MEDICINE FOR ALL

Longer term risks and in vitro fertilization

• Wellbeing of in vitro fertilized

The incidence of congenital abnormalities in children born after in vitro fertilization or ICSI is about a third higher than for children conceived naturally, which means a chance of around 4 per 100 births instead of 3 per 100 births. Nearly all follow up studies have found in vitro fertilization children normal in their physical, mental and social development, but this is is still a subject of ongoing research . There is some evidence of a slightly  increased  risk of childhood cancers. This translates to less than an extra 1 case of cancer per 1000 of in vitro fertilization children.

There is a slightly higher rate of chromosomal abnormality in children from ICSI, and male children may inherit their father’s infertility.

Longer term risks and in vitro fertilization

• Sperm and embryo storage

Frozen sperm and embryos are stored in thin plastic straws immersed in liquid nitrogen. Cross-contamination of straws by viruses such as Hepatitis or HIV is a theoritical risk although it has never been reported. 

There is a very small risk that a liquid nitrogen bank will fail, causing the sperm or embryos stored in it to perish. Bank failure has been reported occasionally around the world.

Longer term risks and in vitro fertilization

• Cancer

Long-term follow up studies have failed to show any association between fertility treatment and ovarian or breast cancer. Pregnancy provides some degree of protection against ovarian cancer

Longer term risks and in vitro fertilization

• Multiple pregnancy

Having twins doubles or triples most birth-related risks to you and babies. Transferring one embryo at a time almost eliminates the risk of twins, but not quite, because the chance of identical twins is higher after in vitro fertilization than from natural conceptions. Around 2% of all births at Fertility Associates after transfer at one in vitro fertilization embryo are identical twins. Identical twins carry a higher risks of complications for the children.

For some people there is a remote risk of multiple pregnancy resulting from the fertilization of an egg not retrieved during egg collection in addition to the embryo(s) transferred.

Longer term risks and in vitro fertilization

• Pregnancy and child birth

Obstetric problems such as blood pressure, bleeding from the placenta (ante partum haemorhage), low birth weight, and premature birth are higher in in vitro fertilization pregnancies. The risks are higher for women over 40 years, and when using donor eggs, and not so high when using frozen embryos.You should take this into account when choosing a doctor or midwife for pregnancy care.

Side effects and risks for men having surgical sperm retrieval (SSR)

• Inflammation in the testes

Surgical sperm retrieval is likely to cause inflammation in the testes that could reduce future sperm production. It can also damage blood vessels in the testes. Up to 80% of men having surgical sperm retieval will have inflammation or pooling of blood (haematomal) at the site of the biopsy. Complete loss of  blood supply and atrophy of the testes has been reported after  a testicular biopsy. A repeated surgical sperm retrieval procedure is more likely to be successful if it is done at least 6 months after the last procedure, suggesting surgical retrieval commonly causes temporary damage to the testes.

Side effects and risks for men having surgical sperm retrieval (SSR)

• Bleeding and infection

Bleeding and infection are possible complications of surgical sperm retrieval, although they are rare. It is not uncommon to feel discomfort for several days, and good scrotal support .

Risks for woman

• Ovarian torsion

In about 1 in 500 cycles an ovary becomes twisted around its blood supply which can cause severe and sudden pain and sometimes the loss of the ovary. It is more common in woman who respond  well to the in vitro fertilization medications and who become pregnant. It is usually resolved by surgery to untwist the ovary.

Risks for the woman

• Ovarian Hyper-stimulation Syndrome (OHSS)

OHSS is the most serious risk in in vitro fertilization, and the severe form in about 1-2% of women. If it is  not treated, severe OHSS can cause blood clots, stroke and even death.

Why it occurs in some people and not in others is unknown, but it only occurs alter the ovaries have been stimulated and then exposed to hCG . It is more common in women who produce more follicles after in vitro fertilization, and in women who have Polycystic Ovary Syndrome (PCOS). It seldom occurs until four days or more after the hCG trigger injection. It occurs when fluid moves from the blood into the abdomen or the lungs.

Mild and moderate cases are usually treated with observation and pain relief, but more severe cases always require admission to hospital. In hospital you may be given intravenous  fluids or have fluid drained from the abdomen.