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Am J Perinatol 2013; 30(10): 881-882
DOI: 10.1055/s-0033-1333668
Letter to the Editor
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

IVF Is Safe over 50 If It Is Not Fatal

Archana Vasireddy
1   Woman's Health Directorate, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
,
Susan Bewley
2   Women's Health Academic Centre, King's Health Partners, St Thomas' Hospital, London, United Kingdom
› Author Affiliations
Further Information

Publication History

20 August 2012

09 November 2012

Publication Date:
20 February 2013 (online)

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In vitro fertilization (IVF) and other assisted reproductive techniques have become more popular and accessible and in turn the number of IVF cycles has increased—in the United Kingdom in 2010, over 57,652 cycles of IVF or intracystoplasmic sperm injection were performed in 45,264 women.[1] A third of women used donor eggs and 1.9% of women were over the age of 45.

The proportion of women wishing to conceive outside the reproductive age range is set to increase further in the future. It is important that women have information to decide whether IVF is safe to pursue.

A recent case series of 101 women over the age of 50 using donor egg IVF to conceive concluded they were at high risk of maternal complications of pregnancy including hypertensive disorders and cesarean section but only drew a comparison of similar risk to singleton pregnancies in younger women using donor egg IVF.[2]

The authors claim that the one maternal death likely due to a myocardial infarction in a 49-year-old woman who was a heavy smoker[2] was unrelated to the pregnancy, but this death would have been classified as an indirect death by the United Kingdom Confidential Enquiry into maternal deaths, which has a similar classification system as the World Health Organization—“resulting from previous existing disease, or disease that developed during pregnancy and which was not the result of direct obstetric causes, but which was aggravated by the physiological effect of pregnancy.”[3] [4] Thus, the maternal mortality rate (MMR) of egg donor IVF pregnancy would be equivalent to 990 per 100,000 maternities (95% confidence interval −0.009 to 0.029). This is more than 20 times higher than the MMR reported in the largest retrospective study to date of mortality from IVF treatment and IVF pregnancies.[5]

A healthy patient effect has been ascribed to women undergoing IVF where only women who are medically fit are selected for treatment.[6] However, it is important that even these “fit” women are still given adequate prepregnancy counseling and advice regarding the risks.[7] It is well known that advanced maternal age is a risk factor in itself for various obstetric complications. In relation to older women requiring egg donation IVF, studies have found an increased risk of pregnancy-induced hypertension, preeclampsia, preterm birth, low birth weight, twin pregnancy, and prolonged labor requiring cesarean section compared with IVF controls.[8] [9] [10] [11]

Figures of adverse outcomes from IVF and egg donation IVF pregnancies may also be underreported. Many women may seek treatment overseas, withhold the IVF information from the obstetrician providing antenatal care, or have different medical providers, therefore outcomes may not reported as a result of the IVF. For example, in one case, a 49-year-old woman underwent IVF abroad resulting in a twin pregnancy. Although antenatal care in her home country was uneventful, postdelivery at term the mother died as a result of cerebral hemorrhage secondary to HELLP syndrome (hemolysis, elevated liver enzymes, low platelets).[12]

Postmenopausal women must be counseled regarding all the risks of IVF and subsequent pregnancy. Whatever the dictates of “informed consent,” there must remain a question of what death rate would make it unethical for doctors to perform an elective request procedure.