Learn all about the potential risks and side effects of IVF or ICSI and how you can successfully minimise your personal risk.
Key Facts:
- Hormone stimulation can cause discomfort such as abdominal pain, bloating, breast tenderness or headaches.
- Ovarian hyperstimulation syndrome (OHSS) is very rare.
- Mild pain or vaginal bleeding may occur after egg retrieval.
- The risk of miscarriage increases with age, especially in women over 40.
- The risk of birth defects in IVF children is similar to that of naturally conceived children.
Introduction
For couples who are unable to conceive naturally, fertility treatment can lead to success. In vitro fertilization (IVF) gives hope to couples facing infertility, but it also carries risks that should be considered when making a decision.
At Cada, it is important to us to inform you comprehensively and transparently. This article is intended to give you an honest insight into the possible risks of IVF treatment. We are not trying to scare you, but to prepare you for the challenges that may arise. We want you to feel safe and in good hands with us.
Through regular check-ins and close support, we minimise the risks as much as possible and can respond to your individual needs at any time. This article highlights the most common side effects of IVF, supported by scientific findings, and shows you ways to minimise these risks.
Risks of IVF
1. Side effects of fertility medications
During assisted reproduction technology (ART) treatments, your ovaries are stimulated so that several eggs come to maturation and thus your chances of pregnancy are increased. This is done by administering hormones, which can also lead to side effects. These are usually mild and disappear after discontinuing the hormones.
Possible complaints that may occur include abdominal pain, nausea, breast tenderness, mood swings, headaches or sleep disturbances. In rare cases, ovarian hyperstimulation syndrome may occur. This is an overreaction of your ovaries to the hormones. In severe cases, OHSS can be life-threatening and hospitalisation may be necessary.
Learn more about possible side effects of fertility drugs in this video:
2. Ovarian Hyperstimulation Syndrome (OHSS)
Overstimulation can occur after hormonal stimulation of the ovaries. In about 1% of women, a moderate to severe form of this syndrome develops. Symptoms of OHSS include severe abdominal pain, nausea, fluid accumulation in the abdomen and breathing problems. Women with a high number of eggs (e.g. with polycystic ovary syndrome, PCOS) have a particularly increased risk. In order to minimise the risk as much as possible, we at Cada rely on individually adapted stimulation protocols and drug doses.
3. Complications during egg retrieval and embryo transfer
Egg retrieval
During egg collection, the eggs are removed from your ovaries using a thin needle that is inserted through the vagina. The fluid is aspirated from the egg sacs (follicles), which also contain the eggs. The procedure is performed under ultrasound guidance. Possible complications include:
- Vaginal bleeding
- Vaginal discharge
- Slight pain
- Feeling of pressure
In rare cases, pelvic infections or injuries to organs (intestines, bladder) or nerves can occur.
Embryo transfer
During embryo transfer, the embryo is inserted into the uterine cavity with a thin catheter. Spotting or vaginal bleeding is also possible here. In extremely rare cases, injuries to the uterus or infections can occur.
Embryo transfer is usually painless. Mild cramps or spotting may occur afterwards.
4. Multiple pregnancies
Although it is now common practice to transfer only one or (in rare cases) two embryos, the risk of multiple pregnancy remains. This may be due to the fact that, despite the transfer of one embryo (SET), it can divide and result in a twin pregnancy. On the other hand, it can also happen that when two embryos are transferred, both implant and one of the embryos divides in addition. This then leads to triplets.
Multiple pregnancies are associated with increased risks and complications, both for the mother and the children. For example, multiple births are significantly more likely to result in:
- Premature births
- Low birth weight
- Gestational diabetes
- Pre-eclampsia
The transfer of only one embryo can significantly reduce the risk of multiple pregnancy without affecting the pregnancy rate. In many cases, SET is therefore the recommended procedure.
5. Ectopic pregnancy
In rare cases, the embryo may implant outside the uterus, usually in the fallopian tube. The risk of an ectopic pregnancy is increased after in vitro fertilisation with embryo transfer. Studies show that 2.1 to 8.6 % of pregnancies after IVF occur outside the uterus, mostly in the fallopian tubes. In comparison, the rate for natural conceptions is about 2 %. Early ultrasound monitoring is crucial to detect and treat this risk.
6. Miscarriages and genetic risks
The risk of miscarriage depends strongly on the woman's age and the quality of the embryos. Women over 40 have a higher risk of miscarriage, even with IVF. One study found that older women (≥40 years) had a significantly increased risk of miscarriage (27 % compared to 12.7 % in younger women).
