RISK TO FEMALE PATIENTS

Ovarian Hyperstimulation Syndrome (OHSS)

This is the most severe side effect of stimulating the ovaries. Signs of OHSS include increased ovarian size, nausea, vomiting, and a buildup of fluid in the abdomen (belly). You may also have difficulty breathing. In some cases, OHSS increases the level of red blood cells, and may cause kidney and liver problems. In the most severe cases, OHSS may result in blood clots, kidney failure, or death. All of these complications occur extremely rarely (less than 0.2% of all IVF treatment cycles).

OHSS occurs at two stages:

• early, 1 to 5 days after egg retrieval (as a result of the hCG trigger); and

• late, 10 to 15 days after retrieval (because of the hCG when pregnancy results following embryo transfer).

The risk of severe problems from OHSS is much higher if you become pregnant. For this reason, your doctor may suggest that all of your embryos be cryopreserved for later use instead of transferring them during the fresh IVF cycle. A frozen embryo transfer would be done later, when there is no risk of OHSS.

Cancer

There is some concern that using fertility drugs can cause breast, ovarian, or uterine cancer. These cancers are more common in women with infertility, so it is difficult to know whether the reason for the cancer is infertility or the drugs used for IVF. In current studies that take into consideration the increased risk of cancer due to infertility, there does not seem to be an increased risk of cancer due to the fertility drugs per se. More studies need to be done to confirm whether there is an association of cancer with use of fertility drugs.