Highlights
- •Subfertility is common in women with liver disease and can persist post-LT.
- •Although the complications of IVF are well described in the general population, its effects on women with liver disease are unknown.
- •Women with LRSF can undergo successful pregnancies with IVF therapy.
- •Complications are potentially greater in women with liver disease, so pre-conception counselling is important.
Background & Aims
Chronic liver disease and liver transplantation (LT) can delay both timing and ability
of women to conceive. With increased awareness and availability of in vitro fertilisation (IVF), the need for accurate counselling is paramount. To date, minimal
data exist on outcomes of IVF in patients with chronic liver disease, cirrhosis, or
post-LT. We report the largest experience of IVF in women with liver-related subfertility
(LRSF).
Methods
A retrospective analysis was performed on 42 women with LRSF who had undergone 57
IVF cycles between 1990 and 2019.
Results
Forty-two women with LRSF received IVF; 9 cycles in 6 women with cirrhosis, 14 cycles
in 11 women post-LT, and 34 cycles in 25 women without cirrhosis. The main aetiologies
of liver disease included HBV, HCV, and autoimmune hepatitis (AIH). Of 57 IVF cycles
evaluated, 43 (75%) resulted in successful implantation. Eight (2 post-LT, 3 with
cirrhosis, 4 without cirrhosis) resulted in miscarriage. The live birth rate (LBR)
was 74% (32/43). Two of 9 (22%) patients with cirrhosis, 4/14 (29%) patients who were
post-LT, and 6/34 (18%) patients without cirrhosis had unsuccessful IVF attempts.
Nine of 57 (16%) IVF cycles resulted in new liver enzyme derangement during therapy,
which improved after treatment completion. Six pregnancies (2 in patients who were
post-LT, 4 without cirrhosis) were complicated by obstetric cholestasis (OC). Ovarian
hyperstimulation syndrome (OHSS) was rare (n = 3, 7%). One patient with AIH-related
cirrhosis decompensated after initiating IVF, warranting discontinuation of therapy.
There were no maternal deaths. Three women developed a hypertensive disorder of pregnancy.
Half the pregnancies resulted in premature deliveries (range 27–36 weeks).
Conclusions
In selected cases, IVF in women with LRSF can be successful. However, patients should
be counselled on the potential increased risks of OHSS, OC, and prematurity.
Lay summary
Women with liver disease or those who have had a liver transplant can experience difficulties
getting pregnant. In this study, we look at whether alternative approaches to achieve
pregnancy are harmful in these women. Overall, there were no significant issues with
the use of in vitro fertilisation in women with liver disease, but they need to be aware of potential
risks, such as early delivery of the baby.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: January 15, 2021
Accepted:
December 16,
2020
Received in revised form:
November 24,
2020
Received:
September 1,
2020
Identification
Copyright
© 2021 Published by Elsevier B.V. on behalf of European Association for the Study of the Liver.
