In Vitro Fertilization Serious Health Annotated Bibliography

Excerpt from Annotated Bibliography :

Secondary risk factors are high E2 serum levels or rising levels, more than 20-25 follicles in both ovaries, the number of eggs retrieved, stimulation agents used, hCG administration, and pregnancy. Younger women are more prone to the syndrome as they are more responsive to gonadotropins and have more follicles than older women. Findings suggested that a lower body mass index carries a risk. Women with PCOS are more sensitive to infused follicle-stimulating hormone and produce more follicles with gonadotropin stimulation. They are more susceptible to developing the syndrome. Those who only have an isolated characteristic of the syndrome develop a comparable exaggerated response to gonadotropins. They are thus also at a higher risk for developing OHSS (Zivi et al.).

Parental Infertility and Cerebral Palsy in Children

A recent Danish National Birth Cohort found that children born through IVF sperm injection have a higher risk of cerebral palsy than children born spontaneously (Zhu et al., 2010). The study compared children born at different periods and those born after IVF. It found that 165 of them or .18% had cerebral palsy or CP. CP is a rare but severe disorder that afflicts about 2 out of 1,000 live births. Cerebral palsy is a rare but severe disorder. It is lifelong disability, which affects family life and healthcare costs. Explanation may be the higher frequency of preterm birth, multiple or disappearing embryo. It suggests that low fertility may be part of the pathway to CP. The association, however, may not entirely be in connection with multiple births or preterm births, as explained by most studies. The vanishing embryo may partly explain the increased risk (Zhu et al.).

Post-Neonatal Hospitalization from Multiple Births

The findings of a recent 7-year population-based cohort study revealed that multiple births increases post-neonatal health care services and costs among IVF children more than among naturally conceived children (Koivurova et al., 2007). The study involved 303 IVF children born between 1990 and 1995 at the Finnish Medical Birth Register. The results bolstered those of previous larger studies. They concluded that costs are higher from the procedure itself to pre-natal and neonatal care. With increasing use of IVF, the incidence of multiple births increases and so do post-neonatal health care costs among IVF children than among naturally conceived and born children

Ethics in Combating the Multiple-Birth Epidemic (Van Voorhis & Ryan 2010)

IVF providers argue that restricting the practice of multiple embryo transfer violates the principle of procreative liberty, patient and professional autonomy and free-market economics (Van Voorhis & Ryan 2010). Bur physicians have that professional responsibility to weigh issues of non-malefience to patients and the judicious use of health care resources vs. patients' individual preference. Responsible professional organizations of reproductive specialists should set up stricter regulations, which are not arbitrary and biased. These should monitor violations and impose sanctions on those practicing unsafe medicine. They should improve or initiate methods, which will maintain optimum pregnancy rates with more effective and ethically responsible means other than transferring multiple embryos or IVF, which impacts health. #


Kashyap, S. And Davis, O.K. (2003). Ovarian cancer and fertility medications: a critical appraisal. 21 (1) Seminars in Reproductive Medicine: Thieme Medical Publishers.

Retrieved on November 24, 2011 from

A review of all available literature was spurred by the question of a 35-year-old woman about the risk of ovarian cancer following IVF therapy. The question has been frequently asked. The association between ovulation induction and the occurrence of ovarian cancer cannot be established by randomized controlled clinical trials. The search for answers was made using four relevant cohort studies, turning up the article "The Risk of Cancer After Use of Fertility Drugs with in-vitro Fertilization." The article drew much controversy and criticism from reproductive medicine and epidemiology groups.

Koivurova, S. et al. (2007). Post-neonatal hospitalization and health care costs among

IVF children: a 7-year follow-up study. 22 (8) Human Reproduction:. Oxford

University Press. Retrieved on November 22, 2011 from

The authors utilized the national discharge register of the Finnish Medical Hospital

to determine if post-neonatal hospitalization and health care costs are higher among children born through IVF than those born spontaneously. The authors' full sample and singleton analyses proved that IVF children are more frequently hospitalized than those born spontaneously. The incidence of multiple births among IVF

conceptions increases all costs from the produce itself to pre-natal and neonatal phases. The finding is well worth considering before opting for IVF.

Owen, C.M. And Segar, J.H. (2009). Imprinting disorders and assisted reproductive technology. 27 (5) Seminars in Reproductive Medicine: Medscape. Retrieved on November 22, 2011 from

This is the alarmed response of experts on the rising popularity of ART since 2002

and the seemingly proportionate increase in imprinting disorders. Results have not been conclusive but evidence has been established to link ART with one or a few of the disorders. The increase in the number of imprinting disorders associated with ART should lead experts and couples to exercise greater caution.

Storck, S. (2010). In vitro fertilization. Medline Plus: ADAM, Inc. Retrieved on November 22, 2011 from http://www.nlm,

ADAM, Inc. is accredited by the American Accreditation HealthCare Commission.

The accreditation verifies that ADAM observes standards of quality and accountability in information. ADAM has the distinction as the first to provide quality and accountable online health information and services.

Van Voorhis, B.J. And Ryan, G.L. (2010). Ethical obligation for restricting the number of embryos transferred to women: combating the multiple birth epidemic from in vitro fertilization. 28 (4) Seminars in Reproductive Medicine: Thieme Medical Publishers.

Retrieved on November 22, 2011 from

The bane of contention in this piece is that highly trained practitioners can no longer rely on the integrity of providers to follow existing guidelines. The authors caution against going into extreme and damaging public trust, which in turn,

relies on other parties' professional self-regulation. Professional organizations in the reproductive field of medicine do not possess the ability to impose discipline besides simply suspending membership when practitioners

markedly violate time-honored standards of care.

Zhu, J.L. et al. (2010). Parental infertility and cerebral palsy in children. 25 (12) Human

Reproduction: Oxford University Press. Retrieved on November 22, 2011 from

Cerebral palsy in children is rare but serious and afflicts 2 per 1,000 live births. It is a lifelong disability, which produces significant distresses in the family. It also incurs much healthcare cost to society. The researchers sought to determine the association by using a broad cohort sample. Results showed that ART children stand a higher risk of developing cerebral palsy.

Zivi, E. et al. (2010). Ovarian hyperstimulation syndrome. 28 (6) Seminars on Reproductive Medicine: Thieme Medical Publishers. Retrieved on November 22,

2011 from

This work deals on the first stage in the IVF procedure is ovulation stimulation,

using human gonatrophins or hCG. hCG is a recognized promoter of OHSS. The risk increases with pregnancy, especially multiple pregnancies. The very objective of IVF or ART is to induce pregnancy. It often uses multiple embryos for the purpose. Different clinical classifications have been made, but whatever the grade or category, life-threatening consequences…

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