Risks and Side Effects

Adnexal Torsion: in less than 1% of the times, the stimulated ovary can twist on itself, cutting off its own blood supply. Surgery is required to untwist or even remove it.

Assisted Hatching: there is a small risk of injury to the embryo(s) that could result in damage and non-viability. Although some studies show clear improvement in implantation following assisted hatching, others show no benefit. If pregnancy is successfully established, miscarriage, ectopic pregnancy, stillbirth, multiple births, and/or birth defects may still occur. There is insufficient information at this time as to whether the occurrence of any of these problems are increased or decreased by assisted hatching.

Birth Defect: the rate of birth defects after gonadotropin or IVF is not higher than in the general population (2-4%). Furthermore, these children are developmentally not different from their peers.

Egg Retrieval: is an outpatient procedure performed under anesthesia. It may cause moderate discomfort after the procedure. Incidental puncture of the bladder may lead to transient hematuria (blood in the urine). There is a small possibility (1/1000) of infection, bleeding or damage to bowel/abdominal organs that may require further observation or emergency surgical procedure to correct the incurred injury. There are also the risks associated with the sedation/anesthesia: nausea, respiratory depression, headaches, and cardiovascular collapse. There have been deaths reported from the use of anesthetic agents used during the retrieval, although such events are extremely rare.

Embryo Transfer: usually causes minimal discomfort/cramping. There is a possibility of bleeding and a very small risk of developing a pelvic infection or a tubal pregnancy.

Fertility Drugs (clomiphene citrate, Follistim®, Gonal-F®, Bravelle® or Repronex®): may result in the enlargement of the ovaries and development of ovarian cysts that may cause pain, bloating and discomfort in the lower abdomen but the ovaries eventually return to the normal size and shape. Individuals should not be physically active during this time since cysts may rupture and cause problems, some serious enough to require hospitalization and even surgery. Very rarely, overstimulation or “ovarian hyperstimulation syndrome” (OHSS) may cause abdominal swelling and fluid retention severe enough to lead to cardiovascular collapse (shock). The risk of this serious complication is rare (<1%). If severe OHSS occurs, it may require hospitalization for intravenous fluids and monitoring until the syndrome resolves. Therefore, careful monitoring during the use of these drugs is required in order to minimize these risks. Finally, there has been much speculation as to whether or not the use of fertility drugs causes ovarian cancer. To date the answer to this question remains unknown. Previously, there were three poorly designed studies that suggested an increased incidence of ovarian cancer in women who have received fertility drugs. However, there are more recent studies that do not show such an association. There are no studies to date that demonstrate a definite cause and effect relationship between fertility drugs and ovarian tumors/cancer (both benign and malignant).

GnRH Analog (Lupron®): may be associated with temporary hot flushes, body aches, vaginal dryness and other menopausal-like symptoms during the time in which the estrogen levels are low.

Intracytoplasmic Sperm Injection (ICSI): although this procedure increases the chances that the eggs will be fertilized, fertilization may still not occur. There is a small risk of injury to the egg(s) that could result in damage.

Multiple Pregnancy: up to 20% of pregnancies resulting from gonadotropins are multiple gestations, in contrast to a rate of 1-2% in the general population. Typically twins occur in approximately 25%-35% and triplets 5-10% of the pregnancies. Triplet and higher order pregnancies are high risk events and are associated with poorer obstetric outcomes than singleton births. Multiple birth pregnancies have a higher rate of preterm labor, stillbirth, neonatal deaths, maternal morbidity and mortality compared to singleton births as well as increased financial costs and emotional stress. The opportunity to reduce the number of fetuses (multifetal reduction) to a smaller number will be discussed with you, including the associated complications inherent to this procedure.

Progesterone: may cause the woman to feel pregnant. Side effects include: bloating, nausea, depression, increased appetite, weight gain, fatigue, sleepiness, headache, and sleep disorders.

For more information on infertility treatment and side effects, contact the Beth Israel Center for Infertility and Reproductive Health.