What Are the Risks of In Vitro Fertilization (IVF)?

By (embryologist) and (babygest staff).
Last Update: 06/26/2019

In vitro fertilization (IVF) is a complex assisted reproductive technique that has allowed many people to achieve their reproductive desire.

There have been several advances in in vitro fertilization processes but there are still risks and complications that can be generated in women undergoing IVF.

The possible risks derived from the in vitro fertilization process are mainly associated with the phase of ovarian stimulation and the transfer of embryos to the woman's uterus.

Risks associated with ovarian stimulation

Ovarian stimulation is performed by administering hormonal drugs to develop more eggs in a woman's ovaries.

The main risks associated with this stage of the IVF process are detailed below.

Ovarian Hyperstimulation Syndrome (OHSS)

This syndrome is characterised by an excessive response of the ovaries to hormonal drugs administered for ovarian stimulation. It is associated with an increase in the size of the ovaries and an accumulation of fluid in the abdomen.

Ovarian hyperstimulation requires medical assistance and strict control to avoid serious consequences.

This hyperstimulation syndrome can cause abdominal pain and bloating, diarrhea, vomiting, discomfort. It usually lasts about a week and the symptoms are due to inflammation of the ovaries. It is also possible that the syndrome leads to more intense symptoms such as weight gain or heaviness when breathing.

In more severe cases (which are rare) it can cause an increase in fluid in the abdomen and lungs, which can result in a larger ovary and lead to dehydration, shortness of breath, or severe abdominal pain.

Currently, ovarian stimulation based on drugs containing clomiphene citrate, FSH and LH is rigorously controlled by ultrasound and/or blood analysis. In this way, it is possible to predict ovarian hyperstimulation syndrome and, therefore, to abandon the treatment in order to avoid it.

Egg retrieval

Egg retrieval is done by ovarian puncture, which requires deep sedation of the patients. This is a simple surgical procedure that lasts about 20 minutes.

The main risks associated with this phase of the IVF process derive from the use of anaesthesia, so patients may feel slight discomfort, dizziness, pressure drop, etc.

On the other hand, although very rarely, problems can appear caused by the puncture of the patient ovaries to obtain eggs. This refers to puncturing the pelvic organs, causing heavy bleeding or infection, but it is not common.

Ascites

Ascites is a plasma accumulation (blood) in the abdominal cavity. It occurs when hCG is given to a woman. The ovarian puncture is performed and after a few days, the woman begins to notice abdominal distension and pain in the ovaries.

This alteration causes discomfort and compresses the intestines, making digestion and/or breathing difficult.

However, ascites is not a common complication. It can only occur in women who suffer from OHSS and are not controlled. Treatment of ascites involves reducing symptoms and hydration.

It is usually resolved in 8-10 days.

Risks for the pregnancy

Other possible risks of IVF are those related to pregnancy. They are mainly due to embryo transfer after fertilization in the laboratory and implantation in the uterine cavity.

The following can be highlighted:

Ectopic pregnancy
it consists of the implantation of the embryo in a place other than the uterus, in the fallopian tubes for example. The percentage of risk of this happening in IVF is 2-5% when it is 1% in a natural pregnancy.
Multiple pregnancy.
it carries more complication and risk than a single pregnancy. It is therefore important to know in detail the risks of transferring more than one embryo and to balance the specific risk/benefit for each situation according to the characteristics of the embryos and the uterus of the surrogate. In addition, with assisted reproductive techniques there has been a boom in the rate of twin or triple pregnancy. This, combined with the advanced age of women undergoing IVF, makes the risks greater for both the mother-to-be and the babies.
Miscarriage
it occurs in 20% of cases and are usually biochemical abortions. It usually occurs in the first few weeks of gestation. However, the risk of suffering a miscarriage in an IVF process is not higher than in a natural pregnancy, only that with IVF more biochemical abortions are detected than in natural pregnancies. Biochemical abortions in a natural pregnancy go unnoticed as a normal rule.
Preterm pregnancy
babies born after IVF treatment are more likely to be premature. It is due to increased levels of relaxin, a hormone produced in the corpus luteum.

Risks in babies born from IVF

Several studies indicate that babies born through an IVF process are usually more likely to have chromosomal abnormalities than those conceived naturally. Usually, the highest incidence of chromosomal abnormalities in these babies does not derive from the IVF technique itself, but from the factors that cause sterility.

On the other hand, there is not enough evidence to confirm an increased risk of congenital malformations in babies born by IVF processes. In addition, these babies are not different from naturally conceived babies in terms of psychological, cognitive and motor development.

Other complications associated with IVF

In addition to OHSS, medication administered to promote ovarian maturation and control ovulation can lead to other side effects, such as:

  • Mild pain and bruising at the injection site of the drugs
  • Sickness or vomiting
  • Swelling
  • Abdominal pain
  • Breast sensibility
  • Increased vaginal discharge
  • Mood swings
  • Fatigue.
  • Allergic reaction

Finally, to comment that assisted reproduction techniques imply a physical, financial and emotional commitment on the part of the couple. This can lead to psychological and emotional stress, especially if IVF is unsuccessful. Patients may feel frustration at not getting their reproductive desire.

FAQs from users

Can ICSI produce the same risks as conventional IVF?

By Marta Barranquero Gómez (embryologist).

Yes, ICSI or intracytoplasmic sperm injection has the same risks as conventional IVF. In both cases the same processes of ovarian stimulation, puncture, etc. are carried out.

The main difference between the two is that in ICSI the previously selected sperm is introduced directly into the egg with the help of a microinjector. On the other hand, conventional IVF consists of bringing the egg into contact with a large quantity of sperm.

Is IVF more likely to cause fetal malformations?

By Marta Barranquero Gómez (embryologist).

There are several studies that indicate a higher probability of chromosomal abnormalities in fetuses after assisted reproductive treatment than in naturally conceived fetuses. However, there are no differences in relation to congenital malformations, i.e., anatomical anomalies in the fetus.

Are there greater risks when IVF treatment is given to older women?

By Marta Barranquero Gómez (embryologist).

Yes, as age increases, the risks become greater for both the future mother and the fetus. In addition, the possibility of achieving pregnancy is reduced.

Is there ethical controversy in IVF techniques?

By Marta Barranquero Gómez (embryologist).

Yes, many people think it is unethical to create embryos artificially in a laboratory. In addition, they do not see it as appropriate to reject those embryos of poor quality and therefore have no chance of giving rise to a pregnancy.

Despite all this, it is a legal assisted reproduction technique and has helped thousands of people fulfill their reproductive desire.

Suggested for you

Repeated IVF failures occur on numerous occasions. If you want more information, you can visit the following link: Recurrent IVF Failure: Causes and Solutions to be Parents.

We have also commented that one of the risks of an IVF treatment is multiple or twin pregnancies. If you want to read more about it, you can click here: What Are the Risk of Twin Pregnancy in Surrogacy Process?

Our editors have made great efforts to create this content for you. By sharing this post, you are helping us to keep ourselves motivated to work even harder.

References

Authors and contributors

 Andrea Rodrigo
Andrea Rodrigo
Embryologist
Bachelor's Degree in Biotechnology from the Polytechnic University of Valencia. Master's Degree in Biotechnology of Human Assisted Reproduction from the University of Valencia along with the Valencian Infertility Institute (IVI). Postgraduate course in Medical Genetics. More information about Andrea Rodrigo
Adapted into english by:
 Marie Tusseau
Marie Tusseau
Babygest Staff
Editorial Director of Babygest magazine in French and English. More information about Marie Tusseau

Find the latest news on assisted reproduction in our channels.