Referral & Treatments

Complications and risks of assisted conception treatment

Multiple Pregnancy

When we transfer more than one embryo into the uterus, there is a risk that you may have more than one baby developing. There are potentially serious implications of having either twin or triplet pregnancies. Multiple pregnancy (twins or triplets) leads to a greater risk of miscarriage, premature delivery (with possible death or handicap of one or all babies)

And the necessity for the babies to spend some time on the special care baby (intensive care) unit. Out of all the couples who have had an ongoing triplet pregnancy in our hospital, 85% deliver 3 babies. However, 13% of couples lost all their babies principally cause of premature delivery. With a multiple pregnancy there is also increased chance of spending time in hospital with problems such as raised blood pressure or other medical conditions in pregnancy. All triplet pregnancies are delivered by caesarean section and a significant proportion of twin pregnancies may also need caesarean section to deliver the babies. Finally, when you get all three babies home, you may well need some assistance to help you cope.

We follow certain guidelines from the HFEA regarding the transfer of embryos. We generally prefer to transfer 2 embryos particularly in women under the age of 40. It should be noted that the chance of conception does not appear to be significantly increased if 3 rather than 2 embryos are transferred. We would consider transferring 3 embryos in older women over 40.

Ovarian Hyperstimulation Syndrome

This condition occurs when the ovaries over respond to the hormone injections used to stimulate the growth of the follicles that contain the eggs.

Rather than the usual number of around 10 eggs, many more eggs may start to mature. This can result in the ovaries enlarging with some abdominal discomfort. The very high concentrations of hormones made by these developing follicles can make you feel nauseated. Fluid can accumulate in the abdomen and can cause abdominal distension. Sometimes fluid can form around the lungs and heart as well. The blood can become thick leading to blood clots and this can be an extremely serious condition.

It is rare for the condition to become severe and to require hospitalisation (1:200). You should however , look out for warning symptoms after the egg collection namely bloatedness, nausea, vomiting, diarrhoea, breathlessness and general malaise. If any of these occur, then you should contact the clinic immediately. There is always somebody available through clinic. Occasionally, admission into hospital will be necessary and the usual treatment is with intravenous fluids, a drip in the arm.

Down regulation. Side Effects

Some people may develop headaches with GnRH agonist treatments (Nafarelin, Buserelin, Zoladex and Prostap). Usually the headache can be treated with Paracetamol. Some women also complain of fleeing stuffy, like a head cold. Occasionally women develop 'hot sweats', similar to those experienced by women going through the menopause. This shows that the drug is working and the symptoms will disappear once your FSH injections start. Any injections of course can cause local pain or irritation.

Complications and risks of.....

Risks of the Egg Collection Procedure

At the time of an egg collection a needle is carefully passed through the wall of your vagina into the ovary under ultrasound vision. The needle can transfer germs from your vagina into the pelvis and lead to an infection. The risk of this is greater if you have an active vaginal infection. We take the precaution of cleaning your vagina before an egg collection. You are advised to let us know if you are suffering from vaginal infections or an offensive discharge.

Potentially the needle can also enter a blood vessel leading to internal bleeding or a loop of the small or the large bowel leading to internal infection. The risk of this complication is quite remote. We have never had this complication since 1991 when this programme was first established. You however have to be aware of this risk and your co-operation in the egg collection procedure is extremely vital. Sudden, uncontrolled and jerky movements can cause the needle to follow an unintended course. You are also at risk if you have pelvic adhesions that include bowel or if you have chronically infected tubes that are distended with fluid that may still contain bacteria. In some circumstances we may advise removal of these tubes prior to the treatment e.g. in patients with chronic symptomatic pelvic inflammatory disease or repeated IVF failures.

Risk of equipment failure:

The trust maintains service contracts for all equipment that is regularly serviced. There are also many standard operating procedures in the laboratory that help us have an early warning for problems. Despite all our efforts and very uncommonly equipment failure may sometimes lead to loss of eggs or embryos. This is a 'Category A' incident that will be immediately notified to HFEA, the trust and yourselves. There would usually be a thorough investigation and steps taken to prevent a recurrence of similar problems. The HFEA also operates an Alert system which we use to learn from incidents elsewhere.