High-risk pregnancy

High-risk pregnancy – definition and key factors

Every pregnancy comes with a certain amount of risk, irrespective of whether it was assisted or happened naturally. The emergence of new life is a highly complex process and the cell division processes during the first days and weeks are in particular highly prone to failure. Today we know that many pregnancies end during this early stage, even before they are detected – even in young, healthy couples, the pregnancy rate is no higher than 20-30% per cycle. 

What qualifies as a high-risk pregnancy?

From the age of 35, a woman’s ability to reproduce decreases. The probability of a natural pregnancy after you turn 40 is only around 8%, while at the same time the likelihood of a miscarriage increases. Pregnancies after the age of 35 are therefore formally classified as high-riskpregnancies. This does not necessarily mean that there are specific health risks for mother and child. The term “high-risk pregnancy” is mandatory – in practice, this means that the attending doctors must monitor the progression of the pregnancy particularly closely and check it more strictly than usual.

What are the risk factors for a pregnancy?

The woman’s age is one of many risk factors for a pregnancy – even a young woman’s pregnancy is classified as high-risk if there are complications or health problems. The most common risk factors are:

• Chronic diseases such as diabetes or rheumatism
• Metabolic disorders
• Unhealthy lifestyle (poor nutrition, lack of exercise)
• Use of medication
• Alcohol, tobacco and other drugs

Formally speaking, today 25–30% of pregnant women are considered to have high-risk pregnancies. It is far less common for actual complications to occur – also because there is comprehensive medical assistance during the pregnancy.

Opportunities and risks with IVF and ICSI

With the fertility treatment we offer in our clinics, we can significantly exceed the natural pregnancy rates in all age groups. In principle, however, artificial insemination carries the same risks as a natural pregnancy:

• Ectopic pregnancy: Embryos can migrate. Even if the embryo is implanted in the womb, there is still the chance of an ectopic pregnancy. The close examination carried out during fertility treatment results in early detection and treatment of ectopic pregnancies.
• Miscarriage: 10 - 15 % of all pregnancies end in miscarriage. With in vitro fertilisation (IVF), this risk is approximately 15 - 30 %, which can be attributed to the higher average age of the patients.

In vitro fertilisation is carried out in conjunction with a hormone treatment that is aimed at stimulating follicle growth. In addition, we transfer two to three fertilised eggs each time. These procedures increase your chances of pregnancy, but can have side effects:

• Ovarian hyperstimulation syndrome (OHSS): The hormonal stimulation can trigger ovarian hyperfunction, resulting in liquid collecting in the abdomen and severe abdominal pain. If the prescribed check-up appointments are kept during the course of the treatment, the risk of OHSS is a maximum of 2%.
• Multiple pregnancy: In the case of IVF, two to three embryos are transferred every time, so that the probability of a multiple pregnancy increases. In 15 - 25 % of cases, twins are born; in 3% of cases, are triplets are born.

What risks does fertility treatment pose for the child?

In natural pregnancies, the risk of miscarriage is between 2% and 7% in Germany, depending on the extent of the examinations during pregnancy. According to current knowledge, this risk is neither higher nor lower with an IVF pregnancy than in the case of natural pregnancies.
Recent findings indicate that there is an increased risk of transmission of a genetic disorder from parent to child in the case of artificial insemination by ICSI. For example, in 3-5% of men with a serious fertility problem, a genetic factor is responsible, meaning that a child conceived through ICSI might also have a fertility problem. A very small percentage (1-2%) of infertile men also carry the gene for cystic fibrosis, which is also transferred to the child during ICSI. For this reason we recommend genetic counselling and, if necessary, an examination of the genetic material before fertility treatment is started. In our clinics we look at your individual situation and give you comprehensive advice on the diagnostic and therapeutic options to increase your chance of having a baby.