[Maternal risks of medical assistance with procreation]

It is now well demonstrated that assisted reproductive technologies, namely intra-uterine insemination, in vitro fertilization and embryo transfer, and gamete intra fallopian transfer (GIFT) are the source of maternal complications, sometimes life-threatened. All documented hazards concern the short term. Few are related to the techniques: local, regional or general infections, severe hemorrhages. Most are the consequence of controlled ovarian hyperstimulation: ovarian hyperstimulation syndrome (OHSS), thrombosis, multiple pregnancies. High range multiple pregnancies could be prevented by a reduction in the number of embryo transfered, which is now currently limited to two or three in most centers. Similarly, good results can be obtained with intrauterine insemination, while maintaining the multiple pregnancy rate at the physiologic level, about 1%, by avoiding poly-ovulation. In comparison with spontaneous pregnancies, ART pregnancies are more complicated (toxemia, intra-uterine growth retardation, prematurity). The caesarean section rate is over 25% in singleton deliveries, 40% for twins and 89% for triplets. With a long term follow-up of 15 years, no hazard has been demonstrated. Concerns about ovarian epithelial cancer, breast cancer, and premature menopause remain hypothetic. Further studies are in development in this field.