A Summary of the “Risk of Severe Maternal Morbidity by Maternal Fertility Status: a US Study in 8 States”

by Kallie Fell, CBC Research Associate on March 6, 2019

human egg crate

An important study revealing the risks of IVF pregnancies has surfaced. When I first opened this article, I was surprised to read that it had originally been presented at the annual meeting of the American Society for Reproductive Medicine in 2017, but it doesn’t seem like fertility doctors even paused to consider its findings. More and more women are becoming pregnant through IVF using either their own or donor eggs, but I don’t think they fully understand the risks they create for themselves or their unborn babies.

Doctors and scientists looked at pregnancy and delivery outcomes of six types of pregnancies over eight states. The first group was ‘fertile’ women (women who became pregnant without IVF or any other fertility treatment). The second group of women were ‘subfertile,’ meaning that they did not undergo IVF, but did use another type of treatment to become pregnant. Each of the four remaining groups of women utilized IVF to become pregnant, but varied in which egg they used. The IVF groups were broken down into:

  • women that used their own fresh eggs for IVF
  • women that used their own thawed (previously frozen) eggs for IVF
  • women that used fresh donated (from another woman) eggs
  • women that used thawed (previously frozen) donor eggs for IVF donor

I understand that keeping track of these groups can be confusing, but it’s important if you want to understand the results, so I drew out a schematic (the boxes in green are the final six groups of women).

schematic of pregnancies studied

The study population was huge. It included 1,477,522 pregnancies and births! Here’s what they found:

  • ‘Subfertile’ and all four groups of IVF pregnancies had increased risk of blood transfusion at delivery.*
  • ‘Subfertile’ and all four groups of IVF pregnancies had increased risk of 3rd or 4th degree lacerations at delivery.*
  • There was an increased risk for unplanned hysterectomy (removal of the uterus) for three of the IVF groups (IVF pregnancies where mothers thawed their own eggs, and IVF pregnancies from both fresh and thawed donor eggs; or groups 4, 5, and 6).*
  • There was an increased risk for uterine rupture for moms that used their own, fresh egg for IVF (group 3).*
  • ‘Subfertile’ women had highest rates of gestational diabetes, but all four IVF groups had higher rates of gestational diabetes when compared to the ‘fertile’ group.
  • Pregnancies from IVF with donor eggs (either fresh or frozen – groups 5 and 6) had the highest rates of pregestational and gestational hypertension (high blood pressure).
  • Fertile women were the most likely to successfully deliver vaginally.
  • NICU (neonatal ICU) admissions were higher in all fertility treatment groups (‘subfertile’ and all IVF) when compared to ‘fertile’ pregnancies.
  • IVF using donor eggs (either fresh or thawed) had the highest rates of NICU admissions for the baby and intensive care (ICU) admissions for the mother.

*denotes statistically significant findings

This study did not research or delineate the reason behind the increased need for blood transfusions, hysterectomy, or the cause of any other morbidity (such as lacerations and high blood pressure). However, they did discuss (using data from other studies) possible reasons for these outcomes. For example, women who get pregnant using IVF are more likely to carry multiple babies. It is well known that carrying twins or triplets puts the mother at greater risk for adverse outcomes due to over-stretching of the uterus and altered placentation. Further, the risk in cesarean section is increased for older women, the primary targets of IVF and assisted reproductive technologies.

This study did not explicitly state which pregnancies were surrogate pregnancies, but we can assume that surrogate pregnancies would fall into groups 3 and 4 for traditional surrogacy, and groups 5 and 6 for gestational surrogacy. Therefore, this is yet another study that shows us the dangers of surrogacy on exploited women. Regardless, the conclusion is simple and obvious: the risk of severe maternal and fetal morbidities (disease and symptoms of disease) are increased for women that utilize IVF, especially those resulting from donor eggs. At the CBC, we often focus on the harms incurred by those that donate their eggs, but it seems that egg donation is risky for everyone. Does #BigFertility really care about women’s health, or do they only care about the big money?

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