Risks Of In Vitro Fertilization

‘In vitro’ is a Latin word which means ‘in glass’. It refers to a procedure occurring outside the human body. Fertilization is defined as the union of a female egg with a male sperm. In vitro fertilization (IVF) therefore refers to a form of assisted reproductive technology in which eggs are removed from the female ovary, and mixed with sperms in a laboratory culture dish. After fertilization, the eggs (now called embryos) are transferred into a woman’s womb, where implantation and further development takes place.

Are There Any Side Effects Of In Vitro Fertilization Procedure?

For childless parents, IVF is a sign of hope but in some cases, the procedure may have certain risks and side effects. Most notable ones are discussed below:

1. Injectable IVF Medicines And Associated Risks

Injections of hormone gonadotropins (hCG) are given to the female who is undergoing in vitro fertilization to stimulate the production of eggs in the ovary. Various research and clinical studies indicates that exogenous injections of hormone gonadotropins are associated with several risks including:

• Formation of bruises and tender sores at the site of injection
• Transient local allergic reactions like itching and flushing of skin
• Nausea and vomiting
• Breast tenderness
• Increase in the vaginal discharge
• Fatigue
• Mood swings
• Ovarian Hyperstimulation Syndrome (OHSS): Mild temporary symptoms like nausea, abdominal bloating and ovarian discomfort can occur. In severe cases, fluid accumulation may also occur in the abdomen and lungs, resulting in ovarian enlargement, severe abdominal pain and respiratory distress. In very rare cases, it can also lead to abnormal clotting of blood and renal failure.
• An uncertain link between ovarian cancer and fertility medication also exists.
• Study reported in the Human Reproduction journal (1), suggested that risk of melanoma also increases after hormone mediated hormonal stimulation.

2. Egg Retrieval From Ovaries And Associated Risks

Egg retrieval is done with a long needle which is passed through the vagina into the ovarian follicles to remove the egg/s. Although this procedure is ultrasound guided, but in some cases, following complications may occur:

• Pelvic or abdominal pain of mild to moderate intensity; it is usually relieved on its own or can be managed effectively with pain meds.
• Damage to surrounding organs and structures like bladder, intestines or blood vessels
• Infection during or after the procedure. This can be prevented with prophylactic use of antibiotics
• Severe pelvic infections that may require removal of both the ovaries, tubes and uterus

3. Transfer Of Embryo And Associated Risks

A catheter transfers the embryo into the uterus of the female. Following problems can be encountered by the woman during/after this process:

• Mild pelvic cramping
• Slight vaginal bleeding
• Pelvic infection (rarely)

4. Complications During Pregnancy

• There’s a chance of multiple pregnancies especially because multiple embryos are transferred.
• Baby if born prematurely has a somewhat greater risk of developing lung dysfunction, intestinal infections, learning, behavioral and intellectual disabilities etc.
• Pregnancy induced hypertension in the mother
• Gestational diabetes
• Maternal hemorrhage
• Greater chances of delivery by Caesarian Section
• The risk of miscarriage is the same as in natural pregnancies, but increases with maternal age.
• IVF is associated with a slight risk of ectopic pregnancy (implantation in the fallopian tube). The symptoms includes; sharp abdominal pain, spotting, dizziness and low blood pressure. An ultrasound should immediately be performed to confirm the ectopic pregnancy (which can be managed medically or surgically).
• IVF is also associated with a small risk of Heterotopic pregnancy. This is a condition in which one embryo implants in the uterus, and another embryo implants in the tube. Treatment involves removal of the ectopic pregnancy. In majority of the cases, the uterine pregnancy grows and develops safely once the tubal pregnancy is removed.

5. Risk Of Birth Defects In Children Born By IVF

This is a topic under much debate these days. However, experts believe and studies have shown that the risk of birth defects in infertile couples is higher due to late conception or underlying causes of infertility.

Intracytoplasmic Sperm injection (ICSI) is an IVF procedure which is associated with birth defects, sex chromosome abnormalities and some rare genetic imprinting disorders. However it is not fully proven whether these complications are due to IVF procedure or due to defective sperms.

Speak to your fertility specialist to learn more about this procedure and associated risks.

References:

1. Spaan, M., van den Belt-Dusebout, A. W., Schaapveld, M., Mooij, T. M., Burger, C. W., van Leeuwen, F. E., … & Jansen, C. A. M. (2015). Melanoma risk after ovarian stimulation for in vitro fertilization. Human Reproduction, dev023.

2. Sandin, S., Nygren, K. G., Iliadou, A., Hultman, C. M., & Reichenberg, A. (2013). Autism and mental retardation among offspring born after in vitro fertilization. JAMA, 310(1), 75-84.

3. Hansen, M., Kurinczuk, J. J., Bower, C., & Webb, S. (2002). The risk of major birth defects after intracytoplasmic sperm injection and in vitro fertilization. New England Journal of Medicine, 346(10), 725-730.

4. Maheshwari, A., Pandey, S., Shetty, A., Hamilton, M., & Bhattacharya, S. (2012). Obstetric and perinatal outcomes in singleton pregnancies resulting from the transfer of frozen thawed versus fresh embryos generated through in vitro fertilization treatment: a systematic review and meta-analysis. Fertility and sterility, 98(2), 368-377.