What Fertility Clinics Don't Say: The Hidden Risks of Assisted Reproduction

The rapid expansion of Assisted Reproduction Technologies (ART) over recent decades has profoundly reshaped how society understands infertility, motherhood, and fatherhood. What was initially presented as an exceptional medical intervention has gradually become a widely normalized solution for those struggling to have children. More than 15 million children have now been born through ART worldwide;¹ in countries such as Spain, births from these techniques account for nearly 14% of all newborns,² while in the United States they represent approximately 2.6% of annual births.³ 

Yet this normalization has been accompanied by a serious information gap on two fundamental issues: the real success rates of these techniques and the health risks they pose to children. These omissions raise important questions not only for medicine, but also for family studies, public health, the ethics of reproductive decision-making, and even the prospect of future collective litigation.

Public Perception vs. Reality

As I explain in my book The Last In Vitro, public perceptions of assisted reproduction have been shaped by an incomplete and, in many cases, misleading narrative regarding both efficacy and safety. Fertility clinics commonly report their success rates in terms of positive pregnancy tests rather than live births, despite the fact that couples are seeking a child, not merely a favorable test result. This distinction is far from trivial. When official registries are analyzed using live births as the relevant outcome, success rates decline dramatically with age. Among women over 40, the probability of having a child using their own eggs falls to around 5% or 6%; by age 45, it barely reaches 2 percent. Yet public discourse routinely conveys the impression that reproductive technology can effectively overcome the biological limits of age.

Public discourse routinely conveys the impression that reproductive technology can effectively overcome the biological limits of age.

Psychologists are well aware of the considerable emotional exhaustion experienced by many couples after years of failed treatments⁴—an exhaustion that remains largely invisible in public discussions, where success stories and optimistic portrayals of reproductive technology tend to dominate. Yet this psychological burden is not limited to failed cases; troublingly, it is often present in successful ones as well. The low live-birth rates, combined with relatively high pregnancy rates, mean that many positive pregnancies end in gestational loss. When a child is ultimately born alive, the mother will commonly have suffered several miscarriages whose grief she never fully processed. After each loss, the focus shifts to moving forward and sustaining hope for the next attempt. As a result, perinatal psychologists and psychiatrists are increasingly recognizing that some women who become mothers after prolonged infertility and ART enter the postpartum period carrying unresolved reproductive trauma. This may manifest as persistent anxiety, hypervigilance, difficulties enjoying motherhood, and, in some cases, challenges in establishing a relaxed and confident early mother–infant relationship, highlighting the need for specialized psychological support.

Health Problems in the ART Population

Yet perhaps the most alarming concern involves the serious health problems observed in the ART population. The wide range of conditions identified falls into three major categories: congenital disorders detectable before birth, complications related to prematurity identified at birth, and diseases that emerge later in childhood.⁵

Among congenital conditions detectable before birth, elevated risks have been reported across multiple organ systems, including the cardiovascular, respiratory, neurological, digestive, and genitourinary systems. The scientific literature has also documented higher rates of syndromes associated with epigenetic alterations, such as Beckwith-Wiedemann syndrome, Russell-Silver syndrome, Angelman syndrome, and Prader-Willi syndrome. These conditions are especially concerning because they arise at the earliest stages of development and often carry lifelong consequences for both children and their families.

A second category consists of conditions detected immediately after birth, most notably prematurity and low birth weight, which disproportionately affect ART children. The evidence shows that ART children have higher rates of preterm birth, extreme prematurity, low birth weight, neonatal seizures, need for intensive care, and perinatal mortality.

Third, there are conditions that may appear years after birth. Multiple studies5 associate ART with increased incidence of cerebral palsy, epilepsy, autism spectrum disorders, hypertension, asthma, allergies, type 1 diabetes, language disorders, and certain pediatric cancers, including leukemia, lymphoma, melanoma, retinoblastoma, and kidney and liver tumors.

The manipulation of gametes and embryos in laboratory conditions may interfere with the mechanisms that regulate gene expression.

The cause for concern lies not merely in the existence of isolated studies showing elevated incidence, but in the fact that the same pattern of risk appears repeatedly across different countries, populations, and research designs. A significant methodological problem also arises in many studies that compare ART children with naturally-conceived children: variables such as prematurity, low birth weight, or multiple pregnancy are routinely treated as external factors or “confounders,” when in reality they are part of the causal chain associated with assisted reproduction itself. Statistically controlling for them may artificially reduce the apparent impact on children’s health. Put differently, the true increase in risk may be even greater than current studies suggest.

