A new Australian study has revealed that pregnancies resulting from assisted reproductive technology (ART), including in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), may be more likely to be exposed to teratogenic medications—drugs that can harm the developing fetus—compared to naturally conceived pregnancies. The study, which investigated over 57,000 pregnancies, highlights potential risks associated with the use of certain medications during ART procedures.
Researchers found that ART pregnancies had a significantly higher exposure to Category D medications, which are known to pose a risk to the fetus but may be deemed necessary for certain medical conditions, such as managing mental health disorders or epilepsy. These drugs are classified by Australia’s Therapeutic Goods Administration (TGA) as potentially harmful during pregnancy. In contrast, Category X medications, which are known to cause severe fetal harm, were found to be used minimally across all pregnancy groups.
The study was a joint effort by researchers from the University of South Australia (UniSA), The University of Western Australia (UWA), and The Kids Research Institute Australia. Over a two-year period, the team analyzed data from four groups: ART pregnancies (2041 cases), pregnancies induced with ovulation-stimulating drugs (590 cases), untreated sub-fertile women (2063 cases), and naturally conceived pregnancies (52,987 cases).
Findings revealed that 4.9% of ART pregnancies were exposed to Category D medications in the first trimester, compared to just 0.6% of naturally conceived pregnancies. This disparity persisted into later trimesters, with 3.4% of ART pregnancies exposed to Category D drugs versus 0.6% in the naturally conceived group. Exposure to Category X medications remained low across all groups, at less than 0.5%.
Dr. Anna Kemp-Casey, the lead researcher of the study, explained that these differences were primarily attributed to medications prescribed following ART procedures to prevent recurrent miscarriages or implantation failure. For example, ART pregnancies were more frequently exposed to progestogens like medroxyprogesterone acetate, which are commonly used to manage threatened or recurrent miscarriages.
The most frequently used Category D and X medications across all pregnancy groups included paroxetine (an antidepressant), lamotrigine (used for epilepsy), valproic acid (for epilepsy and mood disorders), carbamazepine (for epilepsy), and medications for nicotine dependence.
Professor Roger Hart, co-researcher and IVF clinician at UWA, cautioned that while ART pregnancies are carefully planned, the medications used during fertility treatments may inadvertently increase the risk of birth defects, especially during critical fetal development periods. However, he emphasized that the vast majority of babies born through ART are healthy, and the study does not suggest that ART pregnancies are inherently unsafe.
The researchers concluded that these findings underline the importance of personalized medical care for women undergoing ART treatments, with a focus on careful monitoring during early pregnancy. Further research is needed to better understand the long-term effects of Category D and X medication exposure and to examine the role of maternal health conditions in contributing to birth defect risks in ART pregnancies.
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