Risks and complications of IVF treatment
One unintended childlessness can trigger a serious life crisis for many couples as it persists. Over time, sexual dysfunction, relationship problems, feelings of guilt and...
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Anne Alexander
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One unintended childlessness can trigger a serious life crisis for many couples as it persists. Over time, sexual dysfunction, relationship problems, feelings of guilt and inferiority, and mood swings may arise, limiting various aspects of life.
For many couples, in vitro fertilization (IVF) offers a chance to have a child of their own. However, couples often find not only their inability to conceive but also the medical treatment itself to be a significant burden. The outcome of the treatment plays an important role in this (Goldschmidt 2003). Furthermore, artificial insemination is a medical procedure, and every procedure carries certain risks that can lead to various complications.
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Hyperovulation syndrome
One risk associated with assisted reproduction is ovarian hyperstimulation syndrome (OHSS). OHSS is a potentially life-threatening complication of ovarian stimulation and is one of the main complications of assisted reproduction procedures. It is primarily caused by the external administration of hormones (gonadotropins) to induce egg maturation. Depending on the severity, various symptoms may occur: abdominal distension, discomfort, nausea, vomiting, and even enlargement of the ovaries, free fluid in the abdomen, increased tendency for blood clotting, impaired blood flow to the kidneys, and liver dysfunction. Other complications of IVF treatment may include an increased rate of ectopic pregnancies, infections, thrombosis, damage to organs and blood vessels, and much more.
Multiple pregnancies
Transferring multiple embryos to increase the chances of success always carries the risk of a multiple pregnancy. According to the IVF Registry, 21.3% of all births are twin births, while 0.7% are triplet births. Multiple pregnancies can lead to developmental disorders in the unborn babies or even to premature births. Carrying twins or even triplets to term is an additional and serious risk, especially when combined with the mother’s typically advanced age. In addition, multiple pregnancies are usually delivered via a planned cesarean section, which in turn can lead to complications. These include significant blood loss, blood clots, infections, injury to adjacent organs, impaired wound healing, anesthesia-related incidents, and post-traumatic stress disorder in the mother.
Increased risk of miscarriage and preeclampsia
The risk of miscarriage is generally higher among women who have become pregnant through IVF treatment. This can be explained, on the one hand, by the fact that couples are, on average, older. On the other hand, specific genetic abnormalities may occur, particularly in cases of severe sperm abnormalities. These, too, can be the cause of a potential miscarriage. Maternal preeclampsia, a pregnancy-related condition characterized by high blood pressure, protein in the urine, and fluid retention (edema) in the tissues—which causes swelling in the face, hands, and feet—can also be more likely to occur following artificial insemination. In severe cases, pregnant women with preeclampsia experience additional symptoms such as nausea and vomiting, dizziness, visual disturbances, and confusion.
Severe psychological stress
Many childless couples underestimate the emotional toll of hormonal fertility treatments. For women in particular, both body and mind are under constant stress. This is often compounded by the sometimes severe side effects of hormone therapy. If multiple treatment cycles are necessary, patients constantly swing between hope and disappointment. Studies point to high rates of side effects and mental stress In fact, the stress caused by IVF is considered to be on par with the death of a family member! Studies also show a 52% rate of depression following IVF, regardless of whether the treatment was successful (Zuber-Jerger 2002).
Psychological impairments that remain well-known among experts include: reduced self-confidence and self-esteem, loss of control and competence, violation of personal integrity, anxiety and tension—particularly while awaiting the outcome of treatment—as well as reactive depression following a lack of success (Telus 2001).
Financial burden
Last but not least, couples face a tremendous financial burden. Since the 2004 healthcare reform, most public health insurance plans have covered no more than half the cost of artificial insemination for a maximum of three attempts. The requirements are as follows: the woman must not be older than 40, and the man must not be older than 50. However, both partners must be at least 25 years old. Statutory health insurance providers still require a marriage certificate for fertility treatment. Special rules apply to unmarried couples: They must be living together in a so-called “stable partnership”—whether this is the case is at the discretion of the doctor conducting the consultation.
Artificial insemination can be a real financial burden. This is because very few women get pregnant on the first try. It’s not uncommon for three to four attempts to be necessary. With three rounds of in vitro fertilization and several rounds of insemination beforehand, costs can quickly add up to as much as 10,000 euros. Some health insurance providers also cover a higher percentage of the costs for artificial insemination than required by law. You can find a list of these health insurance providers HERE.
Risks for children conceived through IVF
Over the past 40 years, more than 8 million children have been born following IVF or ICSI, with over half a million children conceived via IVF added each year. During this period, only children up to their 18th birthday were included in studies. Children conceived through assisted reproductive technology (ART) have always been under special monitoring, and to date, only a few abnormalities—such as a slightly increased risk of cancer and skin conditions—have been reported. However, in the past two years, the results of more recent studies have been published. These studies report on older individuals conceived via IVF who suffered from high blood pressure, insulin resistance, and prematurely aged blood vessels as early as adolescence—all conditions that typically manifest only in later life. Furthermore, an increased risk of obesity, particularly in the abdominal region, has been reported. According to recent findings, the risk of cancer is estimated to be 2.5 times higher (Wenderlein 2020). This may have direct consequences for the health of children conceived through assisted reproductive technology (ART), and likely even for the children of these children.
Educate about risks
Women must be fully informed about the risks of the treatment, including the risks to children conceived through IVF. If there are no other treatment options available, women must decide whether they are willing to accept the risk. However, the doctor should always verify that all options for so-called conservative treatment—that is, treatment without IVF—have been exhausted.
Referrals to fertility clinics are often made too hastily
One Pregnancy is a highly complex process and a miracle of nature. In our experience, women are often referred to fertility clinics too early and too hastily. The reason for this is that doctors generally assume that 28-day textbook cycle assume. However, studies show that 70% of all women do not meet this standard. Their individual cycles are shorter or longer, yet perfectly healthy. A ovulation also occurs, just on a different day and almost never in the middle of the cycle. As a result, early and late ovulation often goes undetected by gynecologists, leading to patients being incorrectly diagnosed with anovulatory cycles. The result: The patient is referred to a fertility clinic, even though a natural pregnancy would have been possible. As a result, couples are unnecessarily subjected to significant emotional and financial strain.
References
Goldschmidt S et al. 2003. On the Relationship Between Life Satisfaction in Couples Who Are Childless Without Wanting to Be and Treatment Outcomes Following IVF. Reproductive Medicine 19, 30–39.
Telus M. 2001. Reproductive Medicine: Between Trauma and Taboo. In: German Medical Journal 2001; 98(51-52): A-3430 / B-2889 / C-2685
Zuber-Jerger I. 2002. Reproductive Medicine – Between Trauma and Taboo: An Excessive Willingness to Take Risks. In: Dtsch Arztebl 2002; 99(10): A-617 / B-505 / C-476
Wenderlein JM. 2020. Reproductive Medicine at a Dangerous Impasse? In: Gyne. 5/2020.