7. No guarantee of success
IVF or ICSI treatment does not guarantee pregnancy. Success rates vary depending on various factors, such as the woman's age, the cause of infertility, the number of treatment cycles and the individual health situation.
Even though IVF technology has made great progress in recent years, the probability of pregnancy per treatment cycle remains limited. On average, the success rate is about 30-35% per cycle. This means that several treatment cycles may be necessary to achieve pregnancy.
It is therefore important to set realistic expectations and be prepared for the fact that IVF treatment is not always successful. Psychological counselling can help couples cope with this uncertainty and possible disappointments.
8. Psychological stress
The path to pregnancy through IVF is often associated with high emotional stress. The combined weight of uncertainty, hormone treatments, invasive procedures, and the ongoing struggle with infertility can deeply affect a person's mental well-being.
- The uncertainty of whether the treatment will be successful often leads to stress and anxiety. An entire IVF cycle, from ovarian stimulation to the pregnancy test, is associated with hopes and fears.
- Repeated unsuccessful treatment cycles can lead to disappointment, frustration and grief, which can lead to depression.
- Infertility can bring feelings of grief and loss, impacting a person's self-esteem and their sense of identity as they navigate a different life path than they envisioned.
How can I minimise the possible risks of IVF?
1. Choose a fertility centre with experience
The experience and expertise of the medical team play a crucial role in the success and safety of the treatment. Find out about the success rates, complication rates and the centre's experience with various fertility challenges.
2. Talk openly with your doctor
The initial consultation at the fertility clinic is the perfect opportunity to discuss your individual risk factors and concerns with your doctor. Make sure you understand all the information and have all your questions answered. Together with your doctor, you can develop the most appropriate treatment strategy for you.
3. Maintain a healthy lifestyle
A healthy diet, regular exercise, sufficient sleep and avoiding nicotine and alcohol can increase the chances of successful IVF treatment and reduce the risk of complications.
4. Minimise the risk of multiple pregnancy
Discuss the possibility of single embryo transfer (SET) with your doctor. SET significantly reduces the risk of multiple pregnancy without significantly affecting the chances of pregnancy.
At Cada, we always transfer only one embryo to keep the risk of later complications as low as possible.
5. Take your hormones according to schedule
Carefully follow your doctor's instructions for taking the hormones. If you experience severe side effects or signs of OHSS, contact your doctor immediately.
6. Find out about alternative treatment options
Your doctor can help you explore the full range of fertility treatment options, including intrauterine insemination (IUI) and hormone therapy, to determine the best approach for your individual needs and circumstances.
FAQ
Is the risk of birth defects increased with IVF?
Current studies show that the risk of birth defects in children conceived through in vitro fertilization (IVF) is not significantly higher than in naturally conceived children. This applies both to conventional IVF, where the egg and sperm are brought together in a petri dish, and to intracytoplasmic sperm injection (ICSI), where a single sperm cell is injected directly into the egg.
One study examined the rate of birth defects in singletons and twins after IVF and ICSI. The results showed no significant differences between the two methods:
- Singletons: 0.46% malformations after conventional IVF vs. 0.42% after ICSI.
- Twins: 0.66% malformations after conventional IVF vs. 0.80% after ICSI.
For comparison: The rate of malformations in naturally conceived children is about 0.5 - 0.7%.
There are isolated studies that indicate a slightly increased risk of certain malformations, such as heart defects, after IVF. However, these results need to be confirmed by further research.
Interestingly, the risk of birth defects in women over 40 years of age after IVF treatment may even be lower than with spontaneous pregnancy. This is probably due to the fact that genetic testing of the embryos is often performed before they are transferred to the uterus during IVF.
Can IVF hormones cause cancer?
Several studies have recently been published that have investigated the link between taking fertility drugs and cancer risk. However, these studies have some weaknesses in their implementation, e.g. the difficulty of investigating rare cancers that often do not occur until years after taking fertility drugs.
No increased risk for common cancers
Although infertility itself can increase the risk of certain cancers such as breast, uterine and ovarian cancer, most studies show that taking IVF medications does not further increase this risk.
Possibly increased risk for borderline ovarian cancer
Some studies suggest a possible increased risk of borderline ovarian cancer (a form of ovarian cancer with a low degree of malignancy). However, this increased risk is small and a clear link with the use of fertility drugs could not be demonstrated.
Takeaway
IVF offers many couples with infertility a great chance to have a child. Nevertheless, the IVF process carries certain medical and emotional risks that should not be ignored. Many risks can be minimised through careful medical supervision, individually tailored stimulation protocols and transparent communication. A healthy lifestyle and psychological support can additionally help to reduce the risk.
