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February 25th, 2010
04:27 PM ET

IVF increases risk of stillbirth – or does it?

By Miriam Falco
CNN Medical News Managing Editor

(CNN) - A Danish study suggests that women who have undergone in vitro fertilization or Intracytoplasmic sperm injection to get pregnant, are four times more likely to have their child stillborn, compared with women who conceive naturally or use other types of assisted reproductive technology.

In a study published in the journal "Human Reproduction," researchers looked at more than 20,000 pregnancies and found 742 babies were conceived using IVF, where a woman's egg is fertilized in a petri dish and then placed in a woman's uterus,  or ICSI, where a single sperm is injected into an egg and after a few days the fertilized egg is placed in the woman's uterus (Editor's note: thanks to readers like Kate and Jamie, this sentence has been corrected).  Among the 742 IVF or ICSI pregnancies there were 12 stillbirths.

Researchers emphasize that the overall risk for a stillbirth is still very low. What causes some pregnancies to end prematurely is still unknown and the researcher believes it is linked to treatments. Dr. Kirsten Wisborg, a neonatal consultant at the Aarhus University Hospital in Denmark, the lead author of this new study, said in a press release, "Hopefully the results from our study emphasize the need for continuous follow-up of the outcome of fertility treatments."

However, a Swedish study, published earlier this month, looked at more than 27,000 pregnancies and did not find an increased risk for stillbirths. Dr. Karl Nygren, one of the authors of the Swedish study says in a statement, "We found no increase in stillbirths from IVF/ICSI treatment in this larger group, and this contrasts with the Danish study that found a fourfold increase in the risk of stillbirths between the IVF/ICSI pregnancies and spontaneous pregnancies."

All this information can be very confusing and scary for couples trying to become parents and who are turning to the most invasive reproductive techniques to help them start a family. Dr. James Goldfarb is the director of Infertility Services at the Cleveland Clinic in Ohio. He's also the president of the Society for Assisted Reproductive Technology . Goldfarb tells CNN that regardless of IVF or natural conception, having a stillbirth is always devastating when it happens, and doctors want to know what causes them. He says infection, chromosomal problems, and the placenta separating from the uterus are some known causes, but "most of the time we don't know what caused the stillbirth."

Goldfarb also points out that "it should not surprise anyone to learn that patients getting infertility treatments have a more difficult time conceiving, carrying and delivering health children. That difficulty is what defines the disease of infertility and led those patients to seek treatment in the first place."

So do IVF and ICSI really increase the risk for stillbirth as the Danish study suggests? Goldfarb isn't convinced. "While this is an intriguing paper, it's important that the findings be kept in context. Other studies, even very recent ones from very similar countries, have not found this large an increase in miscarriage rates for IVF pregnancies.”

Goldfarb says in the IVF world, the biggest concern isn't stillbirth – it’s the birth of multiples. Although Nadya Suleman, also known as the Octomom, represents the most extreme case of having multiple babies at once , more twins and triplets have been born since the first IVF baby was conceived 32 years ago. That’s because doctors have been implanting multiple embryos in the hope that it will lead to a pregnancy. When a woman carries multiple fetuses, the risk of complications goes up, including premature birth, which can lead to the babies’ having underdeveloped lungs, brain, and other organs. They may also have difficulties fighting off infections. Limiting the number of embryos being implanted per IVF cycle greatly reduces that risk, Goldfarb said.

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.


soundoff (16 Responses)
  1. ALQNAsMommy

    We conceived our first baby using IVF & ICSI using my husband's frozen sperm after he was declared infertile due to chemo treatments (implanted two embryos). Our son was stillborn without known cause at 40 weeks, 3 days. The death of a child at any age is the most devastating occurance a parent can face. Until stillbirth is recognized as such a loss many parents will continue to suffer in silence. If you lose a parent you are called an orphan. If you lose a spouse you are a widow/widower. If, however, you have the great misfortune to lose a child ... you are often shunned and left to grieve alone. That grief is too painful to label. Whether or not IVF/ICSI is somehow related to stillbirth or not (my opinion it is not) I am very grateful to Dr. Gupta and CNN for their bravery to even post such a story.

