Possible risks associated with IVF treatment

It is important to remember that any medical or surgical treatment has risks, adverse effects and side effects. All couples should be aware that Mother Nature is not a perfect midwife and that one baby in 40 born in Queensland will have a birth defect. There is no clear evidence that infertility medicines, if properly used, increase this risk. Furthermore, approximately one in 10,000 pregnant women in Queensland will die during pregnancy.

In addition, cancers tragically occur not only in mothers, but also in babies. For example, every year breast cancer is newly diagnosed in approximately 150 Queensland women, 40 years or younger. There is also no clear evidence whether infertility medicines might increase this risk.

Nevertheless, statistics for Queensland and Australia indicated that there has never been a safer time in history to have a baby.
Anyone taking medication for any reason should be aware of the possible side effects and should report adverse effects to those managing their treatment. The drugs used for IVF and GIFT are known to create some minor side effects in the women, but there is no evidence of increased risk to a baby born as a result of a properly managed treatment. For gynaecological operations, the usual risks of serious complication or death are approximately 1 in 5,000 operations.
We emphasise again that this information is aimed at providing realistic and accurate advice for you at this stage of your reproductive life.

Multiple pregnancy

One of the most significant adverse outcomes of IVF treatment in recent years has been the increase in the multiple pregnancy rate, contributed by improved response rate of treatment as well as improved implantation rates. This factor can be somewhat confusing to an infertile couple who might welcome a multiple pregnancy as a bonus. In fact a multiple pregnancy carries significant risks to both the mother and the infants when compared to singleton pregnancies. Medical complications through the pregnancy are increased and include an increased incidence of high blood pressure (pre-eclampsia) and antepartum haemorrhage (bleeding before the onset of labour). Neonatal complications are significant and include a higher incidence of growth retardation of one or both infants. In a twin pregnancy there is a significantly higher incidence of premature birth. This latter factor contributes significantly to the problems faced by patients who have achieved a pregnancy after a long period of infertility. A number of procedures are being actively investigated to reduce the incidence of multiple pregnancy: single embryo transfer in selected patients as well as extended embryo culture (up to the blastocyst stage) to allow adequate pregnancy rates with single embryo transfers. Improved success with cryo-preservation of embryos has allowed an increased use of single embryo transfers and subsequent frozen embryo transfer cycles (should a pregnancy not arise in the index stimulated cycle). These factors should be considered carefully and discussed with the Clinician and Nurse Coordinator throughout your IVF treatment cycle. Before each embryo transfer the Clinician and Embryologist will discuss with you the indications for single or multiple embryo transfer.

Follicle Stimulating Hormone (FSH) : Puregon and Gonal F

These drugs are used to encourage development of a group of follicles in the ovaries. Because the ovaries are swollen with follicles, some tenderness and swelling of the abdomen may be experienced. The increase in the hormone oestrogen as a result of multiple follicle growth can cause breast tenderness. Other common symptoms include slight nausea, dizziness and slight abdominal swelling or bloated sensation as with pre-menstrual syndrome.

Ovarian Hyperstimulation Syndrome (OHSS)

Hyperstimulation is a potentially dangerous medical condition that can occur in women who have had gonadotrophin for ovulation treatments or IVF therapies. We do not yet fully understand its causes and take steps to minimise its impact. A small sub group, approximately 1-2% of patients will develop what we classify as severe hyperstimulation syndrome and require hospitalisation and close, intense medical supervision. Women who are at more risk are young and thin or with polycystic ovary syndrome. They are more at risk of achieving excessive egg numbers, which seems to increase the risk of this condition developing. This is likely to occur in women who develop in excess of 20 eggs, but has been known to occur with fewer eggs. If we think a woman is at significant risk of developing this condition, we can cancel the cycle before giving the HCG injection. This tends to prevent the development of severe ovarian hyperstimulation syndrome (SOHS). The condition can also be worsened in these patients by the establishment of a pregnancy. Therefore an option is to collect the eggs, fertilise them and freeze the embryos with a view to transferring 1 or 2 embryos in a future cycle, when the ovaries have returned to mormal. Another method used to minimise the risk of OHSS is to infuse a solution called Albumen in theatre if more than 15 eggs have been collected and to use progesterone pessaries rather than Profasi injections for luteal phase support.

