Raj Mathur
Raj Mathur
MD, FRCOG, St. Marys Hospital Manchester

What are the risks of fertility treatment?

So many people have had treatments like IVF and ICSI, that it is easy to think that there is no risk in having them. But all medical treatment carries some risk, and fertility treatment is not an exception. But what are the risks of fertility treatment? These risks mainly fall on the woman. She is the one injecting hormones and having procedures to collect eggs and transfer embryos, as well as carrying the pregnancy.

Poor response

The hormones used to stimulate the ovaries are powerful, and fertility doctors try to use them in the ‘right’ dose to get a response form the ovaries that isn’t too high or too low. You can see why a poor response is a problem – if very few eggs develop there may not be any eggs available for fertilising with sperm, or there may be no embryos to transfer, and treatment will have failed. In most cases, doctors are able to predict in advance if this is likely, by using tests such as an Anti-Müllerian Hormone (AMH) level in the blood of the woman. In women with a low AMH, doctors may advise a high dose of hormones for stimulation, to get the most out of the ovaries. If the AMH is very low, there may be no point in even trying to get eggs from the ovaries, and donor eggs would have to be considered instead.

Over response

The opposite problem – when the response of the ovaries is too high – can lead to a condition called OHSS (Ovarian Hyperstimulation Syndrome). This only occurs after the woman has had the trigger injection, and usually only starts after the eggs have been taken from the ovaries. Part of the reason why clinics do ultrasounds (scans) and blood tests to monitor the response, is to check if the woman is at high risk of developing a high response which increases the chances of getting OHSS. The fertility care team may then change the type of trigger injection or advise you to freeze all embryos and not have a fresh embryo transfer.

How do you tell if a woman is developing OHSS? Typically, she notices that her tummy is swollen and uncomfortable. She may be passing less urine than usual and may also become breathless (short of breath). If any of these symptoms develop, it is important to get medical attention right away. 

Couple talking about the risks of fertility treatment

Your fertility clinic should have given you a contact for this, or you may need to contact your nearest hospital and ask to be seen by a gynaecologist. In some cases, upwards of 2% of all IVF cycles, women may develop OHSS that is severe enough to need hospital admission. Others are fine at home, taking paracetamol (acetaminophen in the US) for pain and making sure they eat and drink normally. OHSS settles in a few days if there has been no embryo transfer but may take longer if a pregnancy has implanted.

Bleeding

In order to collect the woman’s eggs, doctors insert a needle through the vagina into the ovaries. In a small number of cases, this can cause internal bleeding and the woman has pain and feels faint. If this happens after discharge from the clinic, urgent medical attention is needed. Fortunately, this is rare, as is the risk of infection due to the egg collection procedure.
One factor that can greatly increase the risk of problems in pregnancy is if the woman conceives twins, or even triplets. This is called a ‘multiple pregnancy’ and puts the mother and babies at significantly higher risk compared to a ‘singleton pregnancy’. For the babies, these risks include prematurity, growth restriction, an increased risk of needing special care immediately after birth and even an increased risk of death soon after birth. For this reason, fertility clinics should try and keep the chances of a multiple pregnancy to a minimum, by restricting the number of embryos they transfer.

Pregnancy after IVF

Ultimately, the aim of fertility treatment is to have a baby. There are some risks that go with being pregnant after IVF more than with pregnancies conceived naturally. The chance of miscarriage is higher for instance. If the woman has problems with her fallopian tubes, there is a risk of ectopic pregnancy. This is one of the reasons why an early pregnancy ultrasound scan should be performed if the woman conceives with treatment.

Health of the baby

Couples often worry whether their baby has a risk of problems or ill health if they conceive with fertility treatment. The first thing to say is that the majority of babies conceived by IVF or ICSI are absolutely healthy and research studies on them are reassuring. However, there is an increased chance of the baby having a congenital abnormality, particularly if conceived after ICSI. 

There is no abnormality that only occurs in babies conceived in this way, and of course any pregnancy can be affected by such problems, but there does seem to be a higher chance of this in ICSI babies.

Research also shows that, compared with babies conceived naturally, IVF babies are slightly more likely to be born ahead of time (prematurity) and to be smaller in size (growth restriction). We don’t know if these problems are due to the IVF treatment itself, or whether couples who need fertility treatment have a higher risk of these problems in any case.

One factor that can greatly increase the risk of problems in pregnancy is if the woman conceives twins, or even triplets. This is called a ‘multiple pregnancy’ and puts the mother and babies at significantly higher risk compared to a ‘singleton pregnancy’. For the babies, these risks include prematurity, growth restriction, an increased risk of needing special care immediately after birth and even an increased risk of death soon after birth. For this reason, fertility clinics should try and keep the chances of a multiple pregnancy to a minimum, by restricting the number of embryos they transfer.

Giving consent for fertility treatment: A UK perspective

Every country has its own laws for how fertility treatment is regulated. In the UK, these rules are quite strict and require the clinic to get detailed consents in writing from both partners seeking treatment. For instance, clinics must seek your written consent if they are to inform your doctor or other health professionals involved in your care. In this respect, fertility treatment is different to other types of medical treatment.

Other consent forms that you are likely to be asked to complete are about how you wish your sperm, eggs and embryos to be used. For instance, do you want your embryos frozen, and if so, for how long? The law prescribes maximum time limits for this, and your clinic will advise you on the time limit applicable to your particular situation.

One of the things you have to think about, if you are a man having treatment in the UK, is what happens in the event you were to die, or to permanently become incapable of making a decision. You must state whether, in such a scenario, you would or would not be happy for your sperm to be used to create embryos, and for those embryos to be transferred to your partner. Most couples would have had no reason to even think about such things before they come to fertility treatment, but this is an important discussion to have with your partner before IVF.