Infertility is an all-too-common, painful reality for couples trying to conceive. Defined as the inability to become pregnant within one year of trying, infertility is estimated to affect one in five women in the United States . Oftentimes, women’s physical experience of infertility is accompanied by intense feelings of guilt and/or shame, as if their bodies have failed them.
Couples are often told that the only way to have biological children is to undergo medical procedures that involve the handling of the egg or embryo outside of the body, collectively referred to as assisted reproductive technology (ART)*. However, a new study confirms previous research finding risks of ART use for both mothers—particularly those with preexisting cardiovascular risk factors like heart disease and high blood pressure— and their children.
IVF is increasingly popular–but what are the risks to moms and babies conceived using ART?
The main form of ART in the United States is in vitro fertilization (IVF), a procedure in which eggs are removed from a woman’s body and joined with sperm in a laboratory. If fertilization is successful, the resulting embryo is then implanted in the woman’s body. The use of ART is on the rise, having more than doubled during the past decade. One in 50 babies are now conceived this way each year in the United States. That means you likely know someone who was born or had a baby this way.
But a study published earlier this year in the Journal of the American Heart Association (JAHA), a premier medical journal for cardiologists that requires fellow scientists to critically review research before publication (a process known as peer review), found that conceiving a child through ART comes with many risks to both mother and child .
For the study, researchers used a nation-wide healthcare database to evaluate the outcomes of women who had their babies in hospitals between 2008 and 2016. Each hospital delivery recorded in the database was labeled by the way the baby or babies (as in the case of twins or higher multiples) were conceived—that is, via ART or natural conception. 34 million hospital deliveries were analyzed, of which 0.31% of women conceived through ART and 99.69% conceived naturally.
Significant medical risks for moms who conceived with ART compared to moms who conceived naturally
Researchers performed an analysis of the data that accounted for several factors (thereby strengthening the study’s findings), and found that when compared with women who conceived naturally, those who conceived using ART were:
- 57% more likely to have placental abruption, a life-threatening condition for mother and child in which the placenta tears away from the uterus before the baby is born,
- 38% more likely to have a cesarean section,
- 26% more likely to have a preterm birth (which translates to numerous and sometimes long-term health risks for the child or children),
- 152% more likely to have sudden kidney failure, and
- 65% more likely to have an abnormal heart rhythm, also known as an arrhythmia.
To put these increased risks in context, it’s helpful to understand your starting risk for these complications because some are fairly common and others very rare.
Pregnant women who conceive naturally have a:
- One in ten chance of having a preterm birth,
- nearly one in three chance of cesarean section,
- one in 100 chance of placental abruption, and
- less than one in 1000 chance of sudden kidney failure.
Arrhythmias are described as common during pregnancy, but it’s unclear exactly how often they occur.
Increased risks for moms through ART aren’t solely due to risks of multiple-baby pregnancies
Women who conceive using ART are prone to becoming pregnant with multiple babies, which at first glance could explain the worse outcomes compared to women who conceive naturally. However, these outcomes were even seen among women who used ART and became pregnant with only one baby. The women who conceived via ART and carried only one baby were still:
- 86% more likely to have placental abruption,
- 44% more likely to have a cesarean section,
- 57% more likely to have preterm birth,
- 182% more likely to have sudden kidney failure, and
- 89% more likely to have an arrhythmia.
Having worse outcomes was especially pronounced for women who conceived using ART and had cardiovascular disease risk factors when compared with women who both conceived naturally and did not have cardiovascular disease risk factors. These women had a considerably higher risk for placental abruption, cesarean section, preterm birth, sudden kidney failure, arrhythmia, as well as an elevated risk for ischemic stroke (a blockage in a blood vessel in the brain), peripartum cardiomyopathy (a rare form of heart failure beginning during the last month of pregnancy or within 5 months after birth), and venous thromboembolism (blood clot).
Births of ART-conceived children more likely to require longer, costlier hospital stays
When study researchers evaluated the financial impact of ART, they found that women who used ART tended to stay in the hospital longer and have higher hospital charges than women who conceived naturally. These findings are in line with previous, smaller studies.
