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IVF pregnancies do not require routine fetal echocardiogram monitoring

26 July 2021
Appeared in BioNews 1105

Contrary to current recommendations in the USA, routine fetal echocardiogram screening may not be needed for the majority of IVF pregnancies. 

Research carried out by Dr Kurt Bjorkman and his colleagues at the Yale University School of Medicine, Connecticut, found there was no significant difference between the incidence of coronary heart disease (CHD) in IVF pregnancies compared with spontaneously conceived pregnancies. 

Dr Bjorkman commented in Contemporary ObGyn that 'the incidence of CHD present at birth – as detected by fetal echo in [IVF] pregnancies without other risk factors for CHD – was 0.9 percent' which was not significantly different from the rate in the general population. Of the fetuses conceived via IVF which were detected to have CHD, 'most were ventricular septal defects that either resolved spontaneously prior to birth or shortly after and required no further follow-up'. 

The cohort study, published in the journal Fertility and Sterility, looked at records of 181,749 live births and 9252 fetal echocardiograms, of which 2230 were from IVF pregnancies, the majority of which had no additional risk factors for CHD. Researchers findings showed there were limited benefits to performing routine fetal echocardiography in IVF pregnancies where there are no additional risk factors for CHD.

Previous literature on the subject, identified IVF pregnancies as having an increased risk of CHD. Currently the American Heart Association, the American Institute of Ultrasound in Medicine and the American Society of Echocardiography all recommend routine echocardiography screening. 

However, Dr Bjorkman and his team did not find evidence to support this in their cohort study. Patients in the study who had successfully conceived through IVF and who had additional confounding factors, such as an increased rate of multiple gestations and increased maternal age, were reported to have a much higher rate of CHD and were indicated for echocardiogram screening. Whereas the rates of 'clinically significant CHD detected by fetal echo in pregnancies without other risk factors was only 0.2 percent' said Dr Bjorkman. 

These statistics may come as a relief to the increasing number of families using IVF to get pregnant. 

Dr Bjorkman commented that routine echocardiography inflicts 'significant financial and time-consuming burden to the medical system' and 'additional stress' to the patients receiving it; another reason they are encouraging a re-evaluation of the current recommendations for low-risk IVF pregnancies. 

Their results suggest those with certain risk factors should be offered routine echocardiography screening and it should not be scrapped completely.

SOURCES & REFERENCES
Risk factors determine need for fetal echocardiogram in IVF pregnancies
Contemporary Ob/Gyn |  22 July 2021
Utility of routine screening fetal echocardiogram in pregnancies conceived by in vitro fertilization
Fertility and Sterility |  28 June 2021
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