IVF Treatment - Risks and other issues
Ovarian hyperstimulation syndrome (OHSS)
Despite close monitoring, approximately 5% of women will over-respond to the hormone stimulation, i.e. too many follicles develop so that the ovaries become very enlarged. If a woman shows unusual susceptibility during stimulation, she may be 'coasted' (which means the treatment is stopped or reduced to allow the hormones to settle down) or the treatment cycle may be cancelled and the ovaries allowed to return to normal size. Future treatment then requires modification. Occasionally we may proceed with egg collection but not proceed with embryo transfer. Should this be required, any healthy embryos can be frozen and replaced later during a natural, unstimulated cycle. This is safer and our patients safety must remain our highest priority.
If the Syndrome 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 embryo worsening the symptoms.
The symptoms are:
- Severe nausea and vomiting
- Increased abdominal distension (bloating)
- Diarrhoea
- Shortness of breath
- Increasing thirst
- Decreasing of urine output
Mild OHSS, by far the most common form, is usually adequately treated by rest, fluids (2 - 3 litres per day) and mild pain relief. Moderate to severe OHSS (0.2% i.e. one in 500 patients) requires hospitalisation with intravenous fluids, occasionally paracentesis (i.e. draining of abdominal fluid) and close monitoring of blood coagulation. In over 250,000 treatment cycles in Australia, there have been no fatalities but in its severe form the Syndrome can be life threatening and there have been cases of significant blood clotting problems.
Embryo transfer
Transferring the embryo(s) to the uterus may cause mild discomfort and carries a very small risk of infection (carried up from the cervix) and sometimes causes minor bleeding.
Ultrasound egg collection
Ultrasound guided egg retrieval may cause discomfort during or after the procedure and can cause:
- Internal bleeding
- Puncture of abdominal organs
- infection - especially if there are endometriomata
- scarring in and around the ovaries
Miscarriage
Light bleeding (or spotting) occurs in up to 55% of ART pregnancies and should not cause undue concern unless it becomes heavy or is associated with increasing abdominal pain.
Occasionally an ultrasound scan and further blood tests will also be required. Miscarriages still occur in up to 25% of all pregnancies (whether natural or by ART).
Very early miscarriage will not necessarily require curettage (D & C). 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 a reason. We can do all of the necessary and justifiable testing through our Laboratories and we warn you about some advertised, very expensive, poorly justified tests on offer. Miscarriage can be emotionally devastating - counselling is helpful at that time.
» Please refer to our 'Miscarriage' page where you can download the Patient Leaflet.
Ectopic pregnancy
An ectopic pregnancy is one that implants outside the uterus, usually in the Fallopian tube. It occurs in approximately 1-2% of ART pregnancies, usually only when there is pre-existing Fallopian tube damage. The transferred embryos move around for a few days before implanting and can sometimes lodge in damaged tubes. The signs that might indicate the possibility of an ectopic pregnancy are abnormal hormone levels, brown vaginal bleeding and abdominal pain. Another alert signal to us is a positive blood test and an empty uterus on ultrasound. Such a pregnancy is often diagnosable by ultrasound and cannot continue and therefore surgical intervention is required. Early diagnosis not only minimises tubal damage but also usually means the ectopic pregnancy can be treated by laparoscopy rather than by an 'open' operation.
Multiple pregnancy
National figures show twins occur in up to 30%, and triplets in up to 1%, of 'successful' ART cycles. This will be influenced by a number of factors (especially age) but is the result of transferring more than one embryo. We appreciate this creates a dilemma. It is well recognised that putting back more than one embryo increases the chance of achieving a pregnancy, but patients must consider the implications of multiple pregnancy when 2 or particularly 3 embryos are placed into the uterus. There are well recognized problems of difficult pregnancies and labours with multiple pregnancies and an increase in prematurity with further problems for the babies. Of major concern is the 27 fold increased risk of cerebral palsy in triplets, hence we rarely transfer 3 embryos. The decision must be the made by the patients but our current recommendation is as follows:
On the first cycle in women younger than 36 years of age or for those returning after a pregnancy, only one embryo should be transferred. For older women and/or later attempts we recommend two embryos be replaced. Additional embryos can be frozen for later use.
Congenital abnormalities (birth defects)
Every treatment cycle in Australasia must be reported to the National Perinatal Statistics Unit. Annually the Unit compiles all the data and it is reassuring to report that the congenital abnormality rate in ART. babies is no different from that of the general population.
It is important to be aware that there is a likelihood that a male sperm problem, if it is something that you were born with, may be transmitted to sons (on the Y chromosome). At IVFAustralia we are actively involved in this area of research and our genetic counsellor, and geneticist, are available to discuss any concerns regarding this or any other genetic (hereditary) condition.
Cancer and fertility drugs
Ovarian cancer occurs in approximately 1 in 90 women in the general community and is more common in women who have not had children. Breast cancer occurs in 1 in 11 women, again being more common in women who have not had children. The variety of medical and surgical treatments, including the drugs used in ART., may have unknown long term effects. From the Australian cancer registers there has not been any increase in breast or ovarian cancer since the start of IVF treatments.
Furthermore, a study from Monash University, published in 2001, which reviewed patients from 19 years earlier, confirmed no overall increase, except that it noted a slight transient increase in the year after treatment, just as we see in the first year after childbirth. This is said to be a factor of ‘surveillance bias’ i.e. when people have an association with a Doctor/Clinic they are more likely to report abnormal things that happen and disease is more likely to be diagnosed early. The Fertility Society of Australia continues to fund and encourage research into all areas of possible long term effects. IVFAustralia fully supports this responsible approach, which is one of the reasons we have a section in our Agreement Forms regarding long term follow up. Although still rare, it should be mentioned that testicular cancer is more common in men with low sperm counts.
Legal implications
Most of the time IVF and fertility treatment do not raise any serious legal issues for you and your family. However, sometimes particularly in relation to donation of eggs, sperm or embryos there can be quite serious legal considerations.
Although the IVFAustralia team is always available to discuss issues affecting treatment, none are legally trained. We advise all our patients that if they require advice about any legal rights and liabilities arising from their participation in any treatment programme offered by IVFAustralia, or about the legal status of embryo(s) or of any child born as a result of treatment by IVFAustralia (e.g. donated sperm or embryos etc.) they should seek independent legal advice and should not rely in any way upon information received from, or advice given by, IVFAustralia staff.
|
