Assisted Reproduction in Patients with medical conditions
Underlying medical conditions can often be a determining factor in assisted reproduction outcome, as they impose a number of risks for both the mother and the baby. If you suffer from any chronic conditions, including the ones discussed in the sections for obesity, diabetes mellitus, High Blood Pressure (HBP) and genetic conditions, you need to discuss it with your doctor during your preconception consultation. Appropriate treatment and potential management of any underlying conditions can greatly minimize the risks involved.
The World Health Organization (WHO) defines obesity as a condition of abnormal or excessive fat accumulation that may impair health. The Body Mass Index (BMI) is a measure of whether someone is over- or underweight and is defined by a person’s weight in kilograms over their height in squared meters (kg/m2). According to WHO:
- A person with a BMI greater or equal to 25 is considered to be overweight.
- A person with a BMI greater or equal to 30 is considered to be obese.
Under HAAD regulations, a patient with a BMI greater than 35 has to be referred to a weight control program before proceeding with an Assisted Reproductive Technique (ART) treatment.
The risks associated with overweight pregnant women include pre-eclampsia, HBP, and gestational diabetes among others.
In fact, obesity interferes with hormonal and metabolic processes leading to infertility, poor-outcome In-Vitro Fertilization (IVF), or in the case of a pregnancy, it is a reason for repeated miscarriages. We often see obese infertile patients that lose weight, to regain regular, normal ovulations and who then easily become pregnant.
It is a lifelong condition characterized by the loss of body’s ability to absorb and utilize the blood sugar content.
Women with diabetes have a disturbed ovarian function, which is a well-known reason for infertility and repeated miscarriages. Men with diabetes may experience disrupted erectile and ejaculatory functions, such as in retrograde ejaculation that affects the presence of sperms in the semen.
Strict metabolic control often resumes ovulation and allows ovarian stimulation during IVF. Well-controlled diabetes is not associated with miscarriage, but it remains a risk factor for HBP. Close monitoring and treatment adjustment during pregnancy can lead to a good assisted reproduction outcome in these instances.
Affected diabetic men can be treated with medication or undergo a urine sperm recovery method with no further risks involved.
High Blood Pressure (HBP) can occur in pregnancy either as a pre-existing condition (chronic hypertension), or as a pregnancy complication (gestational hypertension), such as pre-eclampsia or the more serious full spectrum eclampsia.
Women with chronic HBP need to continue taking drugs to control blood pressure, although these are replaced with pregnancy-safe alternatives. Generally, HBP is not a contraindication for conceiving, but it is important to remain controlled throughout pregnancy. This is achieved by medication adjustment through frequent monitoring of the mother’s health and the baby’s development (for instance with blood and kidney-function tests as well as ultrasound scans).
The major endocrine organs – namely the pituitary, thyroid gland, adrenal gland and ovary – play very important roles in fertility and during pregnancy. Therefore conditions linked to abnormal endocrine function often lead to infertility and pregnancy complications.
Common endocrine disorders include hypothyroidism or hyperthyroidism, and hyperprolactinemia among others. These can be managed / solved with medical treatments, allowing fertility and pregnancy to occur. Regular screenings and blood tests in these cases can detect problems and lead to the desired outcome, a successful assisted conception, pregnancy with minimal complications and birth of a healthy baby.
For couples with genetic conditions, we offer genetic counselling and careful planning for avoiding propagation of the affected genes.
If the genetic condition does not affect fertility (as in male patients with cystic fibrosis, for instance), fertilization following IVF can be easily achieved. The next step in these instances is to screen the prospective embryo(s) with Preimplantation Genetic Diagnosis (PGD) and / or Preimplanation Genetic Screening (PGS) to select the best one(s) – the non-carrier(s) of the genetic condition – for transfer in the womb.
In cases that the genetic condition influences the success of IVF, a treatment or employment of a method (such as Testicular Sperm Extraction (TESE) in the case of cystic fibrosis) are a pre-requisite to the ART. If successful, the obtained embryo(s) will again be screened and selected for avoiding adverse heredity with PGD and / or PGS.