Many people have heard of assisted reproductive technologies (ART) and often have some understanding of what it entails. It can be as low-tech as artificial insemination, or light touch administration of fertility drugs, all the way up to more high-tech things like embryo testing, embryo freezing, egg and sperm “donation”, and surrogacy. Many have been touched by infertility, in their own life, or know someone that either used IVF or was born as a result of IVF. What many don’t realize, however, is how these ARTs affect women and children. Science is still figuring that out, even though millions of people utilize ART, from ICSI to surrogacy and everything in-between.
It can be easy to assume that science, or leaders in reproductive medicine like the American Society of Reproductive Medicine (ASRM) have our best interest in mind and that research is guiding clinical practice. However, ART is one area it seems clinical practice precedes informative and critical research. The desire to have or build a family seems to outweigh moral thought and critical long-term research on the consequences of such technology. Fortunately, data is emerging and we at the CBC are here to report and inform.
A study in 2022 explored in-hospital complications following pregnancies conceived using various forms of ART. Researchers analyzed hospital deliveries conceived with or without ART between 2008 and 2016, from the United States National Inpatient Sample database. In their study sample, they found that women who used ART to conceive were older, were more likely to have multiple fetuses, and had more comorbidities, like diabetes, hypertension, obesity, hyperlipidemia, to name a few. Huge spoiler alert: they found that “pregnancies conceived by ART have higher risks of adverse obstetric outcomes” such as c-section delivery, pre-term birth, and placental abruption, “and vascular complications compared with spontaneous conception.” More specifically, they found that ART-conceived pregnancies were associated with preeclampsia, acute kidney injury, ischemic stroke, arrhythmia, and venous thromboembolism (even after adjusting for baseline risk profile – that is, after taking comorbidities into consideration- and controlling the data for those comorbidities and pregnancies where multiple babies were born). Finally, they found that women who conceived using ART had higher hospital charges at delivery when compared to women that conceived without this technology. These high costs are a direct result of the nature of ART pregnancies sometimes requiring women to be admitted to high-risk pregnancy centers weeks or months before delivery. Let us not forget that what happens to the mother, has an effect on the fetus or fetuses. Adverse obstetric outcomes, like preterm delivery, can result in long NICU stays for the baby or babies, only adding to an already high hospital bill.
If this is sounding familiar to you, it adds on research by Woo, Luke, Cavoretto, Qin, Merritt, and all of their respective colleagues, co-researchers and co-contributors as well as research by Jennifer Lahl and myself here at the CBC. One major difference from this study and the work of Woo et al., Merritt et al., and Jennifer and I is that this study doesn’t specifically address surrogacy. However, surrogacy requires IVF and IVF is a form of ART. Dr. Merritt and his team wrote, “Analysis of sixty-nine infants delivered from both gestational and traditional surrogate women found an increase in multiple births, NICU admission, and length of stay, with hospital charges several multiples beyond that of a term infant conceived naturally.” Our own research found that surrogate mothers were more likely to have unfavorable outcomes during her surrogate pregnancy, including high blood pressure, hemorrhage, pre-term labor, placenta previa, postpartum depression, and postpartum high blood pressure. Luke and colleagues found that the risk of severe maternal and fetal morbidities is increased for women that utilize IVF, especially those resulting from donor eggs. Women that utilize ART need to fully understand the risks to them and the children they bare if they utilize these procedures. Risks that, I would argue, were not fully disclosed because they aren’t being fully researched and considered prior to be putting into clinical practice.
In the United Sates cardiovascular disease (CVD) is the leading cause of maternal mortality. Not only that, but the maternal-morbidity and -mortality rates in the U.S. have been increasing for years. Per the Centers for Disease Control website, reports shows that severe maternal morbidity has increased from 49.5 percent in 1993 to 144 percent in 2014. Preeclampsia, a risk of ART (including but not limited to surrogacy), is one of the leading causes of maternal morbidity and mortality. Preeclampsia, experienced by Kelly in our film #BigFertility, is a complication of pregnancy characterized by high blood pressure, and/or high levels of protein in urine that indicate kidney damage (proteinuria), and/or other signs of organ damage. Left untreated, preeclampsia can lead to serious — even fatal — complications for both the mother and baby. The current study points out that “adverse pregnancy outcomes such as preeclampsia”, as found in this study and others, “have been established as risk factors for future CVD”. We are knowingly causing and creating a dangerously unhealthy cycle for women and their health ART puts a mother at risk for adverse pregnancy outcomes, include preeclampsia. Preeclampsia is a leading cause of maternal morbidity and mortality, which happens to be on the rise in the US. Preeclampsia in pregnancy and childbirth is a risk factor for future CVD. CVD, including heart disease, is a leading killer in women. We have also been keeping our eye on research like this study we reported on that found that children born from IVF had significantly “increased blood pressure and unfavorable changes in left ventricular structure and function compared with children who were naturally conceived.” Are mothers aware of the short- and long-term risk for themselves and their child or children? Since we aren’t sure exactly how ART affects a child long-term, should we view ART as experimental? Specifically, experimentation on children that cannot consent. Though the medical community failed to heed his warning, bioethicist Paul Ramsey’s words are still true:
My only point as an ethicist is that none of these researchers can exclude the possibility that they will do irreparable damage to the child-to-be. And my conclusion is that they cannot morally proceed to their first ostensibly successful achievement of the results they seek, since they cannot assuredly preclude all damage.
Finally, as the authors of a recent Harvard Business Review report note: “Over 700 women die of complications related to pregnancy each year in the USA, and two-thirds of those deaths are preventable…” So, I ask, why does medicine continue to refer patients to #BigFertility? Why are we okay with this vicious cycle of poor care that can lead to lifelong, dangerous health outcomes? Why are couples with infertility rushed along on a fertility superhighway? Why aren’t we holding #BigFertility accountable to provide better, holistic care? Wouldn’t it make more sense to refer these patients to doctors like Naomi Whittaker who are focused on women’s restorative reproductive medicine?
- Kallie Fell, MS, BSN, RN, started her professional career as a scientist in the Department of Obstetrics and Gynecology at Vanderbilt University Medical Center utilizing a Master of Science degree in Animal Sciences with an emphasis on Reproductive Physiology and Molecular Biology from Purdue University. While assisting in the investigation of endometriosis and pre-term birth, Kallie simultaneously pursued a degree in nursing with hopes of working with women as a perinatal nurse. After meeting Jennifer at a conference, Kallie became interested in the work of the Center for Bioethics and Culture and started volunteering with the organization. It is obvious that Kallie is passionate about women’s health. She continues to work, as she has for the past 6 years, as a perinatal nurse and has worked with the CBC since 2018, first as a volunteer writer, then as our staff Research Associate, and now as the Executive Director. In 2021, Kallie co-directed the CBC’s newest documentary, Trans Mission: What’s the Rush to Reassign Gender? Kallie also hosts the popular podcast Venus Rising and is the Program Director for the Paul Ramsey Institute.