Assistierte Reproduktion

Assisted reproduction (IVF/ICSI) is an established method for the treatment of infertility, though it entails a number of risks and limiting factors for the children and their families that really have to be considered and resolved. They also must be part of informative consultations before applying the selected (methods)/techniques. The following risks are of prime importance: 1. The increasing number of multiple pregnancies. Every multiple pregnancy has to be regarded as a complication of reproductive medicine: the rate of neonatal morbidity and mortality is higher compared to single pregnancies, and the emotional, logistic, and financial factors are significant for the concerned families. To limit these risks, it is preferable to perform only a single embryo transfer even though a lower rate of resulting pregnancies is to be expected. Of course it must be simultaneously provided that methods are developed and applied to transfer an embryo with high implantation potency. Based on existing/present results, the highest priority should not be given to pregnancy rates as high (as possible) but to the lowest possible complication rate for the infant with an acceptable pregnancy rate comparable to that achieved in fertile couples. 2. In assisted reproduction, the risk of fetal abnormalities seems to be elevated, but in some studies, according to the German IVF register, the selected method (ICSI) and other factors such as family abnormalities and environmental factors are relevant. Additional studies are required to clarify this subject and develop possible preventive strategies. 3. The children's psychomotoric development is normal as a rule. The risk of handicaps (retarded development spastic cerebral palsy) increases in accordance with the reduction of gestational period/age and the decrease of birth weight. This in turn is of particular significance in multiple pregnancies.