In rare cases, the stimulation treatment may fail and, consequently, the follicle may not grow. Even increasing the dosage has no effect. During the egg retrieval, egg cells are obtained from an average of 80 per cent of the follicles seen previously on the ultrasound. Occasionally, however, it happens that the follicles are empty, and no egg can be obtained.
Causes can be:
As a rule, up to 80 per cent of the egg cells obtained can be fertilized. Occasionally, however, the fertilization rate is limited as it depends on the maturity of the egg cells and the quality of the male semen.
During the egg retrieval, preparation of the egg cells and incubation of the embryos in the laboratory, the culture may fail due to technical failures or mishaps on the part of employees. If embryos or sperm are frozen, the storage containers can break. As a result, embryos can no longer be used. The Kinderwunsch Institut Dr Loimer, of course, takes all possible measures to prevent this from happening.
In rare cases, embryo transfer through the cervix into the uterine cavity can be difficult or painful. Inflammation of the uterus rarely occurs after insertion. Very rarely does the embryo transfer fail completely.
The biggest (and so far unsolved) problem with IVF is the loss of embryos after transfer due to a failure to implant in the uterine lining. Unfortunately, many embryos do not implant. Since the reasons for this are largely unknown, nothing can be done on our side or yours. Attempts are made to optimise the ‘luteal phase’ (the time after transfer) through hormonal support. The success of the efforts – i.e. the birth of a child – can unfortunately never be guaranteed in advance.
Hormone stimulation can increase the risk of ovarian hyperstimulation. This rare complication usually occurs after the egg retrieval. Warning symptoms are a bloated, distended stomach, pain in the abdomen, nausea, shortness of breath or throat irritation, decreased volume of urine. Clinically, thickening of the blood is the main issue. This increases the risk of ‘blood clots’, so-called thromboses or embolisms. Treatment consists of blood thinning measures. In severe cases, treatment may need to be carried out as an inpatient in hospital, as this can be very dangerous for the patient. If the patient becomes pregnant, these symptoms can persist until the 10th week of pregnancy. After that, they usually go away on their own without permanent damage.
Due to the size of the ovaries, they can also rotate around their own axis. This is very painful and harbours the risk of insufficient blood supply to the affected ovary – in such cases, surgical intervention using a laparoscopy usually has to be carried out, which can also require a short hospital stay.
The Kinderwunsch Institut Dr Loimer does not have the option for stationary monitoring. Therefore, in advance of treatment, we will clarify which specialist gynaecological facility (local gynaecological department with the option of 24 hour care) can be contacted by you in the event of problems or complications.
In most cases, the follicles are punctured under sedoanalgesia or short anaesthesia. Sedoanalgesia or short anaesthesia can also lead to complications (e.g. nausea, vomiting, circulatory problems, headaches and in rare cases even respiratory or cardiac arrest).
Injuries to blood vessels, intestines or the ureter: During the egg retrieval, the doctor pierces the ovaries with a thin needle through the vaginal wall. This could injure neighbouring organs. A smooth puncture of the intestines or bladder is relatively harmless. Injuries to the pelvic wall or the ureter are problematic and could lead to internal bleeding or urine leaking into the abdominal cavity. This can result in a need for surgical treatment in hospital. There is an increased risk of injuries and further complications if the anatomical position of the pelvic organs is unfavourable.
Another risk is the spread of germs into the abdomen with subsequent infection. This complication is also rare and can usually be treated well with antibiotics. An operation is only necessary in rare cases (‘peritonitis’ or abscess in the abdomen). Unfortunately, severe sepsis and loss of organs (necessary removal of fallopian tubes and/or uterus with the result of permanent infertility as well as possible permanent psychosexual disorders) are possible in exceptional cases. In addition to during the egg retrieval, infections can also arise during embryo transfer.
IVF increases the risk of pregnancy with multiples. About 15.25% of all pregnancies that occur are twin pregnancies. Triplet or quadruplet pregnancies, on the other hand, are rare, but can also occur if fewer embryos are used.