Women who develop severe ovarian hyperstimulation syndrome have dramatic enlargement of their ovaries and fluid shifts from the blood stream into the abdominal cavity, causing distension and discomfort and sometimes into the cavity around the lungs creating breathing difficulties. A further risk is that the decreasing volume of fluid in the blood vessels increases the viscosity or thickness of the blood and this can lead to thrombosis or clotting. These clots can later embolize (break-off) and move to other parts of the body causing damage. Some deaths have been recorded overseas from this but no deaths have been recorded in this country. Needless to say severe ovarian hyperstimulation syndrome is a potentially dangerous medical condition requiring hospital admission and occasional admission to intensive care for adequate supervision and therapy. The risk of this condition in an otherwise healthy woman has to be to balanced against any desire for children and while mechanisms are in place to minimise the risk of this occurring, it cannot be absolutely avoided. The condition tends to settle with the onset of the period for those who are not pregnant, but can last into early pregnancy in those that are pregnant.

Anaesthesia

Modern anaesthesia is particularly safe and is always performed by a specialist Anaesthetist who is trained to deal with any particular complications. It is not uncommon to have a sore throat following a procedure and post-operative nausea and vomiting occurs in some patients. There is often also a feeling of tiredness or drowsiness for some hours following the procedure. Serious complications can occur with allergic reactions to the anaesthetic agents used and depression of the respiratory system. It is thought that 1 person in 20,000 who has an anaesthetic is likely to die as a direct result of anaesthesia. Specialist Anaesthetists are trained to minimise any risk to the patient and will see you prior to any anaesthetic procedure to inquire about your medical and past anaesthetic history.

Cancer and infertility

Infertility occurs in about one in eight Australian couples.

Cancer occurs in approximately one in three Australian women. The most common cancers in Australian women are cancer of the breast (lifetime risk 1 in 14 women); bowel (1 in 25 women); lung (1 in 53); ovary (1 in 94) and pancreas (1 in 159).

Breast cancer

Of the cancers of the sex organs, breast cancer is most common, occurring in 1 in 14 Australian women. The cause, or aetiology of breast cancer is unknown. Various factors or diseases make breast cancer more likely. Breast cancer in a mother or sister increases the risk, as does a non-cancerous or benign breast lump of some types.

Breast cancer is more common in infertile women. Some medical research suggests that cigarette smokers are at increased risk.

Monthly breast self-examination is recommended in all women. All lumps should be investigated immediately. Most breast lumps are benign. There is no screening method for breast cancer, although mammography detects small cancers.

Ovarian cancer

Ovarian cancer occurs in about 1 in 90 women. Its aetiology is also unknown.

Ovarian cancer may also occur in families in 10-15% of cases.

Ovarian cancer has been reported to be more common in women who drink milk every day.

Ovarian cancer is also suggested to be more common if a woman uses talcum powder on her vulva for personal hygiene.

Ovarian cancer is also more common in infertile women.

Oral contraceptive pills decrease the risk of cancer of the ovaries. This remarkable advantage of “The Pill” occurs, not only while the women takes “The Pill”, but also for at least five years after stopping the pill, there is no screening method for ovarian cancer. Every woman is advised to have a gynaecological examination and “Pap Smear” every two years to minimise the risk of ovarian, uterine and cervical cancers.

Cervical cancer

The lifetime risk of cervical cancer is 1 in 95 women.

Cervical cancer can be screened by cervical cytology, by the Papanicolaou or pap smear. The aetiology of cervical cancer is related to sexual activity. For this reason, every woman having sexual intercourse should have a pap smear every 2 years. An increased number of sexual partners and a papilloma or wart virus infection also increase the general risk of development of cervical cancer.

A pap smear every 2 years, as well as regular gynaecological and breast examinations, are currently the best methods to prevent or detect women’s cancers.