Assisted Reproductive Technologies

Like any medical procedure, ARTs involve both benefits and risks. Fertility drugs, whether used alone or in conjunction with IVF, can lead to a condition known as ovarian hyperstimulation syndrome, which, in rare cases, can be life threatening. This risk extends not only to women taking the fertility drugs for their own benefit, but also to egg donors who take fertility drugs to increase the number of eggs they will be able to donate.

One of the most serious risks associated with ARTs is the significantly increased likelihood of multiple gestation. About one-third of all IVF-generated pregnancies result in multiple births; approximately one-fifth of these multiple pregnancies are triplets or higher-order multiples. The use of fertility drugs without IVF also is associated with an increased risk of multiple pregnancies.

Multiple pregnancies involve significant risks. A woman pregnant with multiples is more likely to develop diseases like anemia, high blood pressure (hypertension), and pre-eclampsia. In addition, approximately 10 percent of children in multiple births die before their first birthday, and the surviving children are at significantly increased risk of lifelong disability. To reduce these risks, some women who have high-order multiple pregnancies undergo multifetal reduction, a procedure in which one or more of the fetuses are aborted. Although this procedure increases the likelihood that the remaining fetuses will be born healthy, it does not eliminate the risks associated with multiple gestation. Moreover, it is emotionally difficult and ethically problematic for many patients.

The high rate of multiple gestation associated with IVF is a result of efforts to increase the likelihood of pregnancy by transferring multiple embryos into the uterus in a single cycle. Physicians have been criticized for failing to adequately inform patients of the risk of multiple gestation (New York State Task Force on Life and the Law 1998). In the United States, professional organizations have recommended limits on the number of embryos transferred per cycle, although physicians are not legally required to adhere to these limits. Some European and Asian countries have imposed mandatory limits on the number of embryos physicians may transfer in each cycle.