Complications of Assisted Conception

For most couples, assisted conception is without any major health problems. However, it is important that you are aware of the risks to you and your pregnancy should you undergo treatment with or without pregnancy. The most commonly seen complications are multiple pregnancy, ectopic pregnancy, Ovarian Hyper stimulation Syndrome (OHSS) and infection or bleeding at the time of egg collection.

Multiple Pregnancy

Multiple pregnancies, mainly twins, can follow most types of fertility treatment, including IVF, ICSI, GIFT and ovulation stimulation, with or without IUI (intrauterine insemination).

Multiple pregnancy is associated with:

The age of the woman producing the eggs

The number of eggs she produces

The number of embryos generated following IVF or ICSI

The quality of those embryos

The number of embryos transferred with IVF or eggs with GIFT

Whether frozen embryos have been stored (a patient with enough embryos to store is more likely to become pregnant)

The duration of infertility

The number of previous failed treatment cycles

Whether the patient has had a previous pregnancy or live birth

Triplet pregnancies carry greater risks than do twin pregnancies, which in turn are riskier than singletons. There is an increased risk of miscarriage, prematurity, intrauterine growth retardation, low birth weight and cerebral palsy as well as maternal complications, such as anemia, hypertension and caesarean section. In the rare situations where 3 conceptions implant, reduction to twins or a singleton maybe discussed. There is a small risk (approximately 6%) that a pregnancy might end in miscarriage following pregnancy reduction.

Our staff will assess these factors and discuss the number of embryos for transfer, to maximize your chance of a singleton pregnancy and minimize the risk of a multiple pregnancy.

Ectopic Pregnancy

IVF, GIFT, and to a lesser extent IUI, all carry a small risk of ectopic (outside the uterus) pregnancy. In IVF this means about 3%, and in GIFT 5%, are ectopic, although of course this means that at least 95% of pregnancies are in the correct place.

 

Our strategy to detect ectopic pregnancy as early as possible is to confirm pregnancy using a sensitive blood test for the pregnancy hormone BhCG, and then perform a vaginal ultrasound scan 3 weeks after the blood test. By then we can detect an intra-uterine pregnancy. If no pregnancy is detected on vaginal; ultrasound but the BhCG remain high, an ectopic pregnancy is likely and further tests, including a repeat of the blood test or a laparoscopy, arc wise. Usually, detecting an ectopic pregnancy this early means we can avoid the dangers of the pregnancy rupturing and we can also deal with it laparoscopically rather than use a full abdominal incision (laparotomy).

Ovarian Hyperstimulation Syndrome (OHSS)

During your treatment cycle you will have a course of injections to stimulate the production of follicles. These injections are given in a carefully controlled way to try to produce more eggs than you would usually make. We have enormous experience using this treatment and pay great attention to matching dosage to response precisely and carefully.

Despite our efforts, some women are excessively sensitive to tiny doses of the hormones, and up to 5% may develop some degree of ovarian hyperstimulation (OHSS). Although OHSS is unpleasant at the time, this condition is short-lived and, fortunately, recovery occurs within a few days to two weeks.

OHSS involves temporary enlargement of the ovaries and accumulation of fluid inside the abdomen. It might be mild with only abdominal bloating or pain similar to period pains or in moderate cases, increased abdominal discomfort accompanied by nausea, vomiting and diarrhoea. In severe cases, which are rare, the woman feels unwell, restless, nauseus and has abdominal swelling, flushing and palpitations. For such women admission to hospital may be necessary for monitoring and intravenous fluids.

During OHSS the ovaries enlarge excessively and may contain up to 30 - 40 follicles or more. After egg collection the ovaries remain large and fluid accumulates in the pelvis. The symptoms include abdominal discomfort and swelling, and sometimes thirst, nausea and sickness. Typically the onset is a few days after the IVF or GIFT procedure has been performed and the problem may last for a week or so before everything returns to normal.

Ultrasound scans help us greatly. If we feel that you are in danger before the egg collection, we may advise that the injection that you do not have the final maturation injection (human chorionic gonadotrophin, hCG). This will prevent the development of OHSS. This is only done if there are very many follicles associated with a very high oestrogen level. If egg collection proceeds but we suspect OHSS we may freeze all the embryos and cancel the fresh embryo transfer procedure since pregnancy frequently makes the symptoms of OHSS worse. In such cases, you would come back at a later date to have a frozen embryo transfer which is often very successful.

In the majority of OHSS cases no special treatment is required other than painkillers and drinking extra fluid, but you need early medical advice. Rarely, in fewer than 1% of cycles, the condition is more serious and without medical intervention may be life-threatening. In such rare cases, you need to be admitted to hospital for an intravenous drip. Further surgery is rarely required and complete recovery is expected.

Sometimes symptoms may persist when pregnancy occurs, however OHSS does not affect the success rates of IVF and does not cause miscarriage.

We advise all patients to call our nurses and doctors daily as communication is vital. Patients with discomfort should: drink plenty of fluids (at least 3 liters of water, juice or milk daily); start a high protein diet (meat, eggs, fish); avoid excessive physical activity. The nurse or doctor may advise you to come to the Centre for blood tests or monitoring by ultrasound scanning.

Please be reassured that OHSS is rare and that the majority of cases are mild with symptoms resolving within a few days. However, please maintain communication with our nurses and doctors.

Egg Collection

There are small risks of internal haemorrhage and/or infection associated with ultrasound guided transvaginal egg collection as with many invasive procedures. We routinely administer an antibiotic to try and prevent any infection. You may experience abdominal discomfort/pain after the egg collection procedure, for which you can take pain killers.