Complications in IVF programs
Ovarian hyperstimulation syndrome (OHSS)
The drugs administered during IVF stimulate the ovaries to recruit and mature multiple follicles, in order to obtain many eggs. However, in few cases, it is possible that hyperstimulation of the ovaries might occur leading to the development of the syndrome. OHSS occurs in 5% of women undergoing IVF. It is classified as mild, moderate and severe, depending on the severity of the symptoms.
Drugs used in IVF
Protocols of multiple follicle development
The severe form of OHSS occurs in only 1% of women. It usually develops in women with polycystic ovaries.
Subsequent pregnancy is not compromised by the syndrome. However, OHSS is trigerred and amplified by the presence of pregnancy. The symptoms include abdominal distention and discomfort, stomach ache, nausea or vomiting, increase of body weight and reduced urination (oliguria). In more severe cases it can also cause breathing difficulties, respiratory difficulty, fainting and deviation of hematological and biochemical parameters. The latter form requires hospitalization for monitoring and treatment.
OHSS can be treated and prevented
In the last nine years at Eugonia, we use a special drug regime to prevent the incidence of the syndrome in high risk women. Using this method we have managed to successfully treat almost all cases on an outpatient basis.
A detailed report of OHSS prevention has been published in Fertility and Sterility, official journal of the American Society for Human Reproductive Medicine (ASRM): Administration of methylprednizolone to prevent severe ovarian hyperstimulation syndrome in patients undergoing in vitro fertilization (Lainas et al., Fertil Steril, 78(3):529-533, 2002).
At Eugonia OHSS is prevented and treated effectively on an outpatient basis. Our high technical background minimizes possible complications of IVF
Ectopic pregnancy
Ectopic pregnancy is the attachment of the embryo to an extra-uterine cavity, most usually in the fallopian tubes.
It can happen after natural conception at a rate of 1-15%. The rate is slightly higher in IVF programs. It is diagnosed in time (6th week of gestation) as the first ultrasound that is performed 14 days after the positive pregnancy test can accurately identify the location of embryo development.
Ectopic pregnancies are treated using laparoscopic surgery.
Multiple pregnancy
ART methods and IVF programs are related with increased percentages of multiple pregnancies.
Twin pregnancies do not usually present problems, provided that monitoring is performed with increased alertness and care.
In triplet, quadruplet etc pregnancies, the problems are more frequent and difficult. They also affect the health of the mother and cause a high incidence of premature labours. The worse, albeit rare, complications of premature labour are related with brain hemorrhage leading to brain paralysis.
Are there long-term effects on health?
Generally speaking, no. Public worries (mainly due to incomplete information) are theoretically possible but practically unlikely.
All the large international epidemiological studies corroborate that the danger of ovarian, uterine or breast cancer are similar to the general population.
Large epidemiological studies from Australia (29700 women, Lancet 1999), Great Britain (5556 women, Hum Reprod 2002), France (92555, Hum Reprod 2004), as well as other studies and reviews (Ness et al, Amer J Epidem, 2002; Kashyap et al, Obst Gynecol, 2004) have shown that there is no statistical difference between women having taken IVF drugs and developed breast, ovarian or uterine cancer, and women who developed cancer without having taken any drugs.
There are no high risk indications for cancer in IVF children compared with children born with natural conception (studies on 17000 and 30364 IVF children, Klip et al, Hum Reprod, 2001).
For prevention reasons, all women must undergo a Pap test and breast examination. Mastograpgy is recommended to women over the age of 35. In cases with breast history (individual or family) we must consult a special mastologist regardless of age before the onset of drug administration.
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