Dr Abayomi Ajayi

The recent revelation by former American First Lady, Michelle Obama, that she and former President Barack Obama had their daughters through IVF is another confirmation of the infinite boundaries of infertility and the widespread benefits of IVF.Michelle, who recounted in her new book how she suffered a miscarriage before she and Barack opted for IVF to have their two daughters, emphasised the importance of talking to young mothers about the fact that miscarriages happen.

Michelle said she quickly realised that at 34 or 35, a woman’s egg production is limited. She noted that it is important to talk to young mothers about the fact that miscarriages happen.  More and more Nigerians are turning to assisted reproductive technologies to conceive. Michelle Obama’s revelation will go a long way to help normalise the problem of miscarriage and encourage couples that have undergone IVF to open up about their struggles with infertility.

ART is any fertility treatment that involves fertilising an egg outside the body, and the most common type is IVF. With IVF, a woman’s ovaries are stimulated to produce eggs using medication, and then they’re removed from her ovaries. In a laboratory, a man’s sperm is combined with the eggs to produce a fertilised egg, which is then reinserted into the woman, where, if successful, it’ll result in a pregnancy.

Millions of couples all over the world now turn to fertility clinics for help to have their own babies, and a significant proportion of all births now involve some kind of assisted reproductive technology. But most couples are particularly concerned about IVF and the risk of miscarriage.

Miscarriage is a common complication of pregnancy, with as many as one in five pregnancies resulting in one. However, as a result of the stigma and lack of awareness about these conditions as well as the physical and emotional nature of the experiences, people do not like to talk about these experiences.

Clinically, miscarriage is the spontaneous loss of a pregnancy before the 20th week. Many miscarriages occur because the fetus isn’t developing normally.

Problems with the baby’s chromosomes are responsible for about 50 per cent of early pregnancy loss. Most of these chromosome problems occur by chance as the embryo divides and grows — not because of problems inherited from the parents. Sometimes a health condition, such as poorly controlled diabetes or a uterine problem, might lead to miscarriage. About 10 to 20 per cent of known pregnancies end in miscarriage. The total number of actual miscarriages is probably higher because many women miscarry before they even know that they’re pregnant.

However, it is good to note that miscarriage is usually a one-time occurrence. Most women who miscarry go on to have healthy pregnancies after miscarriage. About one per cent of women will probably have two or more miscarriages.

The predicted risk of miscarriage in a future pregnancy remains about 14 per cent after one miscarriage. After two miscarriages, the risk of another miscarriage increases to about 26 per cent; and after three miscarriages, the risk of another miscarriage is about 28 per cent.

Getting pregnant after the heartbreak and stress of infertility after IVF can bring mixed emotions of joy, relief, and excitement. For some women, the anxiety can be overwhelming and perhaps the most common fear is pregnancy loss, especially if one or more miscarriages have been experienced in the past.

So, does having undergone IVF put a woman at an increased risk of having a miscarriage? Research has found that IVF patients may have a slightly increased risk of miscarriage, but this risk is no more that the risk of miscarriage when conceiving naturally.

Fertility may actually be improved following a miscarriage and there is some scientific evidence that you may even be a little more fertile for a couple of months after a miscarriage. After that time, it returns to normal.

The point to note is that the underlying reasons that cause a woman to seek fertility treatment may create pregnancy issues for some IVF patients. In other words, the cause of your infertility may also be the reason you have an increased risk for miscarriage. There are many common causes of an increased risk for miscarriage when undergoing IVF.

The two most common causes for early pregnancy loss are an implantation dysfunction (problem with the uterus being receptive to the embryo) or a genetic abnormality of the embryo itself.

A salient point to note is that if you have suffered recurrent miscarriages, implantation difficulties may be a factor. Issues such as an autoimmune disorder, thyroid deficiencies, problems with the endometrial lining of the uterus, or an anatomical irregularity of the uterus could be responsible.

This is why it is often best to start with accurate diagnosis from the beginning of treatment so as to fully understand the level of risk.

We know that chromosomal irregularities (aneuploidy) of the embryo may be the cause of most early miscarriages. Most of these abnormalities originate more with the egg than the sperm, and they become more common as a woman ages. This is likely a contributing factor in the higher rates of pregnancy loss seen in women over 40.

Other factors include advanced maternal age: many women who choose to undergo IVF struggle to get pregnant naturally because they are over the age of 35. Women under the age of 35 have as little as a 15 per cent chance of miscarriage when conceiving naturally. Those between 35 and 45 who undergo IVF have up to a 35 per cent risk of miscarriage. For women over 45, the risk of miscarriage increases to 50 per cent.

Underlying health conditions such as endometriosis, polycystic ovarian syndrome, and other reproductive conditions carry an increased risk of miscarriage. These conditions are also some of the more common reasons why women undergo fertility treatments such as IVF.

Ovarian stimulation is also an issue. Most fertility treatments, including IVF, involve a certain level of ovarian stimulation. The greater levels of ovarian stimulation needed, the higher the risk may be for miscarriage.

Early miscarriage is not something that is generally within control and this can be difficult to accept, especially when getting pregnant through IVF can feel like such a controlled process. But having a healthy IVF pregnancy is very much within reach.

Measures such as Preimplantation Genetic Screening (PGS) is used to screen embryos for any chromosomal abnormalities, such as missing, extra, translocated or damaged chromosomes. Similarly, Preimplantation Genetic Diagnosis (PGD) is used to screen for specific genetic disorders, such as cystic fibrosis, but it can also be used for general genetic screening.

In both cases, only genetically normal embryos are selected for transfer. Genetic testing of embryos significantly reduces pregnancy loss for patients undergoing IVF.

Also, because a woman’s eggs are vulnerable to chromosomal damage as they age, use of donor eggs in IVF may be advisable. Failed IVF attempts or unexplained miscarriages may be tackled with the option of an egg donor.

Dr. Abayomi Ajayi

01-4667360, 07026277855   info@nordicalagos.org

 

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123 COMMENTS

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