IVF and obstetric risk: what primary care clinicians should know

In vitro fertilisation (IVF) has been an established treatment for infertility since the birth of the first IVF baby in 1978. Millions of children have now been born worldwide through assisted reproductive technologies (ART), and use continues to rise across both developed and developing healthcare systems.

As access to fertility treatment expands, GPs are increasingly involved in the care of patients undergoing IVF. This includes pre-conception counselling, management of chronic medical conditions, and early pregnancy care. However, familiarity with IVF-related obstetric risks remains variable among primary care practitioners.

This article offers a practical, evidence-based overview of the IVF process, associated obstetric risks, and the role of primary care clinicians in supporting this patient group.

Overview of the IVF process

A basic understanding of IVF helps clinicians interpret patient presentations and anticipate potential complications.

Ovarian stimulation

Controlled ovarian stimulation uses gonadotrophins to promote the development of multiple follicles. Clinicians monitor response and reduce risks using ultrasound and serum hormone levels.

Oocyte retrieval

Eggs are collected transvaginally under ultrasound guidance, usually under sedation. Complications are uncommon but may include bleeding, infection, or injury to surrounding structures.

Fertilisation

Eggs are fertilised with sperm in the laboratory. Intracytoplasmic sperm injection (ICSI) may be used in cases of severe male factor infertility.

Embryo culture

Embryos are cultured for 3–5 days before transfer. In selected cases, preimplantation genetic testing may be performed.

Embryo transfer

One or more embryos are transferred into the uterus. Luteal phase progesterone support is given to enhance implantation. Pregnancy is confirmed by serum β-hCG followed by ultrasound at 6–7 weeks.

Obstetric risks associated with IVF

Preterm birth and low birthweight

IVF singleton pregnancies carry a higher risk of preterm birth and low birthweight compared with spontaneous conceptions. This is thought to reflect both underlying infertility factors and treatment-related influences.

Multiple pregnancy

Multiple gestation remains the strongest predictor of adverse perinatal outcomes in ART. Twin pregnancies significantly increase risks of preterm birth, neonatal morbidity, and maternal complications. Elective single embryo transfer has substantially reduced these risks without reducing cumulative live birth rates.¹

Placental complications

IVF is associated with an increased risk of placenta praevia and placental abruption. Proposed mechanisms include altered endometrial development and patient-related factors such as advanced maternal age and prior uterine pathology.²

Hypertensive disorders of pregnancy

Pregnancies conceived through IVF have a higher incidence of pre-eclampsia compared with spontaneous conceptions. Consider standard antenatal risk assessment and prophylactic low-dose aspirin where clinically indicated.

Congenital anomalies

Some studies suggest a modest increase in congenital anomalies in IVF pregnancies. However, this association is significantly attenuated after adjustment for maternal age and underlying infertility factors, suggesting confounding rather than a direct causal effect of IVF.³

Ovarian hyperstimulation syndrome (OHSS)

OHSS is an iatrogenic complication of ovarian stimulation characterised by increased vascular permeability and fluid shifts.

Clinical severity

Mild OHSS

• Abdominal discomfort and bloating
• Managed conservatively

Moderate OHSS

• Nausea, vomiting, and ascites
• Requires monitoring

Severe OHSS

• Marked ascites, dehydration, oliguria
• Risk of thromboembolism and respiratory compromise
• Requires hospital admission

Severe OHSS is now uncommon due to improved stimulation protocols, including GnRH antagonist regimens and GnRH agonist triggers. However, primary care clinicians may encounter patients presenting after recent fertility treatment, particularly in cross-border care settings.¹

Role of primary care in pre-conception care

Primary care is central to improving IVF outcomes through early optimisation of modifiable risk factors.

Weight and metabolic health

Obesity is associated with reduced fertility and increased obstetric risk. Optimising pre-conception weight improves reproductive outcomes and reduces complications.

Thyroid disease

Thyroid dysfunction should be identified and treated before conception. Even subclinical abnormalities may affect fertility and pregnancy outcomes.

Vitamin D deficiency

Vitamin D deficiency is common in many populations and may influence reproductive outcomes. Correction is recommended in deficient patients.

Diabetes mellitus

Optimal glycaemic control prior to conception is essential to reduce miscarriage risk and congenital anomalies.

Endometriosis

Endometriosis is a common cause of infertility and may affect ovarian reserve and implantation. Early recognition and referral are important in symptomatic patients.

Psychological impact of IVF

Infertility and IVF treatment are associated with increased rates of anxiety and depression. Emotional distress may persist even after successful conception.

Primary care clinicians should routinely assess psychological wellbeing and provide appropriate support or referral to counselling services where needed.

Antenatal care considerations

IVF pregnancies are often managed as higher-risk pregnancies. Key considerations include:

• Early involvement of obstetric services in high-risk cases
• Assessment for pre-eclampsia risk and use of aspirin where indicated
• Increased vigilance for placental complications
• Awareness of increased anxiety in pregnancy following assisted conception

Conclusion

IVF is now a routine part of reproductive healthcare, and primary care clinicians play an increasingly important role in supporting affected patients.

Understanding the IVF process, associated obstetric risks, and opportunities for pre-conception optimisation enables clinicians to provide safer, more informed, and holistic care.

Collaboration between fertility specialists and primary care remains essential to improving maternal and neonatal outcomes in this growing patient population.

References

1. Maheshwari A, et al. Elective single embryo transfer in women with infertility. Cochrane Database Syst Rev. 2016;(4):CD012391.
2. Romundstad LB, et al. Increased risk of placenta previa in pregnancies following IVF/ICSI. Hum Reprod. 2006;21(9):2353–8.
3. Hansen M, et al. Assisted reproductive technology and major birth defects: a systematic review. Pediatrics. 2013;131(1):101–11.
4. Qin J, et al. Perinatal risks of pregnancies conceived by IVF/ICSI. Sci Rep. 2016;6:18803.
5. Henningsen AA, et al. Preterm birth and low birthweight in singletons born after ART. Hum Reprod. 2020;35(8):1949–58.
6. Pinborg A. IVF/ICSI twin pregnancies: risks and prevention. Hum Reprod Update. 2005;11(6):575–93.
7. Ensing S, et al. Risk of hypertensive disorders in IVF pregnancies. Hum Reprod. 2020;35(3):698–705.
8. Delvigne A, Rozenberg S. Ovarian hyperstimulation syndrome. Hum Reprod Update. 2002;8(6):559–77.
9. Humaidan P, et al. Prevention of OHSS in IVF. Hum Reprod Update. 2017;23(3):243–55.
10. Boivin J, et al. Infertility and mental health burden. Hum Reprod. 2007;22(6):1506–21.

Authors: Mehrunnisa, Best Life Fertility Centre Editorial Team, Sharjah, UAE

Corresponding author email address: [email protected]

Alison Bloomer

Alison Bloomer is Editor of Pavilion Health Today. She has over 25 years of experience writing for medical journals and trade publications. Subjects include healthcare, pharmaceuticals, disability, insurance, stock market and emerging technologies.

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