Risks and complications of IVF treatment

Unintended Childlessness: A Psychological and Medical Challenge

For many couples, prolonged infertility can become a severe life crisis, leading to sexual dysfunction, relationship problems, guilt, low self-esteem, and mood swings that affect various aspects of life. In-vitro fertilization (IVF) offers many couples a chance to conceive, but the treatment itself can be just as emotionally and physically draining as infertility itself. The outcome of the treatment plays a crucial role in emotional well-being (Goldschmidt 2003). Additionally, artificial fertilization involves medical interventions that carry risks and complications.

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Ovarian Hyperstimulation Syndrome (OHSS)

One major risk of assisted reproduction is Ovarian Hyperstimulation Syndrome (OHSS), a potentially life-threatening complication caused by hormonal stimulation of the ovaries (gonadotropins).

⚠️ Symptoms vary by severity and may include:
✔️ Abdominal bloating and discomfort
✔️ Nausea and vomiting
✔️ Ovarian enlargement
✔️ Fluid accumulation in the abdomen
✔️ Increased blood clotting risk
✔️ Impaired kidney and liver function

Other IVF-related complications include ectopic pregnancies, infections, thrombosis, and damage to organs and blood vessels.

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Multiple Pregnancies: Increased Risks

To increase success rates, multiple embryos are often transferred, increasing the risk of multiple pregnancies.

📌 According to the IVF registry:
✔️ 21.3% of births after IVF are twins
✔️ 0.7% of births are triplets

Complications of multiple pregnancies:
✔️ Higher risk of developmental disorders and premature birth
✔️ Greater risks associated with advanced maternal age
✔️ Increased likelihood of Cesarean section, which carries risks such as:

• Heavy blood loss
• Blood clots
• Infections
• Organ damage
• Poor wound healing
• Anesthesia-related complications
• Post-traumatic stress disorder (PTSD) in mothers

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Higher Miscarriage & Preeclampsia Risk

Women who conceive via IVF have a higher miscarriage risk, often due to:
✔️ Older maternal age
✔️ Genetic abnormalities in sperm, particularly in severe cases of male infertility

IVF pregnancies also have a higher risk of preeclampsia, a condition characterized by:
✔️ High blood pressure
✔️ Protein in the urine
✔️ Swelling in the face, hands, and feet

⚠️ Severe cases may lead to:
✔️ Nausea, vomiting, dizziness, vision disturbances, and confusion

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Severe Psychological Stress

Many couples underestimate the mental toll of fertility treatments.

⚠️ Emotional burdens on women include:
✔️ Chronic physical and emotional stress
✔️ Strong side effects from hormone therapy
✔️ Emotional rollercoaster due to multiple treatment cycles

📌 Studies indicate:
✔️ IVF-related stress is comparable to grieving the loss of a family member (Zuber-Jerger 2002).
✔️ 52% of women experience depression after IVF, regardless of the treatment outcome.

Other known psychological effects: (Telus 2001)
✔️ Lower self-confidence and self-esteem
✔️ Loss of control and autonomy
✔️ Anxiety and tension while awaiting results
✔️ Reactive depression after unsuccessful treatment

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Financial Burden of IVF

Infertility treatments are extremely costly, and many couples face immense financial pressure.

📌 German health insurance coverage (as of 2004):
✔️ Covers only 50% of IVF costs for up to three attempts
✔️ The woman must be under 40, and the man under 50
✔️ Both must be at least 25 years old
✔️ Marriage is required for full insurance support

📌 For unmarried couples:
✔️ They must prove a stable partnership
✔️ Doctors determine whether they qualify for treatment

❌ Out-of-pocket costs for three IVF attempts and prior treatments can exceed €10,000.

Some health insurers cover a higher percentage of IVF costs than required by law. A list of these insurers is available HERE.

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Health Risks for IVF-Conceived Children

Since 1978, over 8 million children have been born through IVF or ICSI. However, long-term studies have only followed them until age 18.

📌 Recent findings:
✔️ Higher rates of high blood pressure, insulin resistance, and early vascular aging in adolescents conceived via IVF
✔️ Increased abdominal obesity risk
✔️ 2.5x higher cancer risk compared to naturally conceived children (Wenderlein 2020)

These risks not only affect IVF-born children but could also impact future generations.

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The Need for Full Risk Disclosure

Women must be fully informed about the risks of IVF—including potential health risks for their children.

✔️ If no other treatment options remain, couples must decide if they are willing to accept the risks.
✔️ Doctors must ensure all non-IVF treatments have been fully explored before recommending ART.

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Premature Referrals to Fertility Clinics

Conception is a complex biological process and a natural miracle.

📌 Many women are referred to fertility clinics too soon because:
✔️ Doctors base assumptions on a 28-day textbook cycle
✔️ 70% of women do not fit this standard cycle length

Many women have shorter or longer—but perfectly healthy—cycles. Ovulation still occurs, but not always mid-cycle.

Consequences:
✔️ Early and late ovulations often go undetected
✔️ Women may be misdiagnosed with anovulation (no ovulation)
✔️ Unnecessary IVF referrals, despite the possibility of natural conception

This unnecessary medicalization imposes significant emotional and financial stress on couples.

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References

Goldschmidt S et al. (2003). Life satisfaction in infertile couples after IVF treatment. Reproductive Medicine, 19, 30–39.

Telus M. (2001). Reproductive medicine: Between trauma and taboo. Dtsch Arztebl, 98(51-52), A-3430 / B-2889 / C-2685.

Zuber-Jerger I. (2002). Reproductive medicine – Between trauma and taboo: High-risk decision-making. Dtsch Arztebl, 99(10), A-617 / B-505 / C-476.

German Health Insurance IVF Coverage

Wenderlein JM. (2020). Is reproductive medicine at a risky crossroads? Gyne, 5/2020.