Possible disappointments in an IVF cycle

Unfortunately not all IVF cycles are successful.  At IVFAustralia, we believe it is important that you are aware of the possible disappointments as well as the joys that IVF can bring.  

The following is a brief outline of where problems may arise.

Poor response to fertility drugs:

(approximately 5% of cycles started)

In some cases, the ovaries do not respond well to the drugs and an insufficient number of eggs grow.  This is detected by low, or a slow rise in, hormone levels or follicle growth as measured by blood tests and ultrasound.  Setbacks at this stage teach us more about the hormone patterns and we may be able to amend the treatment plan for subsequent attempts.  Cycles cancelled at this stage do NOT incur the full costs of IVF.

No eggs obtained at egg collection:

(approximately 1% of egg collections)

It is important to note that the number of follicles seen on ultrasound does not always reflect the number of eggs collected at the time of surgery.  Sometimes, for reasons that are not always clear, no eggs are collected at the surgery.  This can occur even where an ultrasound beforehand suggests good egg growth.  If this occurs, we will perform a number of tests to find out why it has happened.

None of the eggs have fertilised:

(approximately 5% of egg collections)

On occasion, none of the eggs collected may fertilise.  This is usually due to a problem of the egg and sperm binding  together properly.  When this occurs, our expert embryologists will study the eggs and sperm in detail to try and identify the cause of the problem.  Usually, a special technique to inject the sperm directly into the egg (ICSI) can overcome the problem in a future cycle.  However, it is important to remember that, even when ICSI is used, fertilisation and further division of the embryo does not always occur.

No embryo division:

In some instances, not all embryos will continue to divide and grow throughout the laboratory incubation period following egg collection.  This is more common in embryos grown to Blastocyst (Day 5 of incubation) because they need to continue to be strong enough to divide and grow outside the human body for a longer period of time. This may mean that some couples have no embryos available to transfer.

No additional embryos for freezing:

It is important to note that not all couples will have extra embryos, or extra embryos that are suitable for freezing.  Where there are extra embryos, the scientists will select only those that they think will survive the process. Even when they freeze the 'best', some embryos still do not survive. About 50% of treatment cycles do have more than two suitable embryos and these can be frozen.

Embryo transfer and still no pregnancy:

If the cycle is not going to be successful, the embryo transfer is usually the point at which it will not work.  Unfortunately, many embryos lack all the genes needed to develop fully and, despite a healthy appearance at the time of transfer, will not subsequently implant and develop.

Possible side effects of the IVF treatment 

Ovarian Hyperstimulation Syndrome (OHSS):

This is a condition where women over-respond to the fertility drugs and can develop fluid retention and abdominal swelling.  In 1% of cases, it can be severe and may require admission to hospital for medical treatment.

If OHSS does occur, it usually becomes evident 2-8 days after egg collection and subsides 2-3 weeks later if a pregnancy does not occur.  However, up to 50% of cases are associated with a pregnancy, in which case the symptoms may be more prolonged and severe, the pregnancy hormone (hCG) being produced by the embryos worsening the symptoms.

The symptoms you should be aware of and report immediately to us are:

• Severe nausea and vomiting
• Increased abdominal bloating
• Diarrhoea
• Shortness of breath
• Increasing thirst
• Decreasing urine output

The mild form is usually adequately treated by rest, fluids (2-3 litres per day) and mild pain relief.  More severe cases require hospitalisation with intravenous fluids and sometimes drainage of the fluid from the abdominal cavity.  In over 250,000 treatment cycles in Australia, there have been no fatalities but in its severe form this condition can be life threatening and cases of significant blood clotting problems have occurred.

Complications of the egg collection:

Ultrasound guided egg retrieval normally causes some discomfort during or after the procedure and this can last for two to three days.  This is not normally a sign of serious problems. However, some serious complications can occur.

Infection: This occurs in less than 1 in a thousand cases.  It is more common in women with previous pelvic disease such as blocked fallopian tubes or endometriosis but is still rare in this group.  

Damage to other internal organs, including blood vessels, bladder and bowel: This is fortunately extremely rare although cases have been reported, both in Australia and overseas.

Miscarriage:

Assisted conception does not increase the risk of miscarriage. Miscarriage occurs in up to 25% of all pregnancies whether conceived naturally or by IVF.  Light bleeding (or spotting) occurs in up to 55% of ART pregnancies and should not cause undue concern unless associated with increasing abdominal pain.

