In most cases, treatment is well tolerated and risks are minor. It is, nevertheless, important to be aware of potential side effects.
Ovarian stimulation and injections
Gonadotropin injections can be accompanied by tension in the breasts, a sensation of flatulence, abdominal heaviness, water retention, fatigue and mood swings. Redness or surface haematomas (“bruises”) may appear at the injection site. These reactions are usually of short duration and have no consequences whatsoever.
Follicular needle biopsy
Although considered minor, this is a surgical complication that may trigger complications. The introduction of a needle into the abdomen could cause infection or internal bleeding. Fortunately, such complications seldom occur.
The needle biopsy can be followed by mild to moderate abdominal pain, which quickly responds to analgesic tablets. Vaginal bleeding of minor intensity, originating from the needle biopsy sites, is common in the hours following the procedure.
The ovarian hyperstimulation syndrome
This is the outcome of an excessive ovarian response to gonadotropin injections. The ovaries develop too many follicles. They are distended and painful. This situation may be accompanied by a sensation of malaise, nausea or swelling of the stomach due to an accumulation of fluid around the ovaries. Slight hyperstimulation is rapidly resolved at the end of treatment and has no repercussions. In approximately 1% of cases, hyperstimulation is severe warranting hospital admission for observation and administration of anticoagulants because this situation may trigger the onset of venous thrombosis.
The transfer of several embryos increases the chances of pregnancy but also heightens the risk of multiple pregnancies. In Switzerland, twins account for approximately 25% of multiple pregnancies, and triplets <1%. It should be remembered that the transfer of more than 3 embryos is not permitted in our country.
The aim of treatment is for the couple undergoing treatment to have a healthy child. In young women (< 35 years of age) with a favourable prognosis, the transfer of 2 embryos is preferable.
Compared to a single pregnancy, multiple pregnancies heighten the risks for both mother and child. They are often accompanied by a threat of premature labour, which warrants prolonged bed rest or hospital admission. Hypertension, diabetes, anaemia and delivery by caesarean section are also more common. The most frequent complications for the foetus and newborn infant are prematurity and delayed intra-uterine growth. The incidence of congenital deformities is also higher in children born of multiple pregnancies.
Even if they are positioned correctly in the uterine cavity, the embryos may migrate into a fallopian tube. This complication, which fortunately affects less than 4% of pregnancies arising from in-vitro fertilisation, may be detected at an early stage and medically treated by an injection in most cases.
As with a spontaneous pregnancy, a miscarriage can also occur after in-vitro fertilisation. The risk of miscarriage is approximately 15% in women under 35 years old. It gradually increases with age, reaching 35% after the age of 40.