Like every medical procedure, IVF (in vitro fertilization) has certain risks and complications, such as multiple pregnancy, ectopic pregnancy and OHSS (ovarian hyperstimulation).

Couples who have trouble getting pregnant vouch for the fact that the fertility treatments they go through can take a physical and mental toll. If you find out that you’re infertile and that you can’t conceive naturally, the news can shake you up pretty badly. Add to this the slew of fertility treatments and you feel like you are on a downward spiral of sorts. This is one of the primary reasons why couples going through fertility treatments experience significantly high levels of stress; some also go into depression.

Below are the detail of the risks and complications in IVF.

What is an ectopic pregnancy ?

An ectopic pregnancy is one which develops outside the uterus. Most ectopics are found in the fallopian tube and these are called tubal pregnancies. However, they can also occur at other pelvic sites and these include: the ovary; the abdomen; and the cervix.

Fertilization normally occurs in the outer half of the fallopian tube which is called the ampulla. The embryo is then propelled along the fallopian tube, by the coordinated beating of the cilia which line the tube, towards the uterus. An ectopic pregnancy occurs when the embryo gets stuck in the fallopian tube and implants here, instead of moving on to the uterus.

Ectopic pregnancy occurs once in every one hundred pregnancies. The commonest cause of a tubal pregnancy is tubal damage, which is most often due to pelvic inflammatory disease. If tubal damage is severe, the tube gets totally blocked, as a result of which the patient is infertile. However, with less severe infection, the tube remains open, but the tubal lining is damaged, as a result of which the cilia can no longer function effectively. Other reasons for tubal damage include: tubal surgery, infection following IUCD insertion; and previous tubal pregnancy.

Infertile patients are at increased risk for ectopic pregnancies, for unclear reasons. Perhaps the cause of their infertility is subtle tubal damage. There is also an increased risk for tubal pregnancy after IVF, since the embryo may sometimes migrate after embryo transfer from the uterine cavity to the fallopian tube. The risk of ectopics after GIFT is greater than with IVF.

Watch this video on how to minimize the risks:

OHSS – ovarian hyperstimulation syndrome

The most worrisome complication of IVF is that of ovarian hyperstimulation syndrome (OHSS), because of superovulation. The cause of “ovarian hyperstimulation syndrome” is that superovulated ovaries contain many follicles which are loaded with estrogen. After ovulation, a huge amount of estrogen-rich fluid is poured directly out of the enlarged and fragile ovaries into the abdominal cavity. This fluid also contains chemicals like kallikrein-kinin and VEGF (vascular endothelial growth factor), which then coat the lining of the abdominal cavity (called the peritoneum) and cause it to become very permeable (leaky) . Fluid (serum) literally pours out of bloodstream into the peritoneal cavity because of the “leakiness” of the abdominal cavity’s lining. The ovaries balloon in size, the abdomen swells, and some women may get lightheaded with relatively low blood pressure, or dizzy because of the decreased blood volume. Many women going through IVF (in vitro fertilization) treatment will have mild degrees of ovarian hyperstimulation with a little bit of lower abdominal swelling, discomfort, and dizziness. This does not require hospitalization, just bed rest at home. It is only the rare, severe cases that require hospitalization. The occasional patient today who develops severe hyperstimulation must go into the hospital, have intravenous fluids for several days, and wait for her ovaries to reduce in size and for her body to readjust. Some patients may even need to be admitted into an intensive care unit for monitoring and observation, since this can be life-threatening.

It’s not always possible to achieve a pregnancy via IVF. However when you actually achieve it, it’s definitely worth all the trouble. The effort, pain and frustration then seems nothing more than a long-forgotten bad dream.

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