Forced to Induce at 40 weeks due to IVF Pregnancy?

[SierraBravo]

I was told at my booking appointment that I wouldn't be 'allowed' to continue the pregnancy past 40 weeks, because I conceived through IVF. Looking at other MN posts, I can see that others have had this experience, but that this seems to vary quite a lot, depending on where you live. I'm hoping to get a sense of how common this policy is now (especially since most of the related MN posts are a few years old now).

So, if you had IVF, were you advised to induce before 40 weeks? Were you classed as 'high-risk' during your pregnancy (just due to IVF)? Did you see a consultant and/or was your care consultant-led? And were you able/allowed to give birth in an MLU?

Just trying to get a sense of how these policies vary in different areas.

I’ve no experience of ivf pregnancy but while hospitals do have policies for specific scenarios e.g induction for ivf/gd, YOU still have the final choice about when and how you deliver your baby, although you will probably face a lot of pressure from doctors. If you have no other risk factors that would warrant induction at or before 40 weeks you don’t have to abide by your hospitals policy, although prepare yourself for an uphill battle. I would recommend you read some literature around the topic (lots freely available on google scholar). Knowledge is power, and it will help you have a more productive conversation with the consultant.

My personal experience was that they tried to diagnose me with gd (I didn’t have it, just grow big babies) and my hospitals policy is to induce at 39 weeks, while nice guidelines are 41 weeks. Even then, they said ‘recommend induction’ and the choice would still be mine about whether and when to accept or not.

Hope this is in some way helpful. I’m sure others who have ivf experience will be able to advise you better.

Thanks for the support, Youhavewonaprize. It's good to be reminded that this is all MY choice, and that, really, the onus is on them to convince me that intervention is actually needed.

As far as I know, there aren't any NICE guidelines stating that IVF pregnancies should be induced before 40 weeks, and I believe it is just my local trust's policy to do so. To be honest, part of the purpose of this post is to "gather evidence" so to speak that this is NOT a universal policy (I'm not even convinced that it is common); I think this will help with my confidence so that I can be more assertive in discussions with my consultant.

Yes it just depends where you live, London hospitals tends to stick to the 40 rule, where I live I was treated like anyone else.

AFAIK the research evidence about IVF patients being more at risk after 40 weeks is based on a subgroup of high risk patients (eg ppl over 40) so not representative of ivf patients with no known risk factors.

I think the 40 rule is very heavy handed personally. You can choose not to and request regular monitoring instead.

I know someone who had a home birth with an ivf pregnancy

I am currently 38+3 with an IVF pregnancy and going in to be induced on Tuesday at 39+2 after two failed sweeps as my cervix is still closed (which is suggesting to me my body isn't ready). We have been told the placenta quality dramatically reduces after 40 weeks in IVF pregnancies but now I am questioning this!

I’m ivf first pregnancy no mention of being induced or really bring high risk due to ivf, delivered naturally two days early, second pregnancy ( with be 45 when I deliver) I was told not allowed to go over due date and will have sweeps etc but happy to take their advice

My area don't let ivf pregnancies go beyond 41 weeks. I asked why and they said there has been a "small study" which showed this was a safer option to prevent still birth. But his personal opinion was not that it was something to concern yourself about but 41 weeks was the line

My baby is measuring small and I'll be induced now at 37/38 weeks. Anything over 37 weeks is classed as full term. I'm not loosing sleep over it 😁

I was induced as normal, two weeks over with my first. ELCS with my second. Mind you my midwife seemed a bit confused when I mentioned the IVF, as if to say why would that affect anything.

I was repeatedly told this my community MW, in fact I planned my leave around it as I was told i wasn’t ‘allowed’ to go beyond 38 weeks.

Ended up with ELCS at 39 weeks due to breech. Consultant said they were so busy I wouldn’t have got a ‘social’ induction unless there had been other medical factors.

MW appt at 38+5 I said ‘well, here I am, still pregnant’ as she and I clashed about while preg.

I would always advocate listening to your doctors, but IVF alone should not the only reason to induce. I will say as my pregnancy progressed I got more anxious and got to the point where I wanted him here as I felt I could take more care of him our rather than in - breech plus anterior placenta meant movement were always a bit .

All the best x

Thanks for all the feedback on this!

Actually, it seems like there is more consistency between people's experiences here than I have seen on other MN threads surrounding this topic, so maybe things have become more consistent as time has passed.

I'll add my own experience, since I saw the consultant yesterday after posting this. I'm only 18 weeks ATM, though, so not sure how everything will turn out in the end.

In my case, I was told by the community MW that IVF pregnancies are automatically classed as 'high-risk', and that I would have to see a consultant as a result. She mentioned that I probably wouldn't be 'allowed' go much beyond 40 weeks, as usually that's the case for IVF.

Yesterday, the consultant was able to clarify a few things. After checking my blood pressure, urine, and baby's heart rate, and talking to me, she said she'd see me again at 36 weeks, and that I'd have an extra scan around that time. She said that they'd offer induction at 40-41 weeks, but that it was totally my choice whether or not to do that.

I asked why they offered induction for IVF pregnancies earlier than with low-risk pregnancies, and she said it was because there had been some inconclusive studies suggesting that adverse outcomes (including stillbirth) can be more likely with IVF pregnancies, but that this might also be due to other (confounding) factors, like a long history of infertility (rather than the IVF itself). She said they are just trying to err on the side of caution.

In any case, I've found it really useful and interesting to see how experiences differ in different areas of the country.

Firstly - you cannot be 'made' to have an induction. If you don't want one, you can refuse, because it's only a recommendation - even if it is a very strong one! As PPs have said, not all hospitals have a policy on this, but mine did.

