IVF and ICSI pregnancies show higher exposure to teratogenic drugs

IVF and ICSI pregnancies show higher exposure to teratogenic drugs

A new Australian study has revealed a potential reason why some pregnancies achieved through assisted reproductive technology (ART) may result in birth defects compared to naturally conceived pregnancies.

The researchers found that in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) pregnancies had the highest exposure to teratogenic drugs that can potentially harm the fetus during the first trimester of pregnancy.

These are listed as Category D and X drugs by Australia's Therapeutic Goods Administration (TGA).

The risk associated with the use of category D drugs in pregnancy may be outweighed by the clinical benefit in individual cases such as the management of mental disorders or epilepsy. Category X drugs, on the other hand, are strongly discouraged during pregnancy due to the high risk of fetal harm.

Researchers from the University of South Australia (UNISA), the University of Western Australia (UWA) and the Kids Research Institute Australia analyzed more than 57,000 pregnancies across four concept groups over a two-year period. The groups included Women with Art (2041); those taking medications to induce ovulation (590); untreated subfertile women (2063); and naturally fertile pregnancies (52,987).

Artificial pregnancies had the highest exposure to category D drugs taken in the first trimester.

The study found that 4.9% of artificial pregnancies were exposed, compared to just 0.6% of naturally conceived pregnancies.

The trend continued in later trimesters, with 3.4% of artificial pregnancies exposed to Category D drugs versus 0.6% of naturally conceived pregnancies.

Exposure to category X drugs (which caused the most harm during pregnancy) was low in less than 0.5% of pregnancies across all groups and trimesters.

“These differences in exposure are primarily associated with medications used as adjunctive treatment after ART to prevent recurrent miscarriages or failed implantations, rather than medications used to treat the underlying chronic conditions,” says Dr. Anna Kemp-Casey, who led the study.

For example, artificial pregnancies were more likely to be exposed to progestogens such as medroxyprogesterone acetate during the study period, which may have been used to treat threatened or recurrent miscarriages. “

Dr. Anna Kemp-Casey, UNISA researcher

The five most commonly used Category D/X medications in all pregnancies regardless of conception status were paroxetine, lamotrigine, valproic acid, carbamazepine, and nicotine dependence treatments.

UWA co-researcher Professor Roger Hart, also a practicing IVF clinician and national medical director for urban fertility, says the higher exposure to category D and X drugs in artificial pregnancies during the first trimester may contribute to the higher rate of birth defects in artificial babies.

“Although artificial pregnancies are carefully planned, medications taken during fertility treatments can inadvertently increase exposure to birth defect risks, particularly at critical times in fetal development,” says Prof. Hart.

Researchers say the results show that the vast majority of IVF babies are healthy and do not suggest that artificial pregnancies are unsafe, but they underscore the importance of personalized medical care for women undergoing artificial treatment and close monitoring of women in early pregnancy.

Prof Hart says further research is needed to examine category D and X exposure in pregnancy, as well as underlying maternal medical conditions and their contribution to the risk of birth defects in artificial babies.

The study was published in theAustralian and New Zealand Journal of Obstetrics and Gynecology.

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