    Know your body, know your baby, and count kicks. A slow-down of baby's movements isn't the only thing to worry about. Hyperactivity can be a warning sign as well. Stillbirth is not something that only occured in the "dark ages" or the Grapes of Wrath era. More babies die from stillbirth each year than from SIDS yet the tragedy of these babies dying before birth has been left largely unstudied. If doctors are too afraid to spread the word and talk to their pregnant patients about the risks of stillbirth then who will? It is up to us ... moms, dads, siblings, grandparents, aunts, uncles, cousins and friends. If we as a society are too afraid to address the issue of stillbirth then many more babies will continue to die and many more parents will be sent home with empty arms and broken dreams. For parents of a stillborn baby there is nothing more deafening than absolute silence in the delivery room.

    Fly, sweet baby, fly ... in loving memory of Baby AJM – born still on 1/3/02. Forever in our hearts ... xoxo

    February 25, 2010 at 23:05 | Report abuse | Reply
  2. Kate

    Just a correction: ICSI is the process of injecting sperm into *eggs*, NOT the uterus.

    February 26, 2010 at 07:08 | Report abuse | Reply
  3. Nick

    I’m glad Dr. Goldfarb mentioned that infertility is a disease. That often gets forgotten. There is something biologically wrong in couples who cannot have children naturally. The reason there are so many twins born is that most insurance does not cover IVF and the cost is prohibitively expensive. If I’m going to pay $15,000 out of pocket for an IVF cycle, I want the best possible chance to get pregnant. If implanting 1 embryo might result in a 40% chance of success and implanting 2 embryos might result in a 60% chance of success, without the help of insurance, I think you know which most couples would choose, even if the chance of twins is 30%. If insurance covered IVF, we would see many more single births. You also need to realize that for couples who can’t have children naturally, with a $15,000 price tag for each try, many believe twins wouldn’t be the worst thing in the world, even with the increased chance of complications that go along with them.

    February 26, 2010 at 09:03 | Report abuse | Reply
  4. Sarah

    I'm a neonatal nurse practitioner, and one concern I have about artificially inseminated pregnancies is that they have a high incidence of placenta previa (for some reason, the embryo implants close to the cervix and as the uterus grows, the cervical activity during pregnancy irritates the placenta causing it to bleed or pull away). Not only can this lead to hemorrhaging and stillbirth, it can also cause loss of oxygenated blood to the baby and increase the likelihood of neurological problems. I have noted an increase of autism among babies who were IVF-conceived.

    February 26, 2010 at 11:52 | Report abuse | Reply
  5. Deja

    Of course there would be an increase in stillbirths. When conception happens naturally it is the strongest sperm that finds the egg. With IVF or ICSI it is the sperm the scientist could catch. Also, in natural conception a problem that occurs very early on is eliminated, often before the woman realizes she was ever pregnant. In the controlled environment of the test tube or Petri dish, this process is interrupted by hormone baths. The chances of a problem arising late enough in a natural pregnancy to be considered a stillbirth is very low because of all of the designs in place to terminate early. In the medically induced pregnancies these are not functionally as strongly as they could.
    That is not to say that I am not fully supportive of the advancements medicine has made in fertility, but when you mess with nature you take a chance.

    February 26, 2010 at 12:37 | Report abuse | Reply
    • Asep

      I had a 46 year old patient that stgugrled for years with IVF, and it wasn't until she was treated by her acupuncturist that she was successful. Now her life's dream of having a child is a reality thanks to acupuncture! I am a firm believer.

      September 14, 2012 at 01:55 | Report abuse |
  6. yNOThealthCare w/out insurance parasites

    god cause some pregnancies to end prematurely. what is so difficult about understanding that if god wanted all people to reproduce he would make it happen. doctors play god and politicians scream about abortions.

    Why is it that god gets the credit for everything good, but some other character (that god must have created) gets blamed for all of the ills.

    February 26, 2010 at 12:39 | Report abuse | Reply
  7. Jamie

    This is inaccurate..."ICSI, where the man's sperm is injected into a woman's uterus" (see paragraph 2)

    ICSI is Intracytoplasmic sperm injection is a micromanipulation technique in which the sperm is injected into the egg NOT the uterus.

