IVF and the need for fetal echocardiography

In this article, we want to discuss whether mothers who have used assisted reproductive methods such as IVF need echocardiography of the fetal heart or not?

Expanding the use of IVF method

Holding a baby and breastfeeding him is one of the dreams of every woman and one of the sweetest moments of life for every mother. Families who are facing problems in pregnancy. They have certain challenges in life. Many of these challenges are solved with the arrival of a child. Today, with extensive scientific advances in the world, many cases of infertility among couples are treated. The acceptance of these methods has expanded a lot in recent decades. To the extent that in 2005, during a research in the United States, it was determined that one out of every hundred births occurred through IVF. Therefore, considering that this subject has a large audience. I decided to explain about one of the screening tests in this group. Related article: Is it obligatory to do fetal heart echo?

Different chromosomal abnormalities and genetic mutations cause less than 15% of congenital heart defects. In most cases, the cause of congenital heart disease is unknown. In the studies conducted in different societies, the prevalence of congenital heart diseases in pregnancies that occurred with assisted reproductive methods such as IVF. It is between **one to three times** of people who have conceived naturally.

Fetal heart echo is one of the screening methods for fetal heart defects. It is recommended for all women who have used assisted reproductive methods such as IVF. This method of diagnosing heart diseases in the womb started about 55 years ago, that is, in 1965. At first, abnormal heartbeats were detected in this method, but until today, it has made significant progress. With the advancement of technology and knowledge in this method, abnormal fetal beats have been identified. It is possible to visualize the anatomy of the fetal heart and to diagnose structural congenital heart diseases. Related article: What is fetal heart tape and how is it done?

The best time to do fetal heart echo is from 18 to 22 weeks of pregnancy. Before this time due to the small size of the fetus and after this time due to the ossification of the ribs, the image resolution decreases and the accuracy of the work decreases. An important point that exists in our dear country Iran. This is if a complex heart problem is diagnosed in the fetus and the parents decide to terminate the pregnancy. Abortion is legally allowed only until the end of 18 weeks and 6 days, and abortion is not legally allowed after this time. This shows the importance of the right time to perform echocardiography of the fetus.

However, in recent population studies, the rate of prenatal diagnosis of heart lesions in practice and in different regions is very low and highly variable. Even in some reports** 20% to 42% have been reported. There are several reasons for this difference, including:

- Experience as a sonographer or medical provider. The level of knowledge and skill in this work is very decisive in the result of the work - Time limitations, if done before or after 18 to 22 weeks, fetal heart echo significantly reduces the accuracy of the work - Specific characteristics of patients, such as poor image views in obese mothers or special positions of the fetus during echocardiography, can affect the accuracy of the work - technical limitations or differences in devices with different diagnostic accuracy used for fetal echocardiography

The exact cause of this issue is not known, but there are assumptions based on which they guess that it is one of the causes of this problem. These factors include the following: ### Mother's age In most cases, mothers who use assisted reproductive methods such as IVF. After a few years of their life together, they go for treatment and in most cases the average age of these women is higher compared to women who get pregnant naturally. Certainly, with increasing age, the possibility of problems and complications of pregnancy increases, and heart problems are also among these cases. ### twins In pregnancies where assisted reproductive methods are used. For example, with IVF, the probability of identical twin pregnancy is higher than cases where pregnancy occurs naturally, and it has been proven that the incidence of congenital heart diseases in monozygotic twins is higher than in singleton pregnancies. ### Factors affecting infertility In many cases, we do not know the main cause of infertility in couples. In infertility treatment methods such as IVF, we can cause pregnancy in these couples only during treatment. In other words, we bypass the unknown causes that cause infertility and create pregnancy. This hypothesis is proposed. The same unknown factors that cause infertility in couples also increase the incidence of congenital heart diseases in such pregnancies.

The results of a fetal heart echo suggest the possibility of three different states for the fetal heart, which is very important in the actions and decisions of the parents to continue the pregnancy. The pediatric heart specialist announces one of these results after the echo. ### The fetal heart is healthy: The first condition is that the echocardiogram of the fetus shows that the heart of the fetus is healthy. We assure the couple that there is no dangerous heart problem and the parents can continue the pregnancy safely. It is recommended to perform an echo of the baby's heart after birth, only to check possible small defects, which is the most suitable time from about ten days after the birth of the baby to the end of the first month of life. ### Complicated heart disease in the fetal heart: In the second case, a complex heart disease is diagnosed in the fetus, and in this case, all possible future risks for the fetus and the family itself are explained to the couple. If there is a desire to terminate the pregnancy after the consultation. We will introduce him to the legal doctor for further consultation. ### low-risk heart problem in the fetal heart: The third case is cases where there is a heart problem. But it is not dangerous enough to cause hardship and embarrassment for the family. In other words, it either gets better on its own, or after the birth of the baby, they can be treated completely by performing primary care measures until surgery or angiography. Their child will eventually lead a normal life. Sometimes, in these cases, the family is advised to have the baby born in a hospital with special neonatal unit (NICU) facilities, so that an action can be taken for the baby after birth. In the end, the result of a fetal echo provides this possibility. to detect or rule out a heart problem and this can help the doctor. To give proper advice to parents and help parents to make the best decision for their child's future and their own life. To read more, refer to the following content. https://www.isuog.org/resource/in-vitro-congenital-heart-defects.html https://www.healio.com/news/primary-care/20180102/ivficsi-techniques-may-increase-risk-for-congenital-heart-defects-in-newborns **Dr. Saeed Bitarafan, pediatric and fetal cardiologist**