SIDE EFFECTS OF IVF TREATMENT

SIDE EFFECTS AND COMPLICATIONS OF IVF TREATMENT

SIDE EFFECTS OF IVF TREATMENT


All medical techniques are subject to risks or complications, and the techniques of IVF or ICSI do not escape. However, the risk of MPA is low compared to most medical procedures.

Serious complications are exceptional, accounting for less than 2% of cycles.

Nevertheless, you must be aware of these risks, to know the decision to start the treatment and to be able to recognize the signs promptly.

THE COMPLICATIONS THAT ARE QUITE FREQUENT:


HYPERSTIMULATION (HSO):

It usually occurs in women who have had a very strong ovarian response to the stimulation treatment (many follicles in ultrasound and more than 20 oocytes in the puncture). In reality, IVF cycles are at the limit of hyper stimulation, since the response to stimulation is strong.

It is more common in younger patients, those with ovarian dystrophy (large ovaries with multiple small cysts) and a hormonal profile with elevated AMH (> 5 ng), LH (> 10 MUI) and testosterone (> 0.60 pg).

It corresponds to :

Has a very significant increase in ovarian size

Has water retention. When this retention is very important, it can be accompanied by imbalances in the blood composition, severe if not corrected, and effusions of fluid in the abdomen (ascites), sometimes around the lungs.

There are several degrees of hyperstimulation.

At degree 1, there is simply weight gain that requires only simple monitoring and rest.

At grade 3, hospitalization is essential, sometimes in intensive care, to correct imbalances by infusions and for intensive monitoring in case of major fluid effusions or renal failure.

The frequency of severe hyperstimulation is less than 2% of the cycles in IVF.


When does hyperstimulation begin?


It can start during stimulation, but it can only become severe if ovulation is triggered by Chorionic Gonadotrophins or Ovitrelle. Therefore, the attitude of caution which is to cancel cycles overstimulated allows effective prevention. Symptoms usually occur after a puncture and especially during pregnancy.

When to suspect hyperstimulation?


The best criterion is weight gain. Beyond 3 kilos, one enters the framework of the severe hyperstimulation.

Apart from weight gain, it is the sensation of swelling, abdominal discomfort, with increased waist circumference or even discomfort to breathe which are the best symptoms.

If you are in such a setting, do not hesitate to go back to your gynecologist or emergency center. A blood test and ultrasound are rapidly needed. Then, depending on the severity, simple home surveillance or hospitalization will be decided.


How to treat hyperstimulation?


Moderate hyperstimulation does not require treatment, apart from rest. Severe forms require hospitalization with correction of abnormalities by infusions, or by punctures of ascites or pleura. In most cases, anticoagulant therapy is also in place.

How does hyperstimulation evolve?


Hyperstimulation always heals on its own within 15 to 30 days. This delay may be longer in pregnancy.

What are the risks?


With current treatments, the risks are minimal, although inconvenience and discomfort can be significant. Since the beginning of in vitro fertilization, no fatal cases have been reported in France. The main risk is thromboembolic (formation of clots in the veins), hence the frequent use of anticoagulants.

MULTIPLE PREGNANCIES

COMPLICATIONS-OF-IVF-TREATMENT


IVF exposes the risk of multiple pregnancies, which themselves greatly increase the risk of pathological pregnancy and prematurity.

In most cases, it is in fact transferred more than one embryo, because the pregnancy rate increases with the number of embryos transferred.

In the French statistics, about 20% of the pregnancies obtained are twins and less than 1% are triple or quadruple.

Multiple pregnancies are mostly observed with morphologically perfect embryos during early transfers and in younger patients.

The prevention of multiple pregnancies is based on a prudent policy of embryo transfer (usually no more than two embryos per transfer).


THE INFECTIOUS RISK

COMPLICATIONS-OF-IVF-TREATMENT-PROCEDURE

The removal of oocytes by vaginal puncture of the ovaries always exposes them to an infectious risk, either by the reactivation of a tubal infection or by the contamination by a microbe present in the vagina despite the disinfection made before the puncture.

This complication is more frequent in the case of hydrosalpinx (filled mouth filled with fluid), endometriosis cysts, a history of infection or pelvic surgery.

Gestures involving the introduction of material into the uterus (insemination, embryo transfer) also carry a risk of infection.

The frequency of serious infectious complications is less than 1%.

The occurrence of severe abdominal pain and temperature in the aftermath of an aspiration, embryo transfer or insemination should be promptly consulted to begin antibiotic treatment as soon as possible.

It may be an infection of the uterus (endometritis), tubal (salpingitis), more rarely pelvic peritonitis or ovarian abscess that requires antibiotic treatment and often laparoscopy. This type of complication may require removal of a fallopian tube and, exceptionally, an ovary in the event of an abscess, and may leave sequelae impairing subsequent fertility.