From the perspective of developmental biology, the observed increase in risk makes sense. The earliest stages of embryonic development are extraordinarily sensitive, and the manipulation of gametes and embryos in laboratory conditions may interfere with the mechanisms that regulate gene expression. Procedures such as ovarian stimulation, embryo culture, intracytoplasmic sperm injection (ICSI), and cryopreservation all take place during a critical window in which the embryo is establishing essential programs of genetic and epigenetic regulation. Even minor environmental perturbations at this stage could shape future susceptibility to disease.

The growing use of gamete donation—and its possible biological, psychological, and familial consequences—is another issue the assisted reproduction sector has largely kept out of public view. When an embryo is conceived using the mother’s own eggs, a balanced biochemical dialogue is established between mother and embryo. Although the mother’s body recognizes the embryo as genetically distinct, it is also biologically familiar because it shares half her genetic material. This balance matters because the embryo’s immune system develops within that dialogue. Egg donation, however, may increase the risk of pathogenic structural DNA alterations due to the greater genetic and immunological dissimilarity between the embryo and the recipient mother, potentially compromising genomic stability during embryonic development.

Mental and Emotional Harms

At the psychological level, donor-conceived individuals have frequently reported that not knowing their biological origins can affect identity formation and emotional well-being. Multiple studies⁶ document higher rates of anxiety, depression, and identity confusion in this population, along with a strong desire to know their biological parents and genetic relatives.

It is telling to consider what this population itself has to say and how these harms are being addressed. The psychological distress reported by donor-conceived individuals has led to the creation of advocacy organizations in several European countries calling for an end to donor anonymity, greater recognition of their psychological struggles, and acknowledgment of the right to know one’s biological origins.

Donor-conceived individuals have frequently reported that not knowing their biological origins can affect identity formation and emotional well-being.

Perhaps even more telling is that some Northern European countries have already developed protocols to mitigate these potential harms.⁷ These protocols recommend informing donor-conceived children, around the age of 12, about the circumstances of their conception, while psychologically preparing both the child and the donor—along with their respective families—for a possible future meeting. Such initiatives rest on the premise that early, supported access to one’s biological history may reduce later difficulties related to identity, anxiety, or feelings of deception reported by a portion of the donor-conceived population. 

Wrongful Assisted Fertilization

With these issues in mind, a new legal framework should be created in the field of medical liability law. Consider the already existing legal actions related to “wrongful life” or “wrong­ful birth.” These terms refer to cases in which lawsuits are brought against clinics by parents who argue that had they been fully informed they would have made different decisions regarding the birth of their children. In some cases, it is the children themselves who are the plaintiffs. In cases of ART children who suffer from health problems, we could talk about “wrongful assisted fertilization.” Just as in cases of “wrongful birth,” the parents may have made different decisions had they been fully informed. Under this proposed framework, the millions of patients who underwent ART (with or without a child) could recover their investment by pointing to misinformation about success rates (“nine out of ten”) and risks. Given the precedent of successful wrongful birth and life lawsuits, I believe that wrongful assisted fertilization lawsuits could become a powerful force for badly needed reforms.

A Hidden Health Crisis

I wrote The Last In Vitro to draw attention to these problems, which I believe amount to a hidden health crisis. Regardless of their position on ART, everyone needs to be better informed about ART. Serious public discussion about assisted reproduction will remain incomplete without a serious and transparent discussion of health risks, the real limitations of these techniques, the quality of informed consent, and the familial, social, and public health implications of ART.

Francisco Güell, BS, BPh, MBE, PhD, is a researcher at the Institute for Culture and Society (ICS), University of Navarra. His work explores the biological, medical, ethical, and social implications of assisted reproductive technologies (ART), with a particular focus on child health. He has coordinated European-funded research projects and advises international institutions on reproductive health policy. 

Editor’s Note: This article is adapted from the author's book, The Last in Vitro (2025).

*Photo credit: Shutterstock

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2. Sociedad Española de Fertilidad. Registro Nacional de Actividad 2022 – Registro SEF. Madrid: SEF; 2024.

