Complications of assisted reproduction

Assisted fertilization exposes the patient to some complications that should not be underestimated. All should be informed by the fertility centers where they are being treated.

Let’s see below what are the main “side effects” that can arise during an assisted reproduction treatment.

1) Multiple pregnancy

If 2-3 embryos are transferred during MAP treatment, twin pregnancies have a 25% incidence. Generally there is a tendency not to transfer more than 2 embryos. This is because in a twin pregnancy there is a risk of cerebral palsy of the unborn child 8 times higher than in a single pregnancy. In the case of triplets, the risk is even 47 times greater.

For this reason, the HFEA  has drawn up strict recommendations which indicate the transfer of a maximum of two embryos. However, more and more studies suggest performing the transfer of only one embryo since the success rates in these cases are always better

In this way the risk of twin pregnancies would be limited to monozygotic ones.

For example, in Scandinavian countries, only one embryo is transferred to women under 35 and the rest are frozen. The patient undergoes successive cycles of single embryo transfer until pregnancy is achieved. This is the approach that the scientific community prefers and recommends.

2) Ovarian Hyperstimulation Syndrome (OHSS)

Fortunately, ovarian hyperstimulation occurs in a severe form only in 2% of cases, but in less severe forms it can complicate any assisted reproduction treatment.

It is more likely to occur in women with polycystic ovary syndrome.

OHSS classification:

• Mild (ovary size between 5 and 10 cm): Grade 1 with abdominal pain/malaise or Grade 2 with nausea, vomiting and/or diarrhea
• Moderate (ovary size greater than 10 cm): grade 3 in which grade 2 symptoms are present and sonographic presence of ascites, or grade 4 in which the clinical signs of ascites and/or effusion are added to the grade 3 symptoms pleural, and/or dyspnea
• Severe  ( ovary size greater than 12 cm): grade 5 in which severe circulatory problems and decreased renal function are added to the grade 4 symptoms.

3) Ectopic pregnancy

Ectopic pregnancy can occur following any treatment of ART, even in cases where the embryo is transferred into the uterus, although it is more frequent in patients with tubal pathologies. The risk is 2-5%.

3) Complications of transvaginal oocyte retrieval (TVOR)

Oocyte retrieval ( pick-up) is an invasive procedure not without complications. An infrequent event, which occurs in about 1% of cases or even less, is represented by an ovarian infection with the consequent formation of abscesses, but also damage to the intestine.