Side effects and risks of treatments

A Common side effects

•   Sensitivity, redness and bruising at injection sites
• Local allergic reactions (itching, redness), especially observed with certain estradiol patches and injections of ganirelix (orgalutran-Fyramadel)
•   Nausea
•  tiredness
•  Breast tenderness
•  Increased vaginal secretions

B More severe complications

These are rare, occurring in less than 1% of cases.

• Ovarian hyperstimulation syndrome (OHSS)

During IVF treatment, there is always a controlled ovarian hyperstimulation necessary for the growth of several follicles on each ovary. In young women with follicle-rich ovaries, or women with micropolycystic ovary syndrome, the risk of OHSS is greater, and occurs especially in the event of pregnancy. It is most often moderate, with abdominal bloating sometimes associated with pelvic pain, enlarged ovaries and the appearance of a small amount of fluid in the pelvis. It requires rest at home and prevention of thrombo-embolic complications (phlebitis-pulmonary embolism) by anticoagulant injections.

In very rare cases (less than 1%), SHSO can be much more severe, causing severe dehydration, fluid effusion in the abdominal cavity, around the lungs and heart, renal failure, phlebitis and pulmonary embolism.

• Adnexal torsion

Very rarely, the increased volume of the ovaries due to the stimulation treatment and the large number of follicles growing on each ovary can lead to adnexal torsion. This can lead to severe pelvic pain, requiring prompt medical attention. In most cases, laparoscopic surgery is required to untwist the ovary and safeguard its vascularization.

• Ovarian cysts

These cysts are not serious, but are functional in origin, related to ovarian stimulation. However, their size can cause pain or even adnexal torsion.

•  Thrombo-embolic complications

The use of synthetic hormones such as estrogen-progestogen formulas and oral estrogens, as well as the rise in circulating estradiol levels associated with ovarian stimulation treatment, leads to biological changes in coagulation.

Thrombosis is the obliteration of a venous or arterial blood vessel by a blood clot.

The incidence of venous thromboembolic events during MPA treatment is low. According to data from the French Biomedicine Agency, the overall risk is 0.26% in the case of pregnancy, and increases to 1.78% in the case of ovarian hyperstimulation syndrome.

The risk increases with the patient’s age, personal history of venous thrombosis, and coagulation disorders known as thrombophilias. Long journeys also increase the risk of venous thrombosis.

Arterial thromboembolic accidents are very rare, and in the absence of epidemiological studies their