    February 26, 2010 at 14:11 | Report abuse | Reply
  8. ALQNAsMommy

    Nick,

    That is an ignorant comment ... "there is something biologically wrong in couples who cannot have children naturally." Despite what you say, intertility is NOT a disease ... it is a condition. My husband's cancer was a "disease." Chemo killed his sperm along with the cancer cells which is what led to our infertility "condition." And just so you know ... *GOOD* infertility doctors do NOT go implanting embryos willy-nilly. A good doctor will throughly review the couple's situation. Implanting two embryos is very often the standard decision based on numerous factors. Regardless, this article is about stilbirth ... the death of a baby in-utero after 20 weeks ... not a person's personal decision regarding how many embryos to implant. Please keep the focus on stillborn babies where it belongs.

    Sarah ... you refer to "artificially inseminated pregnancies" ... do you mean in-vitro pregnancies? They are two very different procedures, as I'm sure you know. This article doesn't reference artificial insemination (IUI) at all. Crazy side-note ... the three babies we conceived naturally after our two IVF babies were the ones I ended up having placenta previa with! ; )

    March 1, 2010 at 11:42 | Report abuse | Reply
  9. ALQNAsMommy

    Sorry, Nick ... I know it's not you who personally called infertility a "disease" ... it was indeed Dr. Goldfarb ... I guess he and I will just have to disagree on that one! ; ) My apologies ... it seems I cannot go back and edit my pending post ... so I had to P.S. it here.

    March 1, 2010 at 11:47 | Report abuse | Reply
  10. Dr.D11

    Nick writes:"Dr. Goldfarb mentioned that infertility is a disease....there
    is something wrong in couples who can not have children naturaly".
    No nobody knows whats wrong.
    I know whats wrong:It is the Metabolic Syndome.Ask your doctor.

    March 1, 2010 at 11:59 | Report abuse | Reply
  11. Nick

    ALQNAsMommy,

    Disease: "A pathological condition of a part, organ, or system of an organism resulting from various causes, such as infection, genetic defect, or environmental stress, and characterized by an identifiable group of signs or symptoms."

    I respectfully disagree with you (as do nearly all doctors) when you say infertility is not a disease. I see where you are coming from based on your husband's condition, however, in our case there is something genetically wrong with my wife. She was born with blocked fallopian tubes. She is otherwise healthy. Modern medicine and commonly accepted definitions say you are wrong.

    Also, the number of embryos implanted has plenty to do with stillbirths. 35% of live births from IVF result in multiples (http://apps.nccd.cdc.gov/ART/NSR.aspx?SelectedYear=2007) and multiples increase the risk of stillborns. I agree it's a personal decision how many embryos to implant that should be left up to you and your doctor. It's no one else's business. But my hypothesis is that if insurance covered IVF, there would be more singletons, hence less stillbirths.

    I do speak from experience. My wife had two embryos implanted and recently gave birth to twins. I wouldn't trade them for the world, but we would have implanted one embryo if the cost wasn't $15,000 out of pocket.

    March 1, 2010 at 18:10 | Report abuse | Reply
  12. ALQNAsMommy

    One of our IVF's was covered by insurance ... one was not. We implanted two embryos both times. Nick, at least you and I are still somewhat on the same page ... neither of us went the Octomom route! ; ) I still see a disease as something that is degenerative or life-threatening. I have an IVF friend whose husband was born without a vas deferens ... obviously a necessary transport mode like your wife's fallopian tubes. Still though, something genetic means you are born with it – you typically aren't born with a "disease." However, I can see how something like severe endometrious which can be very degenerating in the sense that it can keep *regenerating* could be considered a disease. Regardless, congrats on your beautiful twins! That's what my friend ended up with, too! ; )

    Just out of curiousity ... have any of you posters lost a child to stillbirth? I fear that these posts are all going to be from those who have a connection to IVF .. but no connection (blessedly) to stillbirth.

    A good discussion nonetheless ....

    March 2, 2010 at 12:46 | Report abuse | Reply
  13. rhea

    Alcoholism is a disease, but infertility is not?

    March 24, 2010 at 12:50 | Report abuse | Reply
  14. Alyssa Clements

    I have to use IVF. I have blocked tubes. I also have had a stillbirth and neonatal loss with twins. My cervix dilated too early. It was not IVF that caused my babies to be gone, it was my body.

    April 16, 2010 at 17:12 | Report abuse | Reply

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