Benefits And Risks

There are benefits and risks for most medical procedures, including in vitro fertilization (IVF).

Side Effects

Patients may experience different side effects at different times in the IVF process.

Gonadotropin stimulation: Gonadotropin stimulation is designed to recruit multiple follicles and eggs. These drugs may increase the risk of multiple gestation, ectopic (tubal) pregnancies or ovarian twisting (adnexal torsion). They also can also cause ovarian hyperstimulation syndrome (OHSS). Click here for the most common side effects of treatment with gonadatropins 

OHSS is a serious medical condition that can happen when the ovaries have been over-stimulated. In the early stages of the condition, ovaries become suddenly enlarged with an accumulation of fluid in the abdomen. Early warning signs of OHSS to be aware of include: pelvic pain, nausea, vomiting, weight gain, and reduced urine production. In more severe cases, fluid may accumulate in the lungs causing breathing difficulties. Other serious complications that may occur include severe fluid imbalances, which can also cause blood clotting problems such as inflammation of veins, stroke, and lung clots.

In rare cases, complications from OHSS, including blood clotting problems and/or breathing difficulties may be life-threatening and could cause death. Some women, such as those with polycystic ovaries, run a higher risk of hyperstimulation and should be identified before treatment begins.

Egg retrieval: Moderate discomfort, bleeding or infection may occur after retrieval. If laparoscopy is used, there are the usual risks of surgery requiring anaesthesia. Damage to the bladder, bowel, or blood vessels is possible while removing the eggs through the aspirating needle. Cramping can also occur after retrieval and usually subsides the next day. Additionally, because the ovaries have been stimulated and may be enlarged, some women may experience a feeling of fullness or pressure that may last for several weeks after egg retrieval.

Embryo transfer: The transfer of embryos to the uterus can cause mild cramping. It is also possible that embryos move into the tube and implant there, resulting in an ectopic pregnancy.

Finally, the IVF process can be psychologically stressful. Patients may benefit from taking steps to reduce stress, such as maintaining good health, utilizing relaxation techniques and seeking support and counseling.

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According to the Canadian Fertility and Andrology Society, the rate of miscarriage was 17% per clinical intrauterine pregnancy (from 14,866 IVF/ICSI treatment cycles performed in 2011) which is in keeping with the overall miscarriage rate for natural conceptions.

According to the American Society for Reproductive Medicine (ASRM), when pregnancy is achieved through IVF, the risk of ectopic pregnancy is about 5%, four times greater than in the general population.

The chances of carrying twins is about about 30%, and 1-2% for triplets or more, increasing the risk of complications related to multiple pregnancies, such as miscarriage, premature labour or gestational diabetes.

Perinatal complications are more common for pregnancies achieved through IVF than for spontaneous pregnancies, but it is not known if this is due to the procedure itself or the underlying reasons for the infertility. A study found that IVF infants have a 9% risk of a major birth defect, compared to 4.2% in naturally conceived infants. Several other studies show no differences in birth defect rates between children of IVF and naturally conceived children. The ASRM has urged more research to resolve these discrepancies. The Journal of Obstertics and Gynecology Canada (JOCG) also recently reported that studies show children of IVF display normal development in the cognitive, socio-emotional and motor skills areas.

Any concerns regarding the long-term effects of IVF, with or without ICSI, should be discussed with your healthcare provider, who may recommend that you meet with a genetic counselor.

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More than 3 million babies worldwide have been born through assisted reproductive technologies. Success rates vary among clinics and by the patient’s age and fertility problem. The results from a large clinic showed that the cumulative conception and live birth rates after five cycles of treatment for women aged 34 or less were 54% and 45% respectively, compared with 39% and 29% for those aged 35–39 years and only 20% and 14% for those over the age of 40.

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