In vitro pregnancy is a sensational event in life of couples and thus, it should be deemed as gold pregnancy. The loss of in vitro fertilization pregnancy can cause a bigger trauma than the normal pregnancy losses as it is achieved in a hard way. Although everything goes well at early stages, some negative situations may be experienced in subsequent stages. Adverse events, also including pregnancy loss, are listed below.
Low HCG Levels: ß- HCG is a test that is analyzed 12 days after in vitro fertilization therapy. The risk of pregnancy loss is lower if the level is approximately 100 in first check and it elevates two folds 2 days later. However, development of gestational sac decreases if the first HCG level is below 50 or if it does not increase two folds on subsequent analyses even though the second reading is >100. This situation is identified as chemical pregnancy.
Development of Empty Gestational Sac: It is expected that the gestational sac is visualized on vaginal ultrasound imaging approximately 10 days after the first blood test. A baby, approximately 6-7 mm in height, and heart beats should be observed in gestational sac 20 days later. We can face a complication, contrary to this, in 10% of patients. In other words, baby cannot be seen in the gestational sac. It is often believed that possible genetic or structural abnormalities of embryo cause defective developments such as this.
Loss of Heart Beats: This means the loss of heart beats while heart beats are visualized in former checks. This situation can occur frequently in the first one month after the pregnancy is diagnosed. This condition represents one of the most traumatic events for couples who are all set to have a baby. Although underlying cause cannot be mostly identified, it is believed that along with genetic and structural abnormalities of embryo, structural problems that decreases intrauterine nutrition result with this condition.
Vaginal Bleeding During Pregnancy: This symptom is often harmless. However, since it reminds miscarriage and it is regarded as threatened miscarriage, it exerts negative influence on couples, although ultrasound verifies a healthy pregnancy. In this case, resting and medicines, containing pregnancy hormone and progesterone, are commonly recommended. Mostly, bleeding disappears in several weeks. Although this type of bleedings is frightening, the possibility of pregnancy to result with miscarriage is a rare situation.
Investigating medical conditions, such as thyroid diseases, anemia, hypertension and diabetes mellitus, which exert influence on pregnancy: Screening tests are very important to foresee possible problems and to take measures. Complete blood count and urinalysis should be repeated at quarter intervals during the supervision of pregnancy. However, this frequency can be modified for suspected conditions. Those tests make us to diagnose many adverse conditions, including but not limited to pre-eclampsia (prednancy-induced hypertension), anemia and urinary tract infection. In addition, pre-diabetes can be investigated with glucose loading test at Week 26.
Determination of Genetic and Structural Anomalies: Ultrasound is the most useful factor to determine genetic and structural anomalies. Organ anomalies can be revealed out with ultrasound imaging at routine monthly visits. The most important gestational age for the follow-up visit combined with ultrasound imaging is week 20, as organ development is completed. Since clearer image of all organs can be obtained, detailed imaging can be done at this week. Considering blood testing, investigations to determine some genetic anomalies, such as Down syndrome, are also very important. These are double, triple or quad screen tests. Double screen test is performed in Week 12 or 13, while triple or quad test is performed in Week 16 and 17. Since those are screen tests in nature, they ensure early diagnosis of the disease by 60-70% in average. Therefore, future or expectant mothers are recommended one of those two tests during pregnancy follow-up. Amniocentesis (obtaining a sample from the fluid that encloses the fetus in mother’s abdominal cavity using a fine needle) clarifies the diagnosis in expectant mothers with increased risk. Recent developments generate details about the fetus (the baby in the mother’s womb) without requirements of obtaining sample from the amniotic fluid. This test is Fetal DNA analysis of the baby in the mother’s womb. Fetal DNA analysis is performed in our facility.
Preventing Preterm Birth: The essential purpose of a pregnancy follow-up is to prevent maternal health and the second one is to ensure that the mother delivers a healthy baby. However, baby can be lost due to preterm birth although he/she is healthy during pregnancy. Even if the baby survives, some negative consequences may occur during the life. Those negative events occur as the baby is not sufficiently developed for extra-uterine life and accordingly, organs are irreversibly damaged easily. Therefore, the preterm birth can influence the fate of the entire family. Accordingly, it is very important to prevent the preterm birth. In this end, most important approach is to prevent multiple pregnancy. We believe that advancements in modern medicine may eliminate the risk of multiple pregnancies in the field of in vitro fertilization by determining embryos that will implant by 100 percent. One another approach with significant importance to prevent preterm birth is to determine insufficiency of cervix. Length of cervix should be measured with vaginal ultrasound especially in Week 12 of pregnancy for every future mother. Normally, this length should be 4 to 6 cm. However, an important risk of preterm birth occurs when it decreased to 3-cm. This risk can be prevented by placing cerclage suture to this region during pregnancy.
Selecting Type of Delivery: Similar to every future mother, expectant mothers of in vitro fertilization pregnancies also are in two minds about caesarean section or spontaneous vaginal delivery. In vitro fertilization pregnancy does not differ from the natural pregnancy in terms of pregnancy and delivery characteristics. The only difference is about the difficulty and troubles taken in the in vitro fertilization pregnancy and the couple might not have another chance, if the pregnancy terminates. In such cases, caesarean section is preferred in order to get rid of the stress of waiting for a delivery at an unclear time and to protect the baby against delivery trauma. However, this condition is caused by different related expectations rather than the way to achieve pregnancy. Even so, it is not correct to decide caesarean section just due to in vitro fertilization pregnancy, if other indications are not also met.
The In Vitro Fertilization implies fertilizing a human oocyte with a human sperm at the laboratory settings and transferring the resultant embryo into the womb.
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