The prevention is based essentially on the vaginal disinfection immediately before puncture and the antibiotics.

The risk of transmission of a disease such as hepatitis B or C or AIDS is virtually impossible in AMP given the obligation to use the disposable material for all procedures and systematic serological screening before management.

RARE OR EXCEPTIONAL COMPLICATIONS:

THE THROMBOEMBOLIC RISK

Treatment of ovarian stimulation, by causing a major increase in estrogen levels, increases the risk of thromboembolism. This risk may be manifested by the occurrence of phlebitis, pulmonary embolism or even strokes.

This complication is rare in patients without risk factors.

On the other hand, the risk is increased in the case of severe ovarian hyperstimulation (with intra-abdominal fluid effusion) and patients at risk (history of phlebitis or pulmonary embolism, resistance to activated protein C, resistance to protein S, Antithrombin deficiency 3 ...).

Age is also a risk factor.


When the suspect?


Most often it is phlebitis, either the lower limbs or the upper limbs. The limb becomes painful, increases in volume. It is often red and hot. It is necessary to consult urgently.

How to treat it?


The basic treatment is the anticoagulant, which will be continued for several weeks.

PREVENTION

PRECAUTIONS-TO-TAKE-CARE-DURING-IVF-TREATMENT-PROCEDURE


In patients with risk factors, an assessment is imperative before MPA, which may lead to anticoagulant prevention.

ALLERGIES

All drugs given in IVF can potentially give allergic reactions, but these reactions are infrequent and usually benign.

The products that give the most allergy are the antagonists (Cetrotide® and Orgalutran®). This is a local allergy with a skin reaction. They are fleeting and do not require treatment to stop.

Severe allergies are rare and for the most part unpredictable. However, it is advisable to always mention known allergies, especially iodine, antibiotics and local anesthetics.

During the consultation, your gynecologist will give you an allergy search form, which you will give to the nurse of the department during the hospitalization for the puncture.

TORSIONS

Torsion of the appendix (ovary and trunk) is a very rare complication.

During stimulation and afterward, the ovary increases in volume and can twist around its pedicle. Ovarian torsion occurs mostly after a puncture and especially in early pregnancy. It results in a very brutal and very intense pain (like a stab wound). The pain is unilateral and often radiates to the kidney and groin. It's an emergency.

How does it evolve?


Frequently, the ovary uncovers itself. The sharp pain then gives way to a dull pain that fades in a few hours.

However, this is not constant, and it is necessary to act either by puncturing the ovary under ultrasound to decrease the volume of the ovary in hopes of spontaneous detention or by laparoscopy to undo the ovary.

If the treatment is done in time, the twist is of no consequence; On the other hand, treatment too late exposes the risk of ablation of the ovary.

THE ANESTHETIC RISK

If the puncture is performed under general anesthesia, the anesthetic risk exists but is extremely low. It will be evaluated by the anesthesiologist, which you must see in pre-IVF consultation.

However, the progress of anesthesia and resuscitation was such that the deadly anesthetic risk of a puncture is equivalent to that taken during a 30-kilometer drive.

If the puncture is performed under local anesthesia, there is a potentially allergic reaction to Xylocaine injection, and any abnormal reaction that you may have had with local anesthesia (e.g., dental care) should be reported. There is also a risk of vascular passage during injection, which manifests itself in a transient feeling of discomfort, sometimes a brief loss of consciousness and convulsions, but which is generally without consequences.

THE HEMORRHAGIC RISK

The puncture of the ovaries consists in introducing a needle into a highly vascularized organ. This always causes a small hemorrhage in the abdomen. In the vast majority of cases, it is of no consequence.

If it is a little important, it can cause persistent pain for a few days. This is often an abdominal bloating with constipation and pain in the shoulders. Rarely bleeding may require laparoscopy following a puncture (usually within 24 hours).

CARCINOLOGICAL RISK

Many patients fear that the hormones used for stimulation will cause cancer in the long term. This has been the subject of numerous studies, and today the conclusions are as follows:

Ovarian cancer: Treatments used in IVF do not increase the risk. It should be noted that sterile women have a higher natural risk of endometrial and ovarian cancer. This natural risk is almost normal if IVF is used to achieve childbirth

Breast cancer: no increase in risk has been demonstrated

Since cervical cancer is of viral origin, there is no relationship with MPA treatments.

What to do in case of a problem?


You may have to deal with unexpected difficulties or symptoms that you think are abnormal. As these treatments are quite specialized, it is best to approach the IVF team to find a solution.

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