Despite a steady increase in the medical treatment of infertility with ART, there is still a lack of published evidence on their safety. Compared with other ART treatments, IVF treatment predisposes to increased maternal risks and complications, since there is alteration of the normal physiological development of pregnancy during IVF. Furthermore, use of stimulating agents can also adversely affect pregnancy outcome, including association with ovarian cysts, ovarian enlargement, and ovarian hyper stimulation syndrome (OHSS) [
3]. Ectopic pregnancy is twice as common, and pregnancy loss after 12 weeks is more prevalent with IVF-conceived pregnancies [
8]. Furthermore, multiple pregnancies account for 25% of IVF-conceived pregnancies [
9]. However, although twin and triplet pregnancies have a higher complication rate overall compared with singleton ones (including preeclampsia, gestational diabetes mellitus (GDM), thromboembolism, and preterm delivery), complication rates overall are similar between IVF-conceived and spontaneously conceived pregnancies [
10,
11]. Future studies should focus on obstetric outcomes with IVF-conceived pregnancies in larger cohorts, well matched with spontaneous pregnancies, including those that result in multiple pregnancies.
One reason for higher rates of maternal adverse outcomes with IVF may relate to the frequent categorization of women undergoing IVF as “high risk,” as they usually present with advanced age, high BMI (> 30 kg/m
2), or a pre-existing medical condition such as PCOS [
12]. A higher prevalence of spontaneous abortion occurs in IVF-conceived pregnancies in women who are also obese and/or have a history of PCOS [
13]. IVF-conceived pregnancy is a “high-risk” intervention with increased risk for maternal and obstetric complications. These include miscarriage, vaginal bleeding, frequent hospitalization, GDM, gestational hypertension, and preterm labor [
14,
15]. However, there is some controversy in the literature regarding the actual risk of adverse obstetric and maternal outcomes with IVF: in a large retrospective study by Kozinszky et al. [
10], data did not show increased rates of obstetric complications with IVF-conceived pregnancy. Cesarean section is more common with IVF. Women may consider IVF-conceived pregnancy as “precious” after many years of infertility and choose cesarean section to prevent perceived complications from a natural delivery, and not necessarily because of medical necessity [
16]. Compared with spontaneously conceived pregnancy, women with IVF-pregnancies are more likely to develop GDM. This association remains following adjustment for maternal and gestational age, and parity [
17]. It is possible that the increased risk for GDM in IVF-conceived pregnancies may stem from association with prenatal obesity or maternal PCOS (conditions that are not always specified) [
18]. Furthermore, association of IVF with GDM may develop indirectly from the effects of IVF therapy on body fat accumulation, or directly from the procedure itself, through incompletely understood mechanisms. IVF may also associate with increased risk of breast and ovarian cancer post-IVF, although this association remains poorly described and more studies are needed [
19].