your risk of miscarriage is not any higher than the general population—one in five. You are, however, more likely to have a multiple pregnancy (unless you used the fertility drugs bromocriptine or gonadotropin-releasing hormone [GnRH], in which case the risk of multiples is no higher than normal). Thirtyfive percent of all ART deliveries in 2000 were multiple births, compared with less than 3 percent for the general population.
• If you've had any kind of tubal repair surgery, your risk of an ectopic pregnancy is greater than that of the general population because your tubes might have scarred as a result of the repair procedure.
• If you're pregnant as a result of artificial insemination, your pregnancy is no more risky than a routine pregnancy (except for the multiple pregnancy issue if you used fertility drugs).
• If your pregnancy is the result of in vitro fertilization (IVF), gamete intrafallopian transfer (GIFT), intrauterine insemination (IUI), or any similar procedure (including microinjection), you do have a higher risk of miscarrying. Anything transferred directly into your fallopian tubes raises the risk of an ectopic pregnancy. But if your ART procedure transferred gametes or embryos directly into your uterus, there is only a slight risk of an ectopic pregnancy.

After the fertilized egg (or eggs!) implants itself securely in the lining of your uterus your chances of a full-term pregnancy are just as good as any other expectant mom. But because of all you've been through to become pregnant and because of the risk of multiples, you should consider calling in a perinatologist to monitor your pregnancy. As noted previously, this is a medical doctor who specializes in the complications of high-risk pregnancy, labor, and delivery.

When you finally deliver your baby, you'll be glad to hear that he or she will not face any more health problems than babies conceived by natural means. That's the good news out of the 2003 Annual Meeting of the European Society of Human Reproduction and Embryology. A study presented at that meeting reported no major differences in birth weight, growth, total IQ, motor development, behavior problems, or prenatal stress were found between the children conceived with infertility treatments and those conceived naturally. So relax!