WHY RISK IT?
The
possible health risks of many fertility treatments are often glossed over—and
not just by doctors who don’t want to emphasize them, but also by patients who
don’t really want to think about them. The risks are an important part of the
big picture, however. They are small but
real.
Negative effects on both mothers and babies are seen more frequently in children of ARTs than in naturally conceived babies. If you’ve already tried any of these techniques, we want you to keep these risks in perspective. In fact, everyone should keep them in perspective, because there may come a time when these are the right strategies for you. These may be risks you are ready to assume. What we wish for all couples trying to conceive is that any risks are necessary risks. What breaks our hearts is people opening themselves up to potential problems when safer options are available.
Negative effects on both mothers and babies are seen more frequently in children of ARTs than in naturally conceived babies. If you’ve already tried any of these techniques, we want you to keep these risks in perspective. In fact, everyone should keep them in perspective, because there may come a time when these are the right strategies for you. These may be risks you are ready to assume. What we wish for all couples trying to conceive is that any risks are necessary risks. What breaks our hearts is people opening themselves up to potential problems when safer options are available.
Our
aim is not to scare women but rather to underscore why they must view ARTs as
options of last resort. The risks are worth it when there is no other way to
have a baby, but they are unnecessary if you can get pregnant in a more natural
way. Following the Making Babies program will allow you to avoid the potential
problems associated with fertility drugs, IVF, and other ARTs, including an
increased risk of ovarian cancer in the mother; a tubal pregnancy; eggs or
embryos with genetic defects; fetal abnormalities; perinatal complications;
pregnancy with two or more babies at once (and all the potential health
problems that go along with that); premature birth (and all the potential
health problems that go along with that); neurological and physical handicaps,
developmental delays, learning disabilities, and mental and behavioral
disorders later in life; and possible infertility (for the baby) later in life.
There
are potential immediate health risks for the mother from ARTs as well,
including allergic reactions to fertility drugs, infection, injury during
retrieval of eggs, bleeding, blood clots, and damage to organs or blood
vessels. Poor lab work, including mix-ups of samples and/or results as well as
basic quality issues, introduces another kind of risk in pursuing technological
solutions to fertility problems.
The Risks of Fertility Drugs
Most
of the risks to the mother come from fertility drugs, and we’ll look at the
potential problems in more detail in chapter 25. On their own, fertility drugs
are the most common approach to infertility issues, and each cycle of IVF
begins with fertility drugs. In both cases, the drugs are used to stimulate the
ovaries to release more eggs. The usual strategy boils down to using more and more
of the drugs, in an attempt to get more and more eggs. But some women receive
doses that are too high. Others are given too many courses of the drugs. And
some are given drugs when they don’t really need them or have a fertility
problem the drugs can’t solve.
High-dose
fertility drugs put women at risk in both the short and long term and increase
the risks for babies as well. At the most basic level, many women experience
headaches, hot flashes, and mood swings, among other familiar unpleasant signs
of hormones at work. These effects may not be dangerous, but they can make a
woman quite miserable, and they place even more physical and emotional stress
on women and couples already pushed to the edge by fertility issues.
Over
the long term, the repercussions are more serious. Some studies show an
increase in cancer risk from fertility drugs, which aligns with what we’ve seen
in some patients with a history of extreme fertility drug use. The most common
serious side effect of fertility drugs is ovarian hyperstimulation syndrome
(OHSS; see page 323). The most severe cases require hospitalization and
sometimes termination of pregnancy. Even with careful monitoring by their
doctors, up to 10 percent of women using these drugs for IVF experience OHSS,
with up to 2 percent having severe cases. OHSS is widely considered to be an
overreaction to the drugs. We might do better to see it as a sign that we are
overreacting in our use of such high doses of these extremely powerful drugs.
Once
women go to all this trouble to get more eggs, it isn’t exactly smooth sailing
from there. Many eggs harvested this way are abnormal, increasingly so as a
woman gets older, and are more likely to produce embryos with genetic defects
than those from a natural cycle. These defects can cause fertility treatment to
fail. Experts worry, too, that the drugs may be causing problems that have yet
to be pinpointed in children born as a result of fertility drug pregnancies.
