Risks, cancellations and side effects
Things to be aware of with IVF
To help you understand what you can expect to encounter during your treatment, you need to be aware that things do not always go according to either desire or plan. Some problems are temporary setbacks or conditions; others can take a considerable emotional and physical toll.
Ovarian hyperstimulation syndrome (OHSS)
It's normal for the ovary to produce fluid in the abdomen as a follicle grows, and to bleed at ovulation. And it's normal for a corpus luteum to form in the ovary and become cystic in the second half of the cycle. Pain can accompany ovulation and the formation of the corpus luteum, while premenstrual tension can cause bloating, irritability, depression and breast pain. When the ovaries are stimulated to increase the numbers of follicles, as occurs in IVF, all these events and their symptoms can be more pronounced than you might expect in a natural cycle. There are three classifications of OHSS severity:
- Mild OHSS - accompanied by enough pelvic pain in the luteal phase to cause a woman to want to rest in bed for a day or two. This occurs in 1 in 30 stimulations.
- Moderate OHSS - requires a hospital stay, mainly for observation and to enable us to give adequate relief of pain. This occurs in about 1 in 250 stimulations.
- Severe OHSS - in about 1 in 1000 stimulations there's enough fluid in either the abdomen or the chest to be of serious medical concern.
OHSS is a self-limited condition and the ovaries will almost always completely recover.
We occasionally find that the ovaries fail to stimulate, and cancelling the cycle may be recommended. Less than 5% of cycles are cancelled. A cycle might be cancelled because:
- Your follicles are not responding to hormone treatment
- Your follicles are over-responding to the hormones, risking hyperstimulation
- Uterine problems such as fibroids or polyps are unexpectedly detected on ultrasound
- Personal reasons.
If you're at risk of hyperstimulation or if a problem is discovered in the uterus, your doctor might suggest that you have a freeze-all cycle rather than cancel the cycle completely. In a freeze-all cycle, the eggs are collected and fertilised then cryo-stored. Because pregnancy or further hormone injections will worsen the risk of ovarian hyperstimulation syndrome (OHSS), a freeze-all cycle is a safer option. This gives the ovaries time to settle down before attempting pregnancy at a later date. When returning for the frozen transfers, there is no need to have any stimulation of the ovaries at all.
Multiple pregnancy risk
At Superior A.R.T., we would like to help you grow your family one healthy baby at a time. So as a rule, we only transfer one embryo. The risk of a twin pregnancy after a single blastocyst transfer is around 2%. In certain circumstances, such as older age of the woman or previous unsuccessful treatment, we will consider transferring two embryos.
If you've had trouble conceiving, the idea of having two babies at one time might seem like a blessing. However, the death rate of twins between 5 and 9 months of pregnancy is 6 times that for single baby pregnancies, while the mortality rate from IVF twins following birth is 4.5% or nearly 1 in 20.
In 2002, Sydney IVF undertook a study in a special subset of couples who had several high quality embryos suitable for both transfer and freezing. They compared the 'take home baby' rate in women under 38 who had two embryos transferred during the fresh cycle with those who had one embryo transferred fresh. Both groups later had frozen embryo transfer cycles if they needed them. The end result was the same: approximately 70% of women in both groups took home a baby after one stimulated cycle. However, five babies died from premature delivery among the IVF treatments where fresh embryos had been transferred two-at-a-time.
Risks of medications
Since ovarian stimulation medications were first used decades ago, there has been concern that their use might increase the risk of cancer. Several large studies have now found that the rates of cancers among women who have used infertility drugs are not significantly different from the rest of the population. There is no evidence to date that the drugs used in assisted conception causes either breast or ovarian cancer.
No fertilisation; no embryo development; no implantation
Fertilisation can fail, and fertilised eggs can fail to divide or undergo cleavage properly. The reason can lie with the sperm (usually fertilisation failure rather than cleavage failure), with the egg, or both. And sometimes it can lie with the lab.
Fertilisation can fail when not enough sperm attach to the egg's surrounding coat. This can happen because the number of healthy sperm is too low, or because there are antisperm antibodies that prevent sperm from attaching. Either way, future cycles can overcome this problem by using ICSI.
In addition, fertilisation and/or cleavage might fail if the follicles from which the eggs were extracted had begun to fail prior to egg collection. This can be an inherent problem with the ovaries, or it can result from suboptimal stimulation.
Most embryos that fail to implant and/or fail to result in a baby (even though they might look normal in the lab) fail through a combination of intrinsic and extrinsic shortcomings. Intrinsic shortcomings might be based on insufficient metabolic energy or an abnormal chromosome count. Extrinsic shortcomings might occur during follicular stimulation or during laboratory handling.
Stresses associated with infertility
IVF treatment can be stressful and intrusive. There are various reasons for this including:
- Demands of stimulated treatment (daily injections, the need for blood tests early in the day, ultrasounds etc)
- Stresses associated with procedures (having an invasive procedure; the discomfort sometimes experienced; providing a semen sample on the day of the egg pick-up)
- Stresses associated with periods of waiting (such as waiting for fertilisation results; pre-embryo checks; and the long wait between transfer and pregnancy test, then the wait for the pregnancy test result)
- The possibility of treatment not being successful.
Luckily, stress itself does not jeopardise the chance of IVF working. Many people have remarked that they have felt worn down by the stresses and the losses associated with infertility. It's not uncommon for people to experience grief in response to the many losses experienced, as well as other emotional responses such as depression and anxiety. With this in mind, you should be aware that Superior A.R.T. provides counselling services that can greatly assist in managing this emotional impact.