Risk during pregnancy and birth after assisted reproductive technologies: an integral view of the problem

Pregnancy and obstetric outcome are the final steps in infertility treatment. Additional data from recent studies demonstrate an increased risk for pregnancy course and obstetric outcome. These risks include an increased risk for intrauterine growth retardation, preeclampsia, and premature birth. Children born after in vitro fertilization and intracytoplasmic sperm injection (ICSI) have an increased risk for major malformations compared with spontaneously conceived pregnancies. Patients have to be counseled about these risks. The question is where these increased risks originate. At present, there are insufficient data available from pregnancies established following hormonal treatment or intrauterine insemination cycles. Therefore, the question is still open for debate, whether either in vitro culture or infertility per se or perhaps other components of the treatment cycle contribute to this risk. There is some evidence that at least the ICSI technique or the in vitro culture technique is not the only or most prominent factor. A long time to pregnancy with subsequent spontaneous pregnancy results in a similar risk profile as pregnancies following infertility treatment. This article discusses a possible pathogenetic model for these observations.