Complications and risks associated with the treatments

It may be stressful to undergo fertility treatment not least mentally because the hope for success is very pro- nounced. The possible physical side effects are described below. There is no indication that there should be any long-term side effects of the treatment. 

Children born after in vitro fertilisation 
Several large studies have shown that the risk of miscarriage and malformations after ICSI and IVF treatment is slightly increased. This does not appear to be because IVF/ICSI treatment as such increases the risk. But the infertile couples who are in need for IVF/ICSI treatment already have a slightly increased risk of pregnancy complications and malformations. 
There is no special indication for CVS (chorion villus sample) or amniocentesis because the pregnancy is achieved by IVF or ICSI. 

All pregnant women in Denmark are offered a nuchal translucency scan in week 11-14 and a blood test (double test) in week 9-12 of the pregnancy. Based on the woman’s age and the results of the tests the risk of a chromosomal abnormality in the fetus can be evaluated. 

Undesirable effects of the hormone treatment 
Some women will experience side effects but most women will only have very mild symptoms. 

During down-regulation, you may experience headache, hot flushes and mood disturbances because of the reduced production of estrogen. These side effects will disappear once the hormone stimulation is started. 

Stimulation of follicle growth is done with the pituitary hormones (FSH or hMG), which are natural hormones. In preparation for oocyte pick-up we aim for a follicle number of 8-14. 

Some women will feel discomfort or tension in the lower abdomen because of the high number of growing follicles. In rare cases many more follicles than intended will grow. In this situation, there is a risk of developing ovarian HyperStimulation Syndrome (OHSS). See more information below. 

Ovarian hyperstimulation syndrome (OHSS) 
If too many follicles ar growing a condition known as the ovarian hyperstimulation syndrome may occur after the hGC injection for final oocyte maturation is given. In OHSS, the ovaries are markedly enlarged. Because fluid may also accumulate in the abdominal cavity, the abdomen may become distended. 

Signs of OHSS may occur in the days after the final oocyte maturation injection (hCG) is given (early onset OHSS). Symptoms may also arise approximately one week after the embryo transfer (late onset OHSS). The late OHSS will almost only occur if you are pregnant. This reason is that the early pregnancy produces hCG which is the hormone that together with many follicles may cause OHSS. 

OHSS may be mild, moderate or severe. The mild to moderate OHSS does not require hospitalisation and will often improve if the woman drinks a lot of fluid after the oocyte pick-up.
The severe form of OHSS requires hospitalisation. Often it is of short duration, but it is a potentially serious condition. Symptoms include a very distended abdomen, trouble breathing, reduced urine production and circulatory problems. 
Less than 1% of our patients will need hospitalisation because of OHSS. If hospitalised most women will be discharged within a few days, but unfortunately we have seen very few (<1‰) patients with severe hyper- stimulation who will need prolonged hospitalisation. 

If you think that you may be hyperstimulated you should always contact us. 

We always try to avoid hyperstimulation by adjusting the dose of stimulation hormone to fit the individual woman. We intend to stimulate so that a suitable number of follicles will grow, but in some women it is not so easy to achieve. Hyperstimulation is always temporary and does not cause long-term effects. 

Allergic reactions 
Allergic reactions may occur during the hormone treatment.
Most often it will be mild reactions like erythema or itching around the site of injection. It will often solve the problem if you switch to another of medicine.
Very rarely, there could be severe allergic reactions with rash, trouble breathing or fever. If you experience such serious reactions, you must not take more of the medicine. You should contact us or another doctor immediately. 

Does hormone treatment increase the risk of getting ovarian cancer? 
A number of studies from Denmark, Sweden and other countries have demonstrated hormone treatment used for IVF does not appear to increase the risk of getting ovarian cancer or endometrial cancer. 

Complications associated with oocyte pick-up 
The oocytes are aspirated through a needle that is inserted into the follicles in the ovaries through the vaginal wall. Therefore, there may be slight bleeding from the vagina after the oocyte pick-up. Very rarely (<1%) does the bleeding require further treatment. The bleeding may be stopped by placing a suture or two at the origin of the bleeding. The suture will disappear by itself. Bleeding after the oocyte pick-up does not alter the chance of becoming pregnant. After the oocyte pick-up, you may have some discomfort in the lower abdomen. If you experience pain after the oocyte pick-up, you may use pain relieving medicine such as Panodil® (paracetamol). 

Infection after oocyte pick-up is very uncommon (<1⁄2%) and should be treated with antibiotics. At the oocyte pick-up you will receive a prophylactic injection of an antibiotic to minimise the risk of having an infection. 

Pregnancy complications 
Miscarriage 
After a positive pregnancy test, the risk of a miscarriage is approximately 20% when the woman is younger than 40 years. If she is older than 40 years, the risk is higher. 

Ectopic pregnancy 
Implantation outside of the endometrial cavity (‘ectopic pregnancy’) occurs in about 1-3% of IVF/ICSI preg- nancies. 

At the embryo transfer the embryos are placed centrally in the endometrial cavity. However, for unknown reasons the embryos may occasionally migrate out into the fallopian tube and implant there.
Signs of an ectopic pregnancy include pain and bleeding early in the pregnancy. Another sign may be that the pregnancy hormone (hCG) starts at a too low level and that the concentration increases at a slower than normal rate. 
If there is suspicion that you may have an ectopic pregnancy, we will take repeated blood tests for hCG to follow the development. If the hCG level does not increase the way it should or if you develop symptoms indicating an ectopic pregnancy (pain or vaginal bleeding) we will refer you to a hospital for further treatment. The treatment may be with medicine or an operation (most often a laparoscopy). 

If we suspect that you may have an ectopic pregnancy we will inform you that you should go to a hospital immediately if you experience abdominal pain or if you do not feel well. If you should experience abdominal pain and you do not feel well you must seek immediate medical assistance. The symptoms may be caused by bleeding from the ectopic pregnancy into the abdominal cavity and may be fatal if not treated immediately.