Pregnancy After Infertility
Pregnancy after infertility at a glance
- Most pregnancies after fertility treatment will proceed normally, but as with normal conception, there are certain risks with any pregnancy.
- The use of fertility drugs with multiple egg follicles, or the use of in vitro fertilization (IVF) with transfer of multiple embryos can increase the chances of a multiple birth, including twins or more.
- Miscarriage, ectopic pregnancy, multiple pregnancy, birth defects and bleeding during pregnancy are possible after fertility is restored.
- An Advanced Reproductive Medicine physician will follow the first few weeks of pregnancy closely. Initially, the levels of serum hCG will be followed and then an ultrasound is undertaken at more than six weeks of pregnancy (two weeks after the missed period). At this time, the location of the pregnancy within the uterus can be determined, although not necessarily the viability of the pregnancy or the fact of multiple births.
The overall rate of miscarriage is generally thought to be approximately 15% for women in their 20s, rising to more than 50% for women in their 40s. Similar rates are seen with pregnancy after infertility.
Some women will have an elevated risk of miscarriage from other clinical conditions including diminished ovarian reserve or uterine factor. Women who have recurrent miscarriage should see their physician for specific treatment for this condition.
Ectopic (tubal) pregnancy
In the general population that conceive naturally, the rate of pregnancy located outside of the uterus – usually in the fallopian tube – is approximately 1%. This rises in women who have a history of tubal problems or previous tubal pregnancy. With fertility treatments and/or IVF, the risk of a tubal pregnancy appears to be slightly elevated. For this reason, the hormone levels and ultrasound in early pregnancy will be carefully followed.
At times, there can be a simultaneous pregnancy within the uterus and a pregnancy within the fallopian tube, known as a heterotopic pregnancy. If a pregnant woman experiences sharp pelvic pain, vaginal bleeding, dizziness or fainting, low back pain or low blood pressure, she should notify her physician immediately.
Although many couples desire multiple pregnancy, they should be aware that the risks are increased, even if there are only twin multiples. These risks include:
- Premature labor.
- Cesarean delivery.
- Maternal high blood pressure.
- Gestational diabetes.
- Birth defects.
The goal of fertility therapy or treatment is the birth of a healthy baby and it is important to use the least aggressive therapy that is consistent with an excellent chance of fertility. This will be discussed at multiple points in therapy by the medical team.
Patients who have triplets or more are usually referred to a maternal fetal medicine specialist; reducing the multiple birth to twins or even a single fetus may be advisable because it is safer for the mother and baby in most cases.
The overall rate of significant birth defects in natural conception is approximately 3% to 5%. The overall rates of birth defects with fertility therapy appear to be similar to this overall rate, although certain kinds of treatments in certain clinical situations may increase the risk. Multiple birth is known to increase risk of birth defects whether the multiple birth is naturally conceived or as a result of fertility therapy. Clomiphene therapy may increase the risk of neural tube defect, usually spina bifida, which may be reduced by using folic acid found in daily multi-vitamins or prenatal vitamins.
Intracytoplasmic sperm injection (ICSI) appears to increase the risk of an extremely rare group of disorders known as imprinting disorders (Beckwith-Wiedemann, and Angelman syndrome) as well as hypospadias, an abnormality of the location of the urethra on the penis in male children. Sex chromosome abnormalities are increased in patients using ICSI but some of this may be the result of the man’s low sperm quality, which may also be a genetic defect. Nevertheless, if ICSI is advisable to reduce the risk of low fertilization, it should be used.
Bleeding during pregnancy
There are many causes of vaginal bleeding in early pregnancy. The American College of Obstetricians and Gynecologists reports that 15%-25% of pregnant women experience bleeding in the first trimester. While it can be alarming, it does not always mean a miscarriage. Usually, slight bleeding will stop on its own.
However, always contact your doctor if you have had any bleeding while pregnant. If the bleeding is more than one sanitary pad every two hours or if there is extreme pelvic pain, you need to contact your doctor immediately. If bleeding is less than this and no pain or dizziness are associated with the bleeding, you may wait until regular business hours to contact your physician.