The Risks of Multiples
The
goal of using large doses of fertility drugs is to get lots of eggs. Not
surprisingly, this raises the risk of pregnancy with more than one baby at a
time. Only about 2 percent of naturally conceived children are twins. Fertility
drugs alone increase the chances of multiples between 6 and 20 percent, depending
on the medication. With IVF the number of multiples goes up even further—about
a third of IVF pregnancies are twins—thanks to the standard American approach
of transferring multiple embryos in each cycle to increase the chances of
conception.
Multiples
pregnancies are high-risk pregnancies. Essentially, a system designed to grow
one new human being is strained to the limit by larger demands. Multiples
pregnancies are more likely to end in miscarriage. They are more likely to
involve cesarean delivery, premature birth (more than half of twins are born
prematurely), and/or low birth weight. (The number of babies born prematurely
has increased drastically over the past two decades, right alongside the number
of babies conceived with technological assistance.) Babies born early or small
have more health problems at birth and over the long term, as well as a higher
risk of death in infancy, than full-term infants. Consider, too, the high
economic costs of the neonatal intensive care premature babies require.
Even
the “solution” to the problem of multiples pregnancies created by IVF is
problematic. “Reduction”—the euphemism used for selective abortion of one or
more fetuses to lower the risks of the pregnancy—is a horrible situation to
have to contemplate. And now evidence is showing that single infants born after
selective (or spontaneous) reduction have many of the same risks and problems
as twins.
The Risks of IVF
Research
shows that babies conceived through IVF are at greater risk, even when they are
in single pregnancies. If you’ve used any ART, or if you think you might, it is
important to remember that the risks of serious, long-term problems in children
born through ARTs are small. For couples with no other viable options for
getting pregnant, these are acceptable risks. But for the many couples for whom
these are avoidable risks, it is
unnecessary to run them.
Less
than 2 percent of naturally conceived children have birth defects, and although
that figure certainly provokes some anxiety in would-be parents, it rightly
doesn’t dissuade anyone from conceiving that way. In babies born through ARTs,
the risks are 50 percent higher: 3 percent. If you could lower the risks for
your child even 1 percent, wouldn’t you?
IVF
babies also are two and a half times more likely than spontaneously conceived
babies to have low birth weight, and that brings with it a raft of health
risks, just as multiple and premature births do. Scientists do not yet agree on
what to blame for the increased risks with ARTs. What is clear is that the more
involved or intense the fertility intervention, the more likely it is that some
problems will emerge over the long term.
The Risks of Not Knowing
Of
all the risks faced by people struggling with fertility issues, the biggest one
is not having a child. That’s what makes all the other risks acceptable—when they are necessary. But the way the
infertility industry operates in America today, these very real risks are too
easily dismissed, never really considered, or taken for granted. If nothing
else, they should give you pause, even if they don’t change your decision in
the end.
Modern
infertility medicine poses subtler risks as well, and these receive even less
consideration. There’s the risk of receiving a diagnosis and being told there’s
nothing to be done about it (and so you’ll never have a baby). There’s also the
risk of receiving the vague diagnosis of “unexplained infertility,” meaning,
really, that Western medicine can’t find anything that needs fixing and so,
again, there’s nothing to be done.
So
many patients come to us having failed IVF, or having been turned down as
candidates for IVF, and their doctors don’t have anything else to offer them,
with the possible exception of donor eggs. They’ve been told that they’ll never
have a baby, perhaps because they are too old or their FSH is too high. For
these women, that’s a terrifying position to be in.
These
are the risks of not knowing—not knowing what is preventing pregnancy and/or
not knowing what to do about it—which the one-size-fits-all approach of
fertility medicine today not only deems acceptable but also implicitly
encourages. But you don’t have to accept them if you follow the Making Babies
path.
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