Worries and Risks

I'm starting to realize that IVF has not in fact made me more paranoid than most pregnant women, pregnancy does that all on its own. In recent weeks I have talked to friends, read message boards and noticed Facebook status updates about all kinds of worries from pregnant women. Most of them are first time moms, but some have been through pregnancy before and still have concerns. Some of those are:

• If I am emotionally stressed can that hurt my baby?
• Can my baby sense fear?
• Is it normal to not feel pregnant in the second trimester?
• Shouldn't I be able to feel my baby by now?
• I felt a flutter yesterday and today I don't feel anything....is my baby still okay?
• How hot is too hot for a bath?
• Is it okay to exercise?
• Will tight pants hurt my baby?

These don't even include the many comparisons I have seen from moms whose second pregnancies are not progressing the same way their first ones did. For me it has been comforting to see that others share my worries and even worry about things that have never crossed my mind (like jumping jacks causing early labor--months early labor).

This has been a hard month for me because other that my small chubby tummy (that really looks more like I overate than a baby bump) I don't feel pregnant anymore. It's still too early to feel the baby really move and I have not had an ultrasound in five weeks--which is our longest wait in between ultrasounds so far! Our next scheduled one is not until the 20 week mark (I am 17 now), but we have decided to go to one of those fetal photo studios some time in the next week to find out our baby's sex. I cannot wait to see our little one again...just to make sure he or she is still growing and moving around in there!

I admit I have been giving myself more reason to worry by looking up possible complications and common risks associated with IVF pregnancies (I know...Google for me is just as dangerous as WebMD for someone with a headache!) I found out that there were risks involved when I first started researching IVF; the most common risks being preterm labor and low birth weight. I don't care how early our baby comes or how tiny baby is, as long as he or she is healthy, so those are not extremely major concerns for me. In the last few weeks I have learned more about why IVF pregnancies are considered higher risk than naturally conceived pregnancies.

It all started about a week after my first appointment with my OB, when her nurse called to tell me that my urine sample showed elevated glucose levels, but it was contaminated (not a "clean catch") so I needed to come back and take another. Two urine samples later (thanks to my high positioned urethra, which apparently is common, the last urine sample was by catheter--which was a very uncomfortable experience) my glucose levels were still elevated. Elevated glucose is a sign of gestational diabetes so my doctor ordered a glucose blood test. For this I had to go in, drink a super sugary drink then wait an hour for them to draw my blood. This test is commonly done at around 28 weeks, but I took it at 15. Luckily everything came back normal.

I found out along the way that patients who become pregnant through IVF are at an increased risk of developing both gestational diabetes and preeclampsia. I started to wonder why. Then I started to wonder why any of the pregnancy risks were higher for IVF pregnancies. What I found is that the risks have more to do with the infertility factor and reasons couples used IVF in the first place than with the procedure itself.

Gestational Diabetes

This is a risk commonly associated with older moms and pregnancies of multiples (twins, triplets, etc.), so maybe IVF pregnancies are more at risk for GD because they also carry a higher risk of multiples and IVF is common among women over 35 trying to conceive.

Preeclampsia

Again, this is a condition that appears to have more to do with maternal age than with IVF in general. That being said, pregnancy in women over 35 is considered higher risk with or without IVF and older moms are often encouraged to see a doctor specializing in high risk pregnancies, like a maternal fetal medicine doctor.

Preterm Birth (before 37 weeks)

Most know this is common in multiple pregnancies, but even singletons are twice as likely to be born prematurely when IVF is used to become pregnant. Doctors don't know exactly why this is the case, but studies suggest it could be due to the hormones women take before embryo transfer playing a role in how the embryo implants, increased monitoring causing doctors to take a baby early because of the foreseen risk of a possible complication or maternal factors (cause of the infertility, maternal age). Likely it is a combination of several factors.

Premature Labor

Causes of infertility play a huge role in this. Uterine defects such as fibroids and scarring can cause poor intrauterine growth and lead to premature labor. Endometriosis and pelvic adhesions can restrict uterine growth, leading to premature labor. Because these types of conditions make it difficult to get pregnant, women with these conditions are more likely to use IVF, so it makes sense that the risk is higher in IVF pregnancies.

Low Birth Weight

Again nobody seems to know exactly why low birth weight is a risk with IVF pregnancies. Low birth weight is another common risk among multiples and multiples are common with IVF, but even IVF singletons have a slightly higher chance of low birth weight compared to naturally conceived babies. Some studies suggest it could have something to do with the ovarian stimulation that occurs before egg retrieval (but that would only impact fresh transfers) and other studies think it might have something to do with how long the embryo grows in the culture (2-3 days vs. 5-6 days) before it is transferred to the woman's uterus. The common conclusion seems to be that more research is needed.

As you can see I did not really get very many clear answers. All I know for sure is that there is a possibility that our baby might come early because of my past uterine polyps, uterine fibroids, and endometriosis (basically my uterus has had issues inside and out!) So far our baby has been growing and developing just fine, and even a few days ahead. For once, my Google research has put my mind at ease. Now if only Google could tell me if we're having a boy or a girl! I admit I am starting to get a little anxious...