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Many couples are still worried that babies born after IVF are abnormal or weak. You need to remember that in one sense there is nothing "artificial" about these babies they aren't synthetic babies, which are being manufactured in the laboratory! Remember that IVF is a form of assisted reproductive technology, where technology is being used to assist Nature to accomplish what it has failed to do for the infertile couple! Over a hundred thousand babies have now been born after IVF treatment, and the risk for birth defects is not increased after IVF treatment.
The most worrisome complication of IVF is that of ovarian hyper stimulation syndrome (OHSS), because of superovulation. The cause of "ovarian hyper stimulation syndrome" is that superovulated ovaries contain many follicles that are loaded with estrogen. After ovulation, a huge amount of estrogen-rich fluid is poured directly out of the enlarged and fragile ovaries into the abdominal cavity. This fluid also contains chemicals like kallikrein-kinin and VEGF (vascular endothelial growth factor), which then coat the lining of the abdominal cavity (called the peritoneum) and cause it to become very permeable (leaky). Fluid (serum) literally pours out of the bloodstream into the peritoneal cavity because of the "leakiness" of the abdominal cavity's lining. The ovaries balloon in size, the abdomen swells, and some women may get lightheaded with relatively low blood pressure, or dizzy because of the decreased blood volume. Many women going through IVF treatment will have mild degrees of ovarian hyper stimulation with a little bit of lower abdominal swelling, discomfort, and dizziness. This does not require hospitalization, just bed rest at home. It is only the rare, severe cases that require hospitalization. The occasional patient today who develops severe hyper stimulation must go into the hospital, have intravenous fluids for several days, and wait for her ovaries to reduce in size and for her body to readjust. Some patients may even need to be admitted into an intensive care unit for monitoring and observation, since this can be life threatening.
At one time this was a very dangerous condition only because it was not fully understood. We now know that by putting a small "paracentesis" catheter into the abdomen and draining all of this fluid, the patient is made much more comfortable, she can breathe more easily, and by getting rid of this estrogen irritation, fluid leakage into the abdomen slows down dramatically. Thus, even in the very rare cases of severe hyper stimulation syndrome, knowledgeable treatment makes the likelihood of any dangerous outcome very remote.
Interestingly, the worst cases of hyper stimulation syndrome occur when a woman becomes pregnant. This is because her placenta is making HCG and stimulating the ovaries to continue to pour out large amounts of estrogen-rich fluid. So although it is a very unpleasant side effect to endure, hyper stimulation syndrome often means good news.
If you grow too many follicles (more than 25), or if your estradiol level is very high, the doctor may be forced to cancel the IVF cycle, because of the high risk you run of developing ovarian hyper stimulation syndrome. Remember that hyper stimulation cannot occur unless ovulation takes place. Thus, if the doctor with holds the HIG injection, there is no risk of developing hyper stimulation. In some clinics, doctors can salvage this cycle by collecting all the eggs and freezing all the embryos. Since the embryos are not transferred, the risk of hyper stimulation is reduced; and the frozen embryos can then be transferred in a future cycle.
Complications can also occur during the egg harvest procedure. The removal of eggs through an aspirating needle entails a slight risk of bleeding, infection, and damage to the bowel, bladder or a blood vessel.
In all techniques of assisted reproductive technology, the chance of multiple pregnancy is increased when more than one embryo or egg is transferred. Although some would consider having twins to be a happy result, there are many problems associated with multiple pregnancies, and problems become progressively more severe and common with triplets and each additional fetus thereafter. Women carrying a multiple pregnancy may need to spend weeks or even months in bed or in the hospital. There may be enormous bills for the prolonged and intensive care for premature babies. There is also a greater risk of late miscarriages or premature delivery in multiple pregnancies.
© Dr. Aniruddha Malpani and Dr. Anjali Malpani www.drmalpani.com
Credits: How to Have a Baby: Overcoming Infertility
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