Based upon recent literature that addresses the utility and cost-effectiveness of screening for congenital heart defects (CHD) in IVF/ART pregnancies, the MFM providers at NWP recommend that screening fetal echocardiograms no longer be performed solely for an indication of IVF if adequate and reassuring cardiac views are obtained on the detailed fetal anatomic survey.
A detailed fetal anatomic survey (CPT 76811) is recommended for IVF/ART pregnancies due to an approximate 30% increased risk for congenital anomalies compared to spontaneously conceived pregnancies. In the same context, fetal echocardiogram has also been historically recommended by some professional organizations, however ACOG in their 2016 Committee Opinion noted that “the incremental yield of such studies (for identifying CHD) after a targeted ultrasonography that is reassuring is unclear and needs to be balanced against available resources.”(1) More recently, several publications have called into question the utility and cost-effectiveness of continuing the practice of performing fetal echocardiograms for IVF/ART pregnancies.
Chung et al., in their cost-effectiveness study from 2020, concluded that The most cost-effective method of screening for CHDs in pregnancies following IVF, either with or without ICSI, is to perform a fetal echo only when abnormal cardiac findings are noted on the detailed anatomy scan. Performing routine fetal echo for all IVF pregnancies is not cost-effective. (2)
Bjorkman et al., published a cohort study in 2021 evaluating 180,000+ live births and 9,000+ fetal echocardiograms (including 2,230 performed for IVF pregnancies). They found that the incidence of CHD in IVF pregnancies without other risk factors is not significantly different from baseline population rates, and most CHDs diagnosed by fetal echocardiography in this group are clinically insignificant. Routine screening with fetal echocardiography in all IVF pregnancies provides limited utility beyond routine prenatal care and need not be recommended without the presence of other risk factors. (3)
Based upon these recent publications, the MFM providers at NWP have readdressed the historic recommendation and regional practice to routinely perform fetal echocardiograms in addition to a detailed fetal anatomic survey solely based upon the indication of IVF/ART. After careful consideration, our consensus expert opinion and recommendation now is to discontinue this practice.
If adequate and reassuring views of the cardiac anatomy are appreciated on the detailed fetal anatomic survey for IVF/ART-conceived pregnancies, a fetal echocardiogram is unlikely to provide significant additional benefit in identifying clinically significant congenital heart disease and should not be performed unless additional risk factors for CHD are present.
We have also created some scripting to help you with counseling patients if they have had a screening fetal echocardiogram for IVF in a previous pregnancy:
The recommendations from our MFM colleagues for imaging in IVF pregnancies have recently been updated, and fetal echocardiogram is no longer recommended. A detailed fetal anatomy study at 20 weeks still continues to be recommended, and this study includes more views of the fetal heart than a standard anatomy study. When normal views of the heart are seen on the detailed survey, the risk of a significant heart defect is not increased compared to a pregnancy conceived without IVF. If an abnormality is suspected, a fetal echocardiogram will be recommended.
Finally, we recognize that some patients may already be scheduled for a fetal echocardiogram at our office based on prior recommendations / guidelines. If a patient is currently scheduled to have a screening fetal echocardiogram for IVF (no other indication listed on referral), we will complete the exam as scheduled. We have also received orders for a screening fetal echocardiogram to be done in the future (October and beyond) for many patients that have yet to be scheduled and require further action. We are in the process of identifying these referrals / orders and will be reaching out individual providers to give you the opportunity for input on your decision to discuss the new recommendations with your patient and a) cancel order for IVF screening echocardiogram (preferred) or b) schedule exam as ordered. If you will be seeing a patient soon that is scheduled for an IVF screening echocardiogram at NWP during September and are able to discuss our new recommendations with them, please let our office know if you decide that you would like to cancel the exam so that we can offer an US appointment to another patient.
- American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice; Committee on Genetics; U.S. Food and Drug Administration. Committee Opinion No 671: Perinatal Risks Associated With Assisted Reproductive Technology. Obstet Gynecol. 2016 Sep;128(3):e61-8.
- Chung EH, Lim SL, Havrilesky LJ, Steiner AZ, Dotters-Katz SK. Cost-effectiveness of prenatal screening methods for congenital heart defects in pregnancies conceived by in-vitro fertilization. Ultrasound Obstet Gynecol. 2021 Jun;57(6):979-986.
- Bjorkman KR, Bjorkman SH, Ferdman DJ, Sfakianaki AK, Copel JA, Bahtiyar MO. Utility of routine screening fetal echocardiogram in pregnancies conceived by in vitro fertilization. Fertil Steril. 2021 Jun 28:S0015-0282(21)00418-0.