We organise an ultrasound a few weeks after the positive pregnancy test to check the pregnancy.  Otherwise the pregnancy is like any other (although more hard won) and you should try to relax and enjoy it.

Occasionally increasing blood loss or pain will necessitate another ultrasound scan and occasional blood tests.  Very early miscarriage will not necessarily require curettage (D&C) but you should contact us or your local GP or Gynaecologist for advice if you are worried.

Should a curettage be required tissue analysis may occasionally give us an indication as to why the miscarriage occurred.  In most cases however, we cannot give you a reason.  We can do all of the necessary and justifiable testing through our laboratories.  We warn you about some advertised, very expensive, poorly justified tests on offer.  Miscarriage after ART is emotionally devastating - counselling is helpful at that time - just call. 

Ectopic pregnancy:

An ectopic pregnancy is one that implants outside the uterus, usually in the Fallopian tube.  It occurs in approximately 1-4% of IVF pregnancies, usually only when there is pre-existing Fallopian tube damage.  It is disappointing to note that ectopic pregnancies still occur even when embryos have been placed in the uterus.

The embryos move around for a few days before implanting and can sometimes lodge in damaged tubes.  The signs of a possible ectopic pregnancy are abnormal hormone levels, brown vaginal bleeding and abdominal pain.  Please advise us immediately if you have concerns.  If you get severe pain you should proceed directly to the nearest hospital. Another alert signal to us is a positive blood test and an empty uterus at ultrasound.  A pregnancy in a Fallopian tube is often diagnosed by ultrasound.  Surgical intervention may be required but if the diagnosis is made early enough, a special injection of drug can dissolve the pregnancy.

Multiple pregnancy:

National figures show twins occur in up to 20%, and triplets in less than 1%, of successful ART cycles.  However, IVFAustralia data for IVF / ICSI for the last 12 months indicate our rate of twins to be around 15% with no triplets being born following IVF.

While most multiple pregnancies end happily, there is nonetheless an increase in serious risks when the pregnancy is twins or above.  The most common complication is premature birth which can cause problems for the future health of the babies - there is a threefold increase in the risk of a baby dying during or soon after the birth as well as fourfold increase in the chances of cerebral palsy.

Multiple births associated with ART are caused by the transfer of more than one embryo.  We normally recommend transfer of one embryo at a time.  Your fertility specialist will discuss this with you.  At IVFAustralia we will never transfer any more than two embryos at a time.

Remember that any extra embryos that are of good enough quality can be frozen so by having a single embryo transfer and freezing an extra embryo you are giving yourself the opportunity of a future pregnancy.

The health of a child conceived through IVF:

The risk of health problems at birth or in the first year of life in children conceived naturally is approximately 4%. However, recent research, carried out in Western Australia and elsewhere, has suggested that, in children conceived after IVF, the risk of health problems at the time of birth is slightly higher at around 5-6%.  This increase does not appear to affect any specific conditions.  it is not clear why this small increase occurs.  It may be related to the processes of creating a child through IVF.  Alternatively, it is possible that men and women who find it difficult to conceive naturally, may already be at higher risk of having health problems in their children.

In addition, pregnancies conceived by IVF are slightly more likely to be complicated by conditions such as premature birth that may affect the health of the child.

At present, it does not seem that variations in IVF, such as sperm injection or embryo freezing have any specific effect on the child.

The available data do not currently suggest any long term effects on the child's health. IVF children have been shown to have normal intellectual and physical development and do not appear to be at higher risk of childhood illnesses. New research is, however, going on continually in this area and it is possible that these findings may change with time.

The health of the parents following IVF: 

There has been concern about the potential effects of fertility drugs on a woman's long term health. 

Ovarian cancer occurs in approximately 1 in 90 women in the general community and is known to be more common in women who women who have not had children.

However, it seems at this stage, that IVF is unlikely to affect the risk of either of these conditions.  The Australian cancer registers have not observed any increase in breast or ovarian cancer since the start of IVF treatments.  In addition, a study from Monash University, published in 2001, which reviewed patients from 19 yeas earlier, confirmed no significant increase in risk.

The male partner is not free from concerns either. Testicular cancer is known to occur more commonly in men with low sperm counts and our fertility specialists advise all men with low sperm counts to have an ultrasound on their scrotum to check for any early signs of this.