The Risks of Assisted Reproduction Treatment

The Risks of Assisted Reproduction Treatment 2020-03-05T21:54:16+00:00

What are the risks associated with IVF treatment?

Like all medical treatments, fertility treatment carries some risks and we will discuss these with you before you go ahead. However, while it is important to have information about the risks of treatment, it is also important to appreciate that most women go through IVF and other assisted conception treatments without serious problems.
Risks can include reactions to fertility drugs that may be prescribed, and also the risks associated with any pregnancy. Other risks, of which some are not yet fully understood, relate to the children born as a result of the treatment. The risks of these treatments can be considered in four areas:
1. The risks associated with the drugs used to stimulate egg production.
2. The surgical risks associated with egg removal during IVF, ICSI and egg donation
3. The risks associated with pregnancy resulting from any treatment
4. The risks of producing an abnormal baby following IVF, ICSI or egg donation

What are the risks associated with the drugs used to stimulate egg production?

Drug reaction
Contact us if you have any unexpected reaction to treatment. You will have been provided with an emergency contact number. Always call rather than worry

Ovarian cancer
It has been suggested that the use of drugs used to stimulate ovaries may increase the risk of ovarian cancer. Women who have never been pregnant are known to be at slightly increased risk of ovarian cancer. The current position is that if a risk of ovarian cancer exists it is very low and unconfirmed.
There has been no association between the use of drugs to stimulate ovulation and the development of uterine cancer (womb cancer), breast cancer or cervical cancer.

Ovarian Hyperstimulation Syndrome (OHSS).

Drugs used to stimulate egg production may lead to a syndrome known as ovarian hyperstimulation syndrome (OHSS).

What is Ovarian Hyperstimulation Syndrome (OHSS)?

Ovarian Hyperstimulation Syndrome (OHSS) is a potentially serious complication of fertility treatment.


Who gets it? 

Any patient undergoing treatment with stimulation drugs during IVF is at some risk of developing ovarian hyperstimulation syndrome (OHSS).

Although we know that it is caused by the drugs we give you to simulate the ovaries, we do not know why only a small number of women develop these problems.


Who is most at risk?

Mild symptoms are common in women having IVF treatment. As many as one in three (33%) women develop mild OHSS. About one in 20 (5%) women develop moderate or severe OHSS.

The risk of OHSS is increased in women who:

  • Have polycycstic ovaries
  • Are under 30 years old
  • Body Mass index (BMI) less than 19
  • Very high ovarian reserve with AMH above 50 pmol/L.
  • Have had OHSS previously
  • Develop multiple follicles and high oestrogen levels during treatment
  • Get pregnant, particularly if this is a multiple pregnancy (twins or more).

What causes it?

Fertility drugs stimulate the ovaries to produce many egg sacs (follicles). Sometimes there is an excessive response to fertility drugs and this causes OHSS.

Overstimulated ovaries enlarge and release chemicals into the bloodstream that make blood vessels leak fluid into the body. Fluid leaks into your abdomen and, in severe cases, into the space around the heart and lungs. OHSS can affect the kidneys, liver and lungs. A serious, but rare, complication is a blood clot (thrombosis). A very small number of deaths have been reported.


How safe is the treatment?

We will always discuss the risk peculiar to yourself and to your own treatment before starting.

The development of follicles is monitored using ultrasound scanning and hormone levels are assessed through blood test. It is very important for you to attend for all of your scan and blood test appointments during treatment. If during the treatment you do appear to be responding in such a way that we are concerned about the degree of risk we will discuss this with you.

You may choose to abandon the cycle of treatment at this stage, or to persist, or in some way to modify the treatment such as to reduce the risk. Rarely we may decide that the risk is too great and will advise that the treatment must be discontinued.

Is there anything I can take to reduce the risk of OHSS?

There is now some evidence to suggest that taking a tablet called Cabergoline may help to reduce the severity of OHSS.

Cabergoline is a tablet used to treat a condition called hyperprolactanaemia (high levels of the hormone prolactin). It holds a product license for suppressing lactation (reducing milk production).

The purpose of a product license is to ensure that medicines are examined for safety, effectiveness and quality. In the United Kingdom (UK) most medicines given to adults have a product licence that outlines the conditions that the tablet can be used for, the dose and the way that the drug is to be taken (i.e. injection, tablet, suppository etc).

There is not a product licence for the use of Cabergoline in the prevention of OHSS and its use for this condition is therefore regarded as being ‘off-label’, i.e. outside the product licence.

Cabergoline has been studied by a group of researchers in Spain (Alvarez C ,Marti-Bonmatil et al 2007) to see if it will reduce the chance of developing OHSS or limit its severity if OHSS develops

Cabergoline works by reducing something called ‘vascular permeability’ (leaky blood vessels), which is causes the build-up of fluid in the abdomen (tummy) in OHSS. Following some initial laboratory based studies, the researchers in Spain went on to perform a clinical trial which was reported in 2007.

The research looked at 69 patients going through IVF treatment who were considered to be at risk of developing OHSS.  Cabergoline reduced the incidence (occurence) of moderate OHSS by half and there was a one third reduction in the incidence of severe OHSS, but the small number of patients meant that this was not statistically significant.  This means that the researchers could not say for certain that this did not occur by chance.