What are the Risks Associated with IVF?

<< back to IVF Table of Contents

The track record of safety for IVF over the years has been very good. Nonetheless, there are risks that you should be aware of:

Multiple Pregnancies

The risk of multiples is directly linked to the number of embryos transferred. Multiple pregnancies carries with it the problems of greater discomfort, higher risks of miscarriage, pregnancy-induced hypertension, fetal growth and development problems, and cesarean section delivery compared to singleton pregnancies. The biggest threat, however, is prematurity. Premature infants can have a host of problems ranging from minor disabilities to major mental or physical impairment to even death. Two methods to minimize high-order multiple gestations (triplets or more) is to transfer no more than two embryos or to selectively reduce the number of embryos after multiple pregnancy occurs.

Ectopic Pregnancy

The world's first IVF pregnancy in 1976 ended up in the woman's fallopian tube instead of her uterus. Even though the embryos are placed in the uterus, they are incapable of embedding in the endometrium immediately and may drift into a fallopian tube. In women with normal fallopian tubes, 1-2% of all IVF pregnancies are ectopic. For those with damaged tubes, the risk can be as high as 4-5%. This is still considerably below the risk for ectopic pregnancies in women with abnormal tubes who conceive naturally. We can usually diagnose most ectopic pregnancies very early in pregnancy, before any risk of rupture of the fallopian tube, which allows a choice between two forms of treatment: laparoscopic surgery to remove the ectopic pregnancy or an injection of a drug called methotrexate to dissolve it.

Ovarian Hyperstimulation

The fertility drugs used in IVF usually cause the ovaries to enlarge somewhat. Some women's ovaries are so sensitive to these medications that they enlarge 4 or 5 times normal size and cause discomfort and leakage of fluid from the blood vessels into the abdomen, a problem called Ovarian Hyperstimulation Syndrome (OHSS). Severe OHSS occurs in less than 1% of patients but usually requires hospitalization and careful treatment to avoid your getting very sick. The hospital stay can sometimes be several weeks, particularly if you are pregnant. We minimize the risk of severe OHSS by carefully monitoring your progress during drug treatment, and adjusting the drug doses as necessary.

Infection

There is a 0.1 percent (1 per 1,000) risk reported in the medical literature that a pelvic infection would occur after egg retrieval. These infections have been mild in some cases and severe, even to the point of requiring major surgery, in others. We always attempt to minimize this risk by using sterile technique and treating you with antibiotics.

Cancer

A study in 1994 showed a possible increase in the risk of ovarian cancer in women who took the fertility pill clomiphene citrate (Clomid) for a long period of time (12 or more months). Clomid is rarely used in IVF, and no studies to date have indicated any increased risk for other IVF medications, but perhaps studies in the future will. However, given the difficulty of demonstrating an increased risk of ovarian cancer despite nearly 30 years of IVF, it is likely that even if the risk is increased it is a slight increase! Counterbalancing this theoretical risk is the known benefit of pregnancy, which substantially lowers the risks of cancer of the breast, ovary and uterus.

IVF section: see next page >>