January is Birth Defects Prevention Month. Dr. Estil Strawn from Froedtert and Medical College of Wisconsin Reproductive Medicine Center explains the relationship between birth defects and in vitro fertilization (IVF).
One worry that many hopeful parents-to-be share is whether their baby will be born with birth defects. So what do the statistics say? Birth defects noted before, at, or shortly after birth, remain one of the leading causes of infant mortality in the U.S. Birth defects in the general population are estimated to occur at 3 to 5 percent of all births. In other words, there is a 3 to 5 percent chance that any woman who gets pregnant naturally will have a child born with some type of birth defect. The good news is that the vast majority of these birth defects are not fatal and can be treated.
Some of the most common types of such birth defects (making up about 90 percent of all birth defects) include:
- Abnormalities in one of the chambers of the heart (ventral septal defect)
- Blockages of the stomach (pyloric stenosis)
- Defects in the flow of urine from the penis (hypospadias)
The cause for about half of all birth defects remains unknown. Some are attributed to genetics and cannot be prevented. Causes for some birth defects include:
- Spontaneous alterations in the child’s DNA or chromosomes (13-15%)
- Something in the genetic makeup of the parents (20%)
- Illnesses in the mother (5%).
Some publications note that in vitro fertilization (IVF) may increase the likelihood of giving birth to a child with a birth defect. This increase may be described as “more than twice the normal rates.” Actual increases range from the “normal” risk of 3 to 5 percent to around 6 to 8 percent with IVF. The actual cause of a potential increase of birth defects with IVF has never been determined, although different groups cite the following reasons:
- The use of hormonal medications
- Culture systems used to grow and sustain the eggs and the embryos with IVF
- Unknown mechanisms, like the parents’ genetics
Some speculate that a parent’s genetic makeup, or struggle to get pregnant, might impact the health of the child. It is important to note that increases in birth defects have not been found in children conceived with donor sperm when the mother has no fertility issues. Similarly, births following egg donation when the male has no fertility issues have also not caused an increase in birth defects.
It is important that patients considering IVF understand that the literature is fairly consistent in noting some increase in birth defects with IVF. It is still unclear whether IVF is associated with a significant negative impact on a child’s intelligence (at least regarding those pregnancies not complicated by multiple gestations (twins, triplets) or premature delivery).
Ultimately, any parent considering IVF has to take the above information into consideration and ask themselves the following questions:
1. Is having a child that has a genetic connection to both of you important enough to accept the above risks?
2. Are you prepared to move towards adoption, foster care, or a childfree existence if unwilling to accept the risks of IVF?
3. Would you consider donor sperm or donated eggs to potentially reduce the likelihood for birth defects? That is, if fertility problems have only been identified in either the male or female partner.
For some couples, IVF represents the best, and sometimes only, option for having a genetic connection to their child. Our group at the Froedtert and Medical College of Wisconsin Reproductive Medicine Center strongly believes that all prospective parents deserve appropriate counseling on all of their options for having a family and strive to provide the best information available.
Estil Y. Strawn, Jr. M.D. is doubly board certified in Reproductive Endocrinology and Infertility and Obstetrics and Gynecology. He is the medical director of the Froedtert and Medical College of Wisconsin Reproductive Medicine Center. Dr. Strawn is also full professor with tenure at the Medical College of Wisconsin where he serves as the director of the division of Reproductive Endocrinology and Infertility in the department of Obstetrics and Gynecology.
Dr. Strawn has been helping patients overcome their fertility problems for 19 years, and has directed a center that is one of the largest providers of fertility services in the state of Wisconsin. This center provides some of the most advanced types of technologies in the country including pre implantation genetic diagnosis (PGD), egg freezing, egg and embryo donation, gestational carriers, as well as robotic surgery for uterine fibroids and reversal of fallopian tube sterilization.