3.  Centers for Disease Control and Prevention. 2022 Assisted Reproductive Technology Fertility Clinic and National Summary Report. Atlanta (GA): US Department of Health and Human Services; 2024.

4.  Ni, Ying, et al. "Differences in fertility-related quality of life and emotional status among women undergoing different IVF treatment cycles." Psychology Research and Behavior Management (2023): 1873-1882.

5.  A more comprehensive review of the literature can be found in Güell, F. (2025). The Last in Vitro. Selected references include: Boulet SL, et al. Assisted reproductive technology and birth defects among liveborn infants in Florida, Massachusetts, and Michigan, 2000–2010. JAMA Pediatr. 2016;170(6):e154934; Carlsen E, et al. Cerebral palsy in children born after assisted reproductive technology in Norway: risk, prevalence, and clinical characteristics. Hum Reprod. 2023;38(1):123–134; Farhi A, et al. Congenital malformations in infants conceived following assisted reproductive technology in comparison with spontaneously conceived infants. Fertil Steril. 2013;99(4):1177–1183; Fountain C, et al. Association between assisted reproductive technology conception and autism in California, 1997–2007. Am J Public Health. 2015;105(5):963–971; Goldsmith S, et al. Cerebral palsy after assisted reproductive technology: a cohort study. Dev Med Child Neurol. 2017;59(11):1181–1187; Henningsen AA, et al. Trends over time in congenital malformations in live-born children conceived after assisted reproductive technology. Hum Reprod. 2018;33(11):2064–2070; Lerner-Geva L, et al. Possible risk for cancer among children born following assisted reproductive technology in Israel. Am J Obstet Gynecol. 2016;215(3): 314.e1–314.e11; Liberman RF, et al. Assisted reproductive technology and birth defects: effects of subfertility and multiple births. Fertil Steril. 2017;108(1):143–150; Lv H, et al. Assisted reproductive technology and birth defects in a Chinese birth cohort study. The Lancet Regional Health–Western Pacific. 2021 Feb 1;7; Sargisian N, et al. Congenital heart defects in children born after assisted reproductive technology: a CoNARTaS study. Eur Heart J. 2024;45(6):4840–4851. https://doi.org/10.1093/eurheartj/ehae572; Spector LG, et al. Association of in vitro fertilization with childhood cancer in the United States. JAMA Pediatr. 2019;173(6): e190392;Weng, Shiue-Shan, et al. "Assisted reproductive technology and risk of childhood cancers." JAMA network Open5.8 (2022): e2230157; Williams CL, et al. Cancer risk among children born after assisted conception. N Engl J Med. 2013;369(19):1819–1827; Yu, Hui-ting, et al. "Association of birth defects with the mode of assisted reproductive technology in a Chinese data-linkage cohort." Fertil Steril. 109.5 (2018): 849-856.8 and Zhang L, et al. Birth defects surveillance after assisted reproductive technology in Beijing: a whole of population-based cohort study. BMJ Open. 2021;11:e047337.

6. Adams, D. H. et al. (2022). Self-reported mental health status of donor sperm-conceived adults. Journal of Developmental Origins of Health and Disease, 13(2): 220–230; Macmillan, C. M. et al. (2021). The motivations of donor-conceived adults for seeking information about, and contact with, sperm donors. Reproductive Biomedical Online, 43(1): 149–158; Montanari Vergallo, G. & Marinelli, E. (2018). Gamete Donation: Are Children Entitled to Know Their Genetic Origins? A Comparison of Opposing. European Journal of Health Law, 25(3): 322–337; Golombok, S. (2021). Love and truth: what really matters for children born through third-party assisted reproduction. Child Development Perspectives, 15(2): 103–109; Jadva, V. & Freeman, T. (2009). The experiences of adolescents and adults conceived by sperm donation: comparisons by age of disclosure and family type. Human Reproduction, 24(8): 1909–1919.

7. Lambert, P. (2025). The experience of donor conceived people accessing donor identity. ESHRE Annual meeting 2025. Telling and talking to donor conceived children and adults about their donor conceived origins (session 82). O–273; Indekeu, A. (2025). Telling and talking about donor conception within the families: How can professionals help? ESHRE Annual meeting 2025. Telling and talking to donor conceived children and adults about their donor conceived origins (session 82). O–272.