Is IVF process risky?

Author Name: Dr Simmi Arora || Mentor Name: Dr Lipsa Mishra on April 08, 2020

Scared of in vitro fertilization or IVF? Well a lot of patients attending an infertility clinic are apprehensive of that term itself, thinking of a bag full of probable risks involved starting from pain till failure or pregnancy complications. To release you from the fear, let’s understand the IVF process a little.

What is IVF?
IVF is one of the assisted reproductive techniques by which sperm and egg are fertilized outside the body. The process is carried out in a petri dish containing culture medium, resulting in formation of embryos which when transferred back to the uterus of woman may implant and grow in the lining of uterus.
There are few risks associated with IVF process, although serious complications are extremely rare in this modern era. Let’s begin from the start of treatment.

Side effects from injections:
Gonadotropins are the drugs that are used in IVF process which help to stimulate and grow the follicles in the ovaries. Majority are subcutaneous injections with the finest needles.

Common side effects with injectables are:
• Nausea & vomiting (occasionally)
• Bruising at injection site; which is temporary
• Mild allergic reactions such as redness of skin, itching
• Heaviness of breast
• Increased vaginal discharge
• Mood swings
• OHSS (Ovarian hyperstimulation syndrome) : usually seen in severe PCOS patients. Mostly symptoms are mild like nausea, abdominal discomfort and bloating sensation which usually resolves within a few days after ovum pickup. In severe cases, ovaries are enlarged with fluid collection in abdomen and lungs causing breathing problems. Very rarely (<1 %), OHSS can lead to blood clots in vessels (thromboembolism) and even renal failure.
But the best part is that your doctor is always aware of such cases and with modern drugs the incidence is negligible (<1%).

Risks associated with ovum pickup process:
Ovum pickup also commonly known as oocyte retrieval process is an interventional procedure by which the oocytes are aspirated from the ovaries with the help of a long thin needle under ultrasound guidance under some anaesthesia.

• Most common risk/side effect is minor vaginal haemorrhage (reported in 3-6% cases). It can be managed by applying local pressure.
• Mild pelvic and abdominal pain, which self disappears after a day or two and can be managed by using pain killers.
• Very rarely there can be injury to pelvic organs such as bowel, bladder and blood vessels and usually minor which heals spontaneously. Blood vessels injury may rarely require emergency laparoscopy.
• Pelvic infections (rare): Patient with previous history of endometriosis, PID (Pelvic inflammatory disease) and pelvis adhesions are at risk of pelvic infections.
• Very rarely, ovarian torsion specially in enlarged ovaries (PCOD).

Risks associated with embryo transfer:
In an IVF process, embryo transfer is not only the final but also the most crucial step. In this procedure, a catheter (loaded with 1-2 embryos) is inserted into the uterus to place the embryos gently into the uterus lining (endometrium). This process does not usually require any sedation.

• Mild discomfort and pain while negotiating the internal os.
• Sometimes vaginal spotting.
• Infections are rare following embryo transfer and can be treated with antibiotics.
Risks or complications during pregnancy:
• Ectopic pregnancy (1%): Can be tubal (most common), cervical and ovarian (rare).
• Heterotopic pregnancy (co-existence of normal intrauterine pregnancy along with extrauterine pregnancy)(<1%): Very rare, may generally require laparoscopic surgery to remove the ectopic pregnancy.
• Risk of miscarriage: Risk is similar in IVF as compared to natural conception and is directly proportional to mother age. It increases with increasing mother’s age.
• Multiple pregnancies: The risk of multiple pregnancies is more when multiple embryos (more than 2) are transferred into the uterus.
• Preterm labour, gestational diabetes mellitus, pre-eclampsia or gestational hypertension, materal haemorrhage (abruption placentae & placenta previa). All these complications are more commonly associated with multiple pregnancy cases.

 The practice of assisted reproductive technology has experienced a shift towards single blastocyst transfer recently as we strive towards decreasing the unpleasant complication of multiple pregnancies without compromising on pregnancy and live birth rates.

Risk of birth defects with IVF:
There is 2-3 % risk of birth defects in general population and is slightly higher among infertile couples, most of which are due to underlying pathology. This is not proven whether IVF process alone is responsible for birth defects.

So, IVF when done for the right couple with the right indication , the benefits certainly outweighs the risks involved. So without fear you should approach your nearest infertility clinic and get the maximum benefit possible.