Complications of Fertility Treatment
Unfortunately, there is no medical treatment that does not carry some form of side effect or complication. This is also the case with fertility treatment. However, fortunately the complications or risks are minimal, and it is often possible to identify those women who are most likely to develop such complications. The most common of these complications are described below:
Ovarian hyper stimulation syndrome (OHSS)
OHSS occurs when a woman’s ovaries over respond to the fertility injections and produce too many follicles. This complication of ovarian stimulation occurs in approximately 5% of women undergoing fertility treatment. OHSS is more common in young women with polycystic ovaries. The development of OHSS is recognised by the symptoms of low abdominal pain and distension and ultrasound scan showing very large ovaries with fluid collecting inside the pelvis and abdomen. Women at risk of developing OHSS will be advised to stop the fertility injections and continue with down regulation till their oestrogen drops to a safe level, when egg collection can be performed. This will reduce the potential risk of OHSS and permits the continuation of the treatment cycle.
In the rare occasion when OHSS risk is too high, egg collection will be cancelled. In other circumstances, the eggs are collected, fertilised and the embryos frozen for future use. Some women may develop OHSS in the two weeks following egg collection. The majority of these women will develop a mild or moderate form of OHSS. When severe OHSS occurs (1.0 – 1.5%), is characterised by nausea and vomiting, abdominal pain, abdominal distension and breathlessness. In these circumstances, hospital admission is warranted. The vast majority of women who are admitted to hospital admission are usually pregnant, while those who are not pregnant will experience a resolution of their symptoms by their next period. However, OHSS can be a serious condition which warrants careful monitoring and treatment in hospital. Having said all of this, prevention, of course, is best and the Clinicians within the Newlife Clinic are highly experienced in measures that minimise the risk of developing OHSS.
Unfortunately, nature is wasteful and there is a risk of Miscarriage in all pregnancies, with the risk being highest in the early weeks. Even in pregnancies conceived naturally, the risk of miscarriage is about 20-25%. This is true for pregnancies that are conceived by IVF. The older the woman is, the higher the risk of miscarriages. For reassurance, women are offered early ultrasound scans that will show pregnancy viability.
An Ectopic Pregnancy refers to a situation where the embryo has implanted in any place other than inside the uterus. The most common place is in the fallopian tubes. It is estimated that ectopic pregnancies with fertility treatment occur in approximately 2.5% of cases.
It can be a life threatening condition, but if it is detected early, treatment is usually safe and effective. This is the reason why ultrasound scan is performed at two weeks after confirmation of pregnancy by urine or blood test. At that stage, a pregnancy inside the womb should be readily detectable. Ultrasound scan may show an ectopic pregnancy or the absence of a pregnancy inside the womb increases the suspicion of the possibility of an Ectopic Pregnancy. Women with an Ectopic Pregnancy warrant an admission to hospital and there are various approaches to management. Most Ectopic Pregnancies are removed by keyhole surgery. Occasionally, medical treatment is warranted. Very occasionally, ectopic pregnancies resolve spontaneously.
Multiple Pregnancy is a recognised hazard of fertility treatment. Fortunately, when it is just twins, the problems are minimal. The difficulties arise in triplet or higher order multiple pregnancies. Potential complications include miscarriage, pre-term labour, and pre-term delivery, with the associated problems of being born early and, of course, surgical intervention. Multiple pregnancies need to be managed in clinics with experience of managing high risk pregnancies. Increasingly, many IVF units are seeking to reduce the risk of Multiple Pregnancy by transferring one embryo at a time. At the Newlife Clinic, we have a multiple birth minimisation strategy aiming to achieve a multiple birth rate of 10% or less as per HFEA policy. We seek to tailor the IVF treatment to the circumstances and needs of the couple at hand. In other words, we do not have a blanket policy of transferring a single embryo, although it is not at all likely that we would transfer more than two Embryos.