Babies conceived via assisted reproductive technology (ART), of which in vitro fertilization (IVF) is the most common, have a slightly higher risk of birth defects, which may be related to factors such as maternal age and lifestyle factors.
The risk of hemolytic disease of the fetus and newborn (HDFN) is not greater in babies conceived through IVF, but it may occur unexpectedly in cases of IVF when sperm is donated. While taking into consideration the blood factors of potential sperm donors can help avoid the risk of HDFN, blood group incompatibility (A, B, AB, O) is more difficult to predict.
What is HDFN?
Hemolytic disease of the fetus and newborn (HDFN) is an immune-mediated red blood cell disorder that occurs when a baby’s RBCs break down quickly, which is called hemolysis. HDFN is caused by a mismatch between a mother’s and her baby’s blood type (A, B, AB, or O) or Rhesus (Rh) factor (Rh-positive or Rh-negative) during pregnancy.
In vitro fertilization (IVF)
IVF is a solution for pregnancy in cases of male infertility, endometriosis and explained infertility and now represents 1.6% of live births in the US and 4.5% in Europe.
The IVF procedure involves a woman’s eggs being extracted and fertilized by sperm, collected either from a partner or a donor, in the laboratory. The resulting embryos are then transferred to the woman’s uterus via the cervix.
Donated sperm is used in cases of male infertility as well as by women who do not have a partner or cannot or do not want to use their partner’s sperm. Sperm donors undergo a rigorous screening process that includes a full medical history, including testing for sexually transmitted diseases, plus testing for hereditary, genetic and infectious diseases.
Donors must be in good physical and mental health and are usually aged between 18 and 40 years old. Lifestyle factors that may affect the sperm quality are also assessed, such as sexual habits and drug use. The donor’s sperm is also analyzed to check for sperm count and shape.
Reducing the risk of HDFN in IVF
As HDFN is a red blood cell disorder, blood type and factor is important to consider when choosing a sperm donor when preparing for IVF. For women who are Rh-negative, it is advised to choose a Rh-negative donor to avoid the risk of Rh incompatibility in the fetus.
HDFN can also occur as a result of ABO blood group incompatibility, with cases of ABO-related HDFN often less severe than Rh-induced HDFN. It most commonly occurs in mothers with blood type O who have babies with blood type A.
HDFN is hard to predict, but once detected, it can usually be successfully treated in utero by intrauterine blood transfusion and following delivery by phototherapy.