A 2018 study found that women who used ART with their own eggs had a nearly four times higher likelihood of having a complication that nearly killed them and women who used ART with someone else’s eggs had a nearly 14 times higher likelihood . A 2017 study showed that women who became pregnant with one baby using ART were nearly twice as likely to have severe disease, such as sudden kidney failure, compared with women who conceived naturally . These complications naturally result in longer, costlier hospital stays for the mothers, and sometimes their children, too.
While the absolute risks (the actual likelihood of experiencing one or more of these problems) are low overall, they are concerning nevertheless, particularly given the United States’ distressingly high rates of maternal morbidity (developing a medical condition while pregnant) and mortality (dying while pregnant or within one year of the end of a pregnancy, per the CDC).
Women deserve to be educated on ART’s risks to themselves and their children
Every research study has limitations. Because the JAHA study relied on medical codes to assess whether a hospital delivery was of an ART-conceived baby, and because there is no consistent definition for ART, the hospital deliveries in the ART group may include women who used procedures such as the stimulation of ovaries with medication to conceive, in addition to procedures that involve the handling of the egg or embryo outside of the body, like IVF. The former procedures are not considered ART by the CDC, while the latter are.
However, women and couples absolutely deserve to know the full gamut of risks for both mothers and children conceived through ART, especially those revealed in this JAHA study. Unfortunately, during a Natural Womanhood webinar earlier this year, veteran OB/GYN Dr. Kathleen Raviele observed that oftentimes research on the negative impacts of hormonal birth control use does not show up in literature targeted towards OB/GYNs or family practice healthcare providers, research on blood clots, strokes, heart attacks, and more serious issues related to hormonal birth control use, for example, ends up in the medical literature read by specialists in pulmonology, cardiology, cardiothoracic surgery.
Similarly, the study explored in this article was published in the Journal of the American Heart Association, a medical journal for cardiologists, and, unfortunately, may never make it in front of the reproductive endocrinologists and OB/GYNs who actually care for women and couples suffering from infertility. Sadly, if OB/GYNs and general practitioners aren’t reading these highly relevant studies, then the likelihood that their own patients will receive adequate education and informed consent to the many risks of ART (and hormonal birth control use) is low.
Restorative reproductive medicine can help couples overcome infertility
So what is a couple struggling with infertility to do? Although ART may seem like the only option for couples struggling with infertility, it’s not. Infertile couples can be treated using restorative reproductive medicine (RRM), a branch of medicine that seeks to find the root cause(s) of infertility and performs interventions intended to restore fertility and improve overall health, leading, hopefully, to natural conception. Currently, three medical approaches—Natural Procreative Technology (NaProTechnology), FEMM, and NeoFertility—use restorative reproductive medicine to effectively (and often, affordably) treat infertility without ART, thereby avoiding any increased harm to mother and child.
*Of note: According to the Centers for Disease Control and Prevention (CDC), the ART umbrella does not include interventions that only stimulate the ovaries for egg maturation (without removing any eggs from the body), or that involve the collection and delivery of sperm to the woman’s uterus as occurs in intrauterine insemination (IUI).
 From the Centers for Disease Control and Prevention (CDC) website: “In the United States, among heterosexual women aged 15 to 49 years with no prior births, about 1 in 5 (19%) are unable to get pregnant after one year of trying (infertility). Also, about 1 in 4 (26%) women in this group have difficulty getting pregnant or carrying a pregnancy to term (impaired fecundity). Infertility and impaired fecundity are less common among women with one or more prior births. In this group, about 6% of married women aged 15 to 49 years are unable to get pregnant after one year of trying and 14% have difficulty getting pregnant or carrying a pregnancy to term.”
 Wu, Pensee et al. “In-Hospital Complications in Pregnancies Conceived by Artificial Reproductive Technology.” Journal of the American Heart Association, vol. 11, no. 5, 2022. https://doi.org/10.1161/JAHA.121.022658
 Cromi, A et al. “Maternal intra- and postpartum near-miss following assisted reproductive technology: a retrospective study.” British Journal of Obstetrics and Gynecology, vol. 125, no. 112, 2018, pp. 1569-1578. https://doi.org/10.1111/1471-0528.15308
 Martin, Angela S et al. “Trends in Severe Maternal Morbidity After Assisted Reproductive Technology in the United States, 2008-2012.” Obstetrics and gynecology, vol. 127, no. 1, 2016, pp. 59-66. doi:10.1097/AOG.0000000000001197