Risks and complications of IVF treatment

Ovarian hyperstimulation syndrome (OHSS)

This is the most serious complication of IVF. Any patient undergoing ovulation induction is at risk of developing OHSS, although some more than others. Ovarian hyperstimulation syndrome may be classified as mild, moderate or severe by symptoms and signs. the worst cases seem tends to be associated with pregnancy. Severe OHSS is a life threatening complication following ovarian stimulation.

The symptoms usually begin 4-5 days after the egg collection. The majority of women have a mild or moderate form of the syndrome and invariably resolve within a few days unless pregnancy occurs, that may delay recovery. Patient may complain of pain, a bloated feeling and mild abdominal swelling. In a small proportion of women, the degree of discomfort can be quite pronounced.

In some cases cysts appear in the ovaries (ovarian cysts) and fluid may collect in the abdominal cavity causing discomfort.

Very rarely the ovarian hyperstimulation is severe and the ovaries are very swollen. The woman will feel ill, with nausea and vomiting, abdominal pain. Fluid accumulates in the abdominal cavity and chest, causing abdominal swelling and shortness of breath. Reduction in the amount of urine produced. These complications require urgent hospital admission to restore the fluid and electrolyte balance, monitor progress, control pain and in some very serious cases, termination of pregnancy. Complications associated with severe OHHS include blood clotting disorders, kidney damage and twisted ovary (ovarian torsion).

Incidence of OHSS

Despite careful monitoring, up to 33% of IVF treatment have been reported to be associated with mild forms of OHSS. Severe OHSS has been reported in 3-8% of IVF cycles (Delvigne and Rosenberg 2002)

Causes of OHSS

Over response to fertility drugs. Cause is unknown. But, women at risk of developing OHHS include.

• Women with polycystic ovaries. There is evidence that adding metformin to ovulation induction in women with PCOS undergoing IVF treatment reduces the risk of developing OHSS (Tang et al. Human Reproduction 2006)
• Younger women.
• High estrogen hormone levels and a large number of follicles or eggs.
• Administration of GnRh agonist.
• The use of hCG for luteal phase support.

Management and treatment options for OHSS

• Withhold hCG administration when the blood estrogen levels and ultrasound scans show a high risk of severe OHHS.

• Proceed with egg collection, inseminate the eggs but have any viable embryos frozen and not proceed to fresh embryo transfer in that cycle and undergo subsequent frozen embryo transfer treatment cycle.
• Coasting to stop the gonadotropin stimulation and continuing the agonist suppression until estrogen levels declines to acceptable levels before proceeding to egg collection.

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