I think (from memory when I was going through this), the study that this policy is based on is Danish, from 2010. It showed a small increase in the risk of stillbirth in IVF pregnancies past 40 weeks gestation, from something like 0.5% to 1% (those aren't the actual figures, as I can't find the study, just giving an indication of the sorts of numbers involved). So in percentage terms, the risk doubled, but in absolute terms, a very small increase.

Again, from memory, the study was well regarded in it's attempts to standardise the data to account for biases, but the fact remains that women that have IVF are more likely to be older, have other health or fertility issues, or have multiple pregnancies, all of which contribute to stillbirth rates unconnected with IVF and it is very difficult to isolate this risk.

When it was me on the receiving end of this, I looked at the data and in the end, accepted the recommendation. I was clear that the risk was very small, but I still didn't want to take it. As it was, DD had other ideas and came at 39 weeks - but I was booked for induction at 40.

I wasn’t offered induction for my ivf baby at 40 weeks but that was 17 years ago and things do move on. I’d listen to the drs advice - they’re the experts and should have the up to date medical knowledge.
Good luck with the rest of your pregnancy

My experience isn't very up to date as DS is now 8 but I got "consultant led care" but never actually saw a consultant, was given the option of midwife led unit and wasn't induced until 42 weeks. I wanted to be induced at 40 but it wasn't an option.

@QuantumWeatherButterfly, are you referring to the study reviewed here? I had actually seen that previously, and thought it was likely the rationale behind the recommendation. I was interested, though, that the evidence didn't seem to be strong enough to contribute to NICE guidelines or policies that are more uniform around the country.

After reading the NHS review, I think the study has done a good job of isolating the IVF procedure from some obvious risk factors (such as "subfertility", as they call it). That said, there are still other possible confounding factors. Other studies have also found contradictory results.

In my case, I'm not sure what I'll decide to do. I'm sure my decision will involve lots more research, and probably will also depend on my feelings closer to the due date.

@sierrabravo yes, I think that is the one. I see the numbers are actually a fair bit bigger than I remembered, but still low in absolute terms. I read the actual base study when it was me in the hot seat, and it was the lack of other supporting evidence that gave me most pause - as you say, other studies have been less conclusive, and 9 years later, there still isn't anything more concrete.

Overall, I felt that this single study wasn't an especially strong basis for the policy, but I am naturally risk averse and I chose to accept the consultant's recommendation. I would do so again (not that there will be an 'again')

I have had two IVF pregnancies, first was classed as high risk due to IVF and I had consultant led care but induction was only discussed as a possibility if I went to 42 weeks - I had a natural birth at 40+6. Second time I was classed at high risk due to my age (41) not the IVF and again had consultant led care. My consultant stated he wanted to induce at 40 wks but I was adamant I wanted a home birth which I had at 39 weeks - all good! It seems to be region by region but I would stress it is your choice. If I had gone to 40 weeks second time round I'm not sure I wouldn't have wanted to just be induced just in case! I would also stress my 2nd child was born nearly 6 years ago now so I'm sure changes have happened! Good luck

My DSD had this pressure of induction at 40weeks. She insisted that unless there was an absolute need, then no.

She went into labour just after 40 weeks and no issues!

Op do you know about the brain thing (benefits, risks, alternatives, instinct, what if you do nothing)? Can be helpful in making decisions like this.

They can't make you do anything, they can recommend and help you make an informed decision that's right for you.

I was considered high risk because I was over 40, but not because I had an IVF pregnancy. I was told however that medical staff would likely treat me differently because they see IVF pregnancies as high stakes, given that people have generally been through a lot to get that far. I was horrified that non-ivf pregnancies were therefore considered to be lower stakes.

@UbercornsGoggles I had similar, the MW said to me that IVF babies are more precious as people have gone through more to get them. I was horrified at the implication that a) all babies aren't precious and b) my DS was less precious than this one as he was naturally conceived

@Cyclemad222, I had not heard about BRAIN, but have now looked it up and will need to read more! It sounds like it could definitely be useful.

@SierraBravo I was told the exact same thing as you. The explanation was that they know when IVF pregnancies were conceived so the dating is more accurate and the placenta works less effectively after 40 weeks. I was consultant led due to IVF and I also have an under active thyroid. I was 34.

I was just so pleased to be having a baby that I never questioned this. I was actually induced at 38 weeks as they said baby was measuring big. It was pretty awful, two days of sitting in hospital with nothing happening then on day 3 they broke my waters. I laboured for 16 hours, took an epidural pretty early doors as the drip made the pain incredible, and was then told they would need to use forceps and finally ended up with an emergency c section and a pretty large blood loss which impacted on my contact with DS straight after birth. He was 9lb4oz.

Given the choice again, I would refuse induction and would demand to go naturally, but at the time I felt pretty out of my depth and DH and DM were encouraging me to go along with the medical advice. Obviously the ultimate goal is a healthy baby and I wouldn't want to jeopardise that but I would be more forceful next time.

@Ginger1982, your experience is exactly what I'm worried about with induction, to be honest. Obviously it wouldn't be the end of the world if the baby were in danger, and my ultimate goal is a healthy baby, but I'm not yet convinced that the risk is great enough just due to IVF to warrant early (before 40 weeks) induction. I'm hoping to avoid induction if possible, as I've heard so many stories where it seems to have lead to other interventions.

@SierraBravo I hope you manage to get what you want! I was also told that because I was consultant led, I wouldn't be able to have a birthing pool at all which was disappointing.