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Your IVF pregnancy

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Sadly, these days infertility affects about one in six couples in Australia. For some couples, assisted reproduction technology (ART) and in vitro fertilisation (IVF) specifically will be the best route to achieve a family. IVF is getting better all the time and now, after more than 30 years, it's a common medical treatment, with 'IVF babies' making up more than two per cent of all births. On the whole, your IVF pregnancy can be expected to be pretty routine and result in the birth of a healthy baby. But statistically, there are a few key differences between IVF pregnancies and pregnancies conceived naturally that you should know about.

Multiple considerations
To begin with, there may be a higher chance of having twins or even a higher-multiple birth with an IVF pregnancy. Many women don't realise that the single most important determinant of pregnancy outcome is whether your pregnancy is a singleton or multiple pregnancy - and this is true to a large extent regardless of whether your pregnancy is a result of natural or assisted conception. So you can expect your pregnancy to be handled very differently if you're pregnant with two or more babies.

This is exactly why these days fewer and fewer Australian fertility clinics are implanting multiple embryos. But I was surprised by a 2013 survey by the National Perinatal Epidemiology and Statistics Unit at the University of NSW, which revealed that the practice is still happening despite most experts strongly warning against implanting multiples. This could be due to the demand of the IVF clinic customers - I guess it's natural that a multiple pregnancy would be seen as an ideal outcome by many parents after struggling with fears that they may never have children at all.

In reality, the majority of multiple pregnancies, especially twins, have no long-term problems and end in healthy babies. But unfortunately it's impossible to predict which multiple pregnancies will be complicated during pregnancy, birth or even later in life. What we do know from studies is that twins conceived through ART are more likely to be born prematurely than twins conceived naturally, although we have no idea why.

Similarly, singleton babies conceived via IVF are twice as likely to be born prematurely as singletons conceived naturally, but again, we're not sure why this is. We've also seen a higher risk of ectopic pregnancy after IVF, with 1.6 per cent of pregnancies being ectopic compared to only one per cent when bubs are conceived naturally. We're not certain why, although we suspect that some women who conceive through ART have undiagnosed issues with the fallopian tube which predispose them to tubal or ectopic pregnancies.

A private matter?
If you do conceive through IVF or other ART, you may have a higher chance of having a caesarean. Part of this is that couples seeking assisted reproduction are often older, and older women are more likely to have a caesarean overall, but that's not the full picture. While Australia-wide the chance of having a caesarean is 28.5 per cent that number jumps to 44.9 per cent for singleton babies conceived through IVF and 76 per cent for multiples conceived via ART.

When it comes to the health of bub, figures are mixed on the risk of birth defects. Most studies show that for any pregnancy, the risk of having a baby with a birth defect (many of them mild and easy to fix) is around four per cent. The rate for babies conceived through ART is a touch higher, between five and eight per cent.
Having said all of this, there's absolutely no need to feel you must engage a private obstetrician unless this is what you'd prefer.

Public obstetric units and midwives are well equipped to handle any pregnancy, even those of the highest risk. Your risk of complications will be assessed and you'll be assigned to the appropriate clinic. You might not be offered a place at a birthing centre if there are obstetric problems or a high degree of risk, but you'll certainly be offered a public birthing option.

The ups and downs
A quick note about the emotional rollercoaster of IVF pregnancies. There is this unfair presumption that any baby conceived through ART is a 'miracle baby' and therefore you have no right to mention the usual concerns and complaints about pregnancy; that any nausea, constipation, back pain, heartburn and even fear about the impending birth or parenthood should be kept to yourself, and any symptom should be treasured as part of the privilege of this pregnancy. As a result, some women feel confused and unsupported in what can be a difficult time for any woman.

Your GP will support you through the emotional ups and downs and you should feel free to see a psychologist through a mental healthcare plan from your GP if anxiety or depression are starting to bite.

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Three-person IVF trial shows encouraging results
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