Are We Sure Fertility Treatment Babies Are Going to Be Okay?

No matter how complex fertility treatment can be, the goal is quite simple: conception and birth of a healthy baby. Having a baby by way of assisted reproductive technology is quite different from "the old fashioned way" -- but for many, therapies that include medications and laboratory techniques provide the only way to parenthood. It's normal and natural for hopeful parents-to-be to worry about how all that intervention might impact their resulting offspring:

"We're finally using IVF to get pregnant. And we're very excited, but a little scared. Is it a fact that babies born after IVF aren't all different in any ways from children born after natural trying-to-conceive efforts?"

Dr. Sonja Kristiansen, Medical Director of Houston Fertility Center responds:

As the mother of two kids, myself, I really understand my patients' worries about whether their children will be impacted by the fertility treatment that helped bring them about. Fortunately, I'm glad to be able to point them to statistics based on long-term studies, now that IVF's been used successfully for several decades.

The first thing fertility patients need to know is that problems may be associated with multiple pregnancies, whether those occur from fertility treatment or not. As I wrote in a 2005 newsletter article, "In all, most concerns about the kids of ART are related to whether or not the children are singletons or multiples." I refer to a patient fact sheet by the American Society for Reproductive Medicine called "Complications and Problems associated with Multiple Births". We make our protocol judgements with very careful consideration of each patient's diagnosis and treatment need in order to avoid multiple pregnancies.

A recent brochure published by an Australian reproductive medicine authority offers some more information on risks for everyone involved in ART -- men, women, and babies -- see Putting the Risks of IVF in Patients' Hands. But you should keep in mind the information is based only on data from Australian fertility patients and their children.

In this 2008 review of studies on the development of children after ART, the researchers concluded that main points to know include:

prematurity and low birth weight are the primary risk factors contributing to poor outcomes in ART offspring

parental characteristics inherent in many (but not all) fertility patients as a group may include mothers or fathers who are already at greater risk, with or without fertility treatment, for offspring born with developmental problems

"IVF babies" overall are more likely to be born prematurely and of lower birth weight than naturally-conceived children (and this may be related to my second point above)

Children of ART are more thoroughly examined as a group than are naturally-conceived babies, so a kind of "hypervigilance" may skew observational research data

and most importantly:

"Large-scale, well-designed studies have found most children born after ART to be healthy, typically developing young children."


~ Dr. Sonja Kristiansen MD

Is My OB/Gyn Right: I Have All The Time In The World?

It's no longer unusual for women to delay pregnancy until well into their 30's or even early 40's. Many young women want to dive into parts of life that are easier to do without children and then settle down with kids later. But plenty still want to grow their families first. Fertility specialists often hear from women in their 20's who've been told by their gynecologists to "be patient":

"We started trying to have a baby as soon as we got married. And even though it's been a year, my OB/Gyn says I'm just overly worried. He says I'm healthy, I have a period every month, there's no reason for concern. Should I really just kick back, relax, and I'll get pregnant, finally?"

Dr. Sonja Kristiansen, Medical Director of Houston Fertility Center responds:

You're not alone! I often talk to young women who want to get pregnant and feel like they're more frantic about it than everyone else. Sometimes, they've heard and read too many over-simplified stories about infertility. But there are times when they may be "on to something" -- a lot of women understand their bodies intuitively, even if they aren't physiology experts.

The unfortunate truth: there are many conditions that can cause you to be infertile and you never know until you try to get pregnant. If you've ever had abdominal or pelvic surgery of any kind, you could have internal adhesions or scar tissue -- most of which cause no pain -- that can be an obstacle for conception. The same is true of several infections, including sexually-transmitted ones and other, less stigmatized infections.

If you're only in your 20's and you've tried for a year to get pregnant without any luck, I and other fertility experts recommend you have some basic fertility testing done. You might not need the assistance of reproductive technology at all. But if you do, it's best to find out sooner than later.

Women's fertility naturally declines as they get older. So of course, older women's response to fertility treatment is generally not as optimal as that of younger women. If you're ready to have a baby, you've tried for a year already, and you're in your 20's, find out now if there's a real problem in the way. Then you can decide whether or not to proceed with fertility treatment.

~ Dr. Sonja Kristiansen MD

Is There Something About IVF That Doesn't Work for Latinas?

If you're a fertility specialist in a metropolitan area of the United States, you likely have patients who identify as Latinas. Or you may not, given the cultural stigma and myths that keep many Hispanic women and couples from even inquiring about fertility treatment. If you're listening closely to your community, you've probably heard something along these lines:

We've been trying to get pregnant for a long time with no luck. I think we're doing everything "right" and I'm worried we have a problem that needs treatment. But friends have told me that IVF and other fertility treatments don't work as well for Latinas as it does for other groups. Is that true? Why would that be the case?

Sonja Kristiansen, Medical Director of Houston Fertility Center responds:

In central Houston, where I've operated a fertility center for more than a decade, my staff and I have made special efforts to reach out to the community around us. Many of HFC's staff are Latinas, and they've heard a lot of myths in their own families about fertility treatment. The other day, I was really glad to hear some positive news coming from a colleague in San Antonio, Dr. Robert Brzyski, that lays to rest one of those myths.

Dr. Brzyski did a study of his clinic's IVF patients and found no difference in success rates between Hispanic and non-Hispanic anglo women who used IVF to get pregnant. He also found that more of the Latinas -- nearly all of whom were Mexican-American -- miscarried, which is a point of concern. But overall rates of success were equal.

There may be differences between ethnic groups in how certain fertility treatments work or not. If significant differences between groups is found, it's possible that the causes are more related to culturally-influenced daily living activities and not genetics. But I've learned from my own diverse patient group that the most important influencing factors are based on the individual, her health, her lifestyle choices (like diet and smoking and exercise), and not on ethnicity, race, culture or any other group demographics.

If you've heard otherwise -- like from friends that IVF doesn't work for Latinas -- then it's very likely they're basing their opinions on a few anecdotes, stories that they've heard through the grapevine themselves, and not on actual research.

~ Sonja Kristiansen, MD

How Many IVF's Does It Take?

Here's an FAQ that a lot of fertility specialists hear:

How many IVF's will I have to go through before I have a baby?

Sonja Kristiansen, Medical Director of Houston Fertility Center responds:

Virtually nobody wants to resort to fertility treatment to have a baby! But if you find yourself in my office, you've likely already come to the conclusion that this is where you need to be to achieve your dream.

So your next question -- "How much of this fertility treatment do I have to endure?!" -- is understandable.

We cannot tell any patient at her first consultation exactly how many fertility treatment cycles she'll go through before she has a baby. In fact, we may not even be able to tell a brand-new patient if IVF is the final answer for her.

I just wrote a blogpost about the success rates (and risks) of IVF, and how success seems to come more often to women who manage to go through the procedure three times or more.

I know, it's not what you want to hear, especially at your first appointment. But remember -- those are statistics, which are mathematical versions of everyday life. Just because statistically your chances of a baby are greater with three or more IVF's, that's not necessarily a fact of life for you and your situation.

Everyone's body and medical history is different. Your causes of infertility, how your body responds to medications... many factors add up to fertility with or without treatment. So while I may not be able to answer the question of "How many IVF's" here on the Internet in a way that will be meaningful to any individual, I can certainly focus in on a good estimate once you and I have run a few diagnostic tests and gone over your personal health history.

~ Sonja Kristiansen, MD