In-vitro Fertilization (IVF): Side effects
In vitro fertilization – a type of Assisted Reproductive Technology is a wonderful treatment option for infertility which involves the fertilization of eggs by sperm outside the body.
When other fertility treatment options fail, IVF is used.
IVF involves the use of medicines in different steps: ovarian stimulation (fertility medications are given to produce more eggs), egg retrieval (collection of matured eggs), fertilization of the egg by sperm in a culture medium and embryo formation, and finally transferring the embryo in the woman’s uterus.
This process, however, is not without risks. With increased preferences for IVF lately, it has become imperative to clearly understand the associated risks.
Hormones administered to stimulate ovaries can have various side effects. The egg retrieval process carries the risks of surgery and anesthesia.
The use of different types of medicines during the process may show a wide range of side effects that you should know about. In general, the most prominent side effects include headache, vomiting, blurred vision, depression and mood swings, chances of miscarriages, multiple pregnancies, premature delivery, low birth weight, ectopic pregnancy, pelvic discomfort, and ovarian cysts.
You may also undergo emotional stress. Other specific side effects are discussed further in this article.
Side effects associated with Ovarian stimulation (use of hormones):
You are administered fertility medicines (injectable hormones) to stimulate egg production and this use of hormones carries risks such as mild bruising and soreness at the injection site, nausea or vomiting, abdominal pain, bloating, hot flashes, breast tenderness, mood swings, fatigue, and in rare cases, ovarian hyperstimulation syndrome (OHSS).
These medicines also have the potential to cause cancers of the breast, ovary, or endometrium; and probably problems with long-term fertility.
Occasionally, the use of fertility medicines is also reported to cause blood clots and kidney failure.
OHSS is mainly characterized by swollen and painful ovaries. This occurs due to the leakage of fluid into the abdomen and causes symptoms such as bloating, nausea, vomiting, diarrhea, mild abdominal pain, and weight gain.
You need to stay hydrated and have proper rest to treat these symptoms. However, rarely OHSS may lead to some serious complications such as shortness of breath and blood clots, in which case, you may need to be hospitalized.
Side effects associated with egg retrieval:
The egg retrieval process involves a surgical procedure using an anesthetic agent. The major side effects are hence associated with sedation, anesthesia, and surgery.
An aspirating needle is used to collect the matured eggs that may cause vaginal bleeding, infection, or damage to the nearby organs surrounding the ovary: bowel, bladder, or blood vessels. You may have mild to moderate pain in the pelvic and abdominal regions.
Pelvic infection, yet uncommon, may be seen and antibiotics may be prescribed to prevent it. Nausea, vomiting, cramping, fatigue, and constipation are other reported side effects seen during or after the egg retrieval process. These side effects usually subside within a couple of days.
Side effects associated with embryo transfer:
A catheter is used to place the embryo into your womb (uterus). You may feel mild cramping and notice slight vaginal bleeding afterward.
The chance of developing an infection is very rare and if that happens, antibiotics are used.
The use of gonadotropins is associated with multiple implantations resulting in multiple births (twin or more). It may be due to the number of embryos transferred or the number of eggs that are stimulated during an ovarian stimulation cycle.
When you have multiple pregnancies, you may be at a higher risk of miscarriage, premature delivery, low birth weight, gestational diabetes, and pregnancy-induced hypertension. It also increases the need for a C-section too. Infant abnormalities also could be seen.
The rate of miscarriage is similar to that observed in natural conception but it increases with your age.
This refers to the implantation of an embryo outside of your womb, usually in a fallopian tube. About 2 to 5 % of women with IVF are reported to have an ectopic pregnancy.
You may experience symptoms like a sharp and stabbing pain, dizziness, vaginal bleeding, lower back pain, and low blood pressure.
In such a case, you need to call your doctor immediately. Ectopic pregnancy needs to be terminated since it is not viable.
Some serious side effects require consultation with a doctor or a hospital visit:
You may need to immediately get medical help if you notice any serious complications after the procedure. Some of these alarming side effects include:
- Fever if > 101ᴏF
- Reduced or stopped urination
- Chest pain
- Calf pain
- Severe and persistent abdominal bloating and discomfort
- Heavy bleeding
- Severe infection
IVF- Medicines used and their side effects:
IVF process involves the use of a different variety of medicines throughout the cycle and each of these drugs is known to possess peculiar side effects.
Fertility drugs are the predominant ones used to increase ovulation or egg production. Several other types of medications are also used such as aspirin, birth control pills, Estradiol, progesterone, leuprolide acetate, and even antibiotics.
Typically, the IVF cycle is started by using birth control pills to prevent early ovulation by regulating the menstrual cycle and preparing the reproductive system for further process.
From there, injectable fertility medicines are used to stimulate ovaries which are then followed by a trigger shot to release mature eggs before retrieval.
Gonadotropins (Puregon, Gonal-F, Bravelle, Follistim, Menopur, Pregnyl, Ovidrel):
Gonadotropins are injectable fertility drugs that contain Follicle-stimulating hormone (FSH) alone or combined with luteinizing hormone (LH).
In normal conditions, both these hormones are produced by the pituitary glands and help to naturally stimulate the ovary to produce single eggs each month.
The FSH injection (with or without LH) acts directly on the ovaries to produce multiple follicles containing multiple eggs. Human chorionic gonadotropin (HCG) is then injected to trigger the release of matured eggs.
The use of gonadotropin injections is commonly associated with common side effects including local irritation at the injection site, headache, fatigue, breast tenderness, abdominal pain, mood swing, nausea, and dizziness.
Occasionally these may lead to rare complications of OHSS (described in an earlier section), multiple and ectopic pregnancies. The risk of cancer associated with the use of gonadotropins is still under study since there is not sufficient evidence suggesting it.
Clomiphene (Clomid, Serophene):
It is a medication used to treat infertility in women without ovulation.
The most common side effects include hot flashes, night sweats, dizziness, mood swings, abdominal pain or bloating, breast tenderness, nausea, headache, vaginal dryness, and rarely blurred vision.
GnRH agonists (Lupron, Lucrin, Synarel):
These agents are prescribed in IVF women to prevent premature ovulation by a natural cycle. This increases the chances of producing fertile eggs and at the same time, prevents the release of eggs before egg retrieval occurs.
Possible side effects include nausea, hot flashes, headache, mood swings, acne, vaginal dryness, dizziness, weight gain, upset stomach, decreased sex drive, and soreness at the injection site.
GnRH antagonists (Antagon, Ganirelix, Orgalutran, Cetrotide):
These agents are used to prevent premature ovulation. Common side effects include pain or bruises at the injection site, abdominal tenderness, nausea, headache, and abnormal menstruation or bleeding.
Progesterone is the primary hormone for the luteal phase which helps in increasing implantation rates and pregnancy rates.
Since the pituitary is downregulated at the start of the IVF cycle, it is necessary to support the luteal phase by using progesterone pessaries. It is reported that progesterone supports the lining of the uterus after an embryo transfer in IVF women.
The usual side effects include headache, breast tenderness, vaginal irritation, burning and slight bleeding. Uterine cramping and mild abdominal discomfort or bloating may also occur.
This estrogen hormone may be prescribed in IVF women to help maintain the endometrial lining of the uterus.
The common side effects are nausea, vomiting, bloating, abdominal swelling, headache, breast tenderness, and slight vaginal bleeding.
This antibiotic may be prescribed orally to treat infections occurring as a side effect during IVF procedures.
The side effects include diarrhea, sore mouth, and genital itching. Doxycycline is known to be associated with increased sensitivity to sunlight and hence reducing exposure to sunlight is recommended.
Some side effects explained:
The IVF process, in itself, is not a cause of weight gain that you may experience. Rather, this is associated with the use of different hormones administered at different steps during the IVF cycle. This weight gain may be due to a couple of reasons.
First, your metabolism may be slowed and, second, it may enhance food cravings- which may, in turn, increase your weight in small amounts. It may also occur due to increased fluid retention in your body.
You may notice increased urination during or after the IVF cycle and this is mainly due to the HCG hormone and, additionally due to an increase in progesterone levels.
However, increased urination, if associated with other symptoms such as blood in urine, fever, flank pain, and painful urination may want to see your doctor for these symptoms also may occur due to a urinary tract infection.
This may occur due to the damage to the tissues near the uterus during an egg retrieval process.
The pain may be similar to the cramping and may even persist for 1 to 2 days after the egg retrieval process. This pain is usually mild and can be managed with over-the-counter pain
Bloating is observed as a common side effect during or after the IVF cycle resembles that seen in a normal menstrual cycle. This is because the hormones used in the IVF cycle are the same ones involved in regular menstruation. It is mainly due to increased progesterone levels.
The surgical procedures involved during egg retrieval and embryo transfer processes might occasionally lead to pelvic infection.
Antibiotics such as doxycycline may be prescribed before or after the procedures to prevent or treat the infection.
You may undergo an emotional or psychological turmoil of stress levels during IVF. This may occur as a result of hormones used for the process and also due to its financial aspects.
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