Possible disappointment in an IVF cycle

Unfortunately not all IVF cycles are successful. At Melbourne IVF, we believe it is important that you are aware of the possible disappointments as well as the joys that IVF can bring.

The following is a brief outline of where problems may arise.

Cancellation of a treatment cycle:

A treatment cycle may need to be cancelled due to poor response to fertility drugs. In some cases, the ovaries do not respond well to the drugs and an insufficient number of eggs grow. This is detected by low, or a slow rise in hormone levels or follicle growth as measured by blood tests and ultrasound. Setbacks at this stage teach us more about the hormone patterns and we may be able to amend the treatment plan for subsequent attempts. Cycles cancelled at this stage do not incur the full costs of IVF.

No eggs obtained at egg collection:

In a normal IVF cycle most, but not all follicles, will yield an egg at the time of your egg collection. The usual proportion is that approximately 70% of your follicles will produce an egg. Some follicles will not produce an egg at all. Small follicles may produce an egg but it will not usually be a mature (or useable) egg. The number of follicles seen on your stimulation cycle scan is not, therefore, the same as the number of eggs expected at your egg collection, particularly if small follicles are included in the count.

No eggs fertilise or divide:

In a very small proportion of cycles (1-3%), none of the eggs will fertilise. On average, around 60% of eggs fetilise, as not all eggs collected at the time of egg collection will successfully fertilise and develop into an embryo suitable for transfer or freezing, nor will all eggs fertilise normally. Sometimes this is due to poor sperm quality or poor egg quality. Usually a special technique to inject the sperm directly into the egg (ICSI) can overcome the problem in a future cycle. However it is important to remember that, even when ICSI is used, fertilisation and further division of the egg does not always occur.

Embryo transfer and still no pregnancy:

If the cycle is not going to be successful, embryo implantation is usually the point at which it will not work. Unfortunately, many embryos lack all the genes needed to develop fully and, despite a healthy appearance at the time of transfer, will not subsequently implant and develop.

Possible side effects of the IVF treatment

Ovarian hyper-stimulation syndrome:

Ovarian Hyperstimulation Syndrome (OHSS) is one of the more serious complications of an IVF cycle. OHSS can occur when the ovaries have over responded to the Follicle Stimulating Hormone. In this instance, the ovaries produce an excessive number of follicles and become markedly enlarged.
The symptoms you should be aware of and report immediately to us are:

• Abdominal pain
• Severe nausea and vomiting
• Diarrhoea
• Shortness of breath
• Increasing thirst
• Decreasing urine output

If moderate or severe OHSS occurs, hospital admission for intravenous fluid therapy and pain relief for up to a few days may be necessary. It is important to stress that OHSS is not a permanent condition however, and over the following 10-14 days your body will return to normal.

In its severest form it is a danger condition and there have been reports in the scientific literature of severe side effects and fatility.
In over 250,000 treatment cycles in Australia, there have been no fatalities but in its severe form this condition can be life threatening and cases of significant blood clotting problems have occurred.

Adverse reaction to drugs:
The large majority of women having IVF treatment will be having a stimulated cycle. This will involve the use of two different groups of drugs. The first one stimulates the ovaries to produce multiple follicles, and the second prevents the premature release (ovulation) of the eggs in those follicles.

The drugs used in IVF treatment are generally of low risk and it is unlikely that you will have any significant side effects. Occasionally side effects include headaches, local skin reaction, and flu-like symptoms.

Complications of the egg collection:
In order to perform the egg collection, a fine needle must be passed through the wall of the vagina, into the abdominal cavity, and into the structure of the ovary. There is a very small chance of developing pelvic infection, pelvic bleeding and damage to the bowel, bladder or other internal organs from this procedure.

Pelvic infection:

the chance of developing pelvic infection following the egg collection procedure, especially if there is a past history of pelvic infection, or endometriosis involving the ovaries. In most cases, the infection would be vey mild and would rapidly be brought under control with antibiotic therapy.

Bleeding:

there is an extremely small risk of causing bleeding, either from the wall of the vagina, or from within the structure of the ovary. Very occasionally, structures surrounding the ovary, such as the large blood vessels, might also be damaged during the egg collection.

Damage to bowel and bladder:

it is also possible for damage to occur to other pelvic structures during an egg collection, such as the bladder or the bowel. This is also extremely rare however there is a possibility that it might require readmission to hospital and further surgical investigation and treatment.

Possible adverse outcomes of your pregnancy and the health of your baby

Miscarriage:

The risk of miscarriage with IVF pregnancy is not any greater than in naturally conceived pregnancies. In IVF, miscarriage occurs in up to 25% of all pregnancies with the chance of miscarriage increasing markedly as the woman becomes older. For women who are over 40 years of age, the risk of miscarriage is as high as 40%.

Light bleeding (or spotting) occurs in up to 55% of ART pregnancies and should not cause undue concern unless associated with increasing abdominal pain.

Ectopic pregnancy:

An ectopic pregnancy is one that implants outside the uterus, usually in the Fallopian tube. The risk of tubal, or ectopic pregnancy is quite small but it may occur in up to 3% of IVF pregnancies. It is more common when there has been previous damage to the tube. The risk of ectopic pregnancy following IVF is no higher than with spontaneous conception.

Multiple pregnancy:
Multiple births from IVF are caused by the transfer of more than one embryo. In most cases we recommend transferring only one embryo as twin pregnancy carries a significantly increased risk of a number of different childbirth and newborn complications. In particular a multiple pregnancy has a five times increased risk of death or major disability.
The health of a child conceived through IVF:

The risk of health problems at birth or in the first year of life in children conceived naturally is approximately 4%. However, research carried out in Western Australia and elsewhere has suggested that, in children conceived after IVF, the risk of health problems at the time of birth is slightly higher at around 5-6%. This increase does not appear to affect any specific conditions. It is not clear why this small increase occurs. It may be related to the processes of creating a child through IVF, or certain types of infertility problems may predispose towards an increased risk of foetal abnormality.

The health of the parents following IVF:

There has been concern about the potential effects of fertility drugs on a woman’s long-term health.

Cancer and IVF:
A major study from La Trobe University published in 2001, which aimed to address whether there was any increase in the numbers of cancers of the breast, ovary and uterus in women on IVF compared with the numbers expected among women of the same age followed up over the same period in the general population, and in the event that there were more of these cancers than predicted, how this might be explained. The study involved 29,700 women who had undergone treatment at ten Australian IVF clinics and the duration of follow-up after treatment ranged form one to 22 years, with the majority followed up for five to ten years.

The findings provide reassurance that the incidence of breast and ovarian cancers in IVF patients is the same as that for women of the same age in the general population when considered over a five to ten year period.
Notwithstanding future research, this study reinforces the importance for women of medical check-ups at regular intervals after fertility treatment.
The male partner is not free from concerns either. Testicular cancer is known t occur more commonly in men with low sperm counts and our fertility specialists advise all men with low sperm counts to have an ultrasound on their scrotum to check for any early signs of this.