Multiple pregnancies are NOT the primary goal of reproductive medical measures, as there is a significantly increased risk of complications (premature birth, gestosis and pregnancy poisoning as well as disability of one or more children. This risk multiplies even further, especially with higher-grade multiples.)
A good measure to reduce the risk of multiple births, which is especially recommended in the first two IVF attempts, is individual transfer: since we have good laboratory technology to allow freezing embryos and using them in subsequent cycles without significantly reducing pregnancy rates, the embryos can also be transferred one after the other instead of together. In a single transfer, there are only about 2 per cent multiples (through division of the embryo).
Although the embryos are actually transferred into the uterine cavity during IVF, there is still a risk of an ectopic pregnancy. Ectopic pregnancies occur in 2 per cent of naturally occurring pregnancies – in artificial insemination this number is 3 per cent. Ectopic pregnancies are very dangerous due to the risk of internal rupture (bursting) with a high possibility of life-threatening blood loss. Should there be bleeding in early pregnancy, pain, discomfort, circulatory problems or slow ß-HCG progression, an ectopic pregnancy must be ruled out at a suitable facility (e.g. a local gynaecological department).
Sometimes these ‘ectopic’ pregnancies do not sit in the fallopian tube, but instead in the exit of the tube or in the area of a caesarean scar and cannot develop correctly. This can also lead to the problems and consequences mentioned above. In these cases too, the patient needs drug or surgical treatment.
If a pregnancy has occurred through IVF/ICSI, the risk of miscarriage is almost twice as high as in the case of a natural pregnancy. However, miscarriages occur for one reason: they often involve embryos that would not have shown the potential for a healthy live birth, the miscarriage often prevents us from having an unhealthy child.
Mental health problems can arise before, during or after treatment. If you have psychological factors that give you cause for concern, please contact us. We will offer you suitable help and measures during the consultation.
A clear connection between hormone treatment and the occurrence of later breast, uterine or ovarian cancer has not yet been clearly proven – but it is possible in principle. Dormant carcinomas can be stimulated, particularly if there is a familial accumulation of such cancer and especially if there are BRCA mutations.
Data on the health of children conceived via IVF and ICSI show different results: the absolute majority of children conceived with IVF and ICSI are completely healthy. While children conceived naturally have a disease rate of around 2 to 5 per cent according to most studies, it is sometimes up to a factor of 2 higher for infertile couples – there seems to be no significant difference between the methods (IVF, ICSI or IUI). In general, couples who need fertility treatment (not limited to IVF and ICSI) are at higher risk having children with health problems.
This may also be due to generic characteristics (undiscovered because the patient herself does not have signs of illness), which are more common in infertile couples than in ‘normally fertile couples’. There is always the rare possibility that unrecognised genetic characteristics can lead to serious illness in the child. Some of these peculiarities can be discovered through genetic laboratory analysis (e.g. a chromosome analysis of both partners).
If genetic mutations are found, there is often – depending on the severity and type of the finding – the possibility of pre-implantation diagnostics (i.e. the genetic examination of the embryo before insertion), which can prevent the birth of a sick child. We would be happy to advise you on these options and also discuss the costs and waiting times.
Age of the parent is likely to play a major role in the health of children: more and more couples want children in a phase of life in which health problems occur more frequently in their offspring. An example is Down Syndrome (Trisomy 21), the frequency of which is correlated to the age of the mother (and also – but less so – of the father) and which occurs significantly more frequently in women over 35 than in younger women. For the paternal age, correlations are not so clear – however, from a paternal age of >45 years, an increased incidence of Down Syndrome and other (but still rate) disorders (neuropsychological development, diabetes) could be expected.
Please note: a purely visual assessment of the embryo, as is done during routine IVF/ICSI, CANNOT be used to detect Down Syndrome. A chromosome analysis of the partner carried out before the start of treatment, for example, does NOT lead to reduction in risk. Many of these disorders are hardly or not at all recognisable before the birth of the child or only develop later in life.
We definitely recommend for ALL children conceived with IVF/ICSO or insemination, comprehensive pregnancy support including ‘early screening’ (ultrasound, NIPT Test) in the 11th to 13th week of pregnancy and an ‘organ screening’ in the 20th to 22nd week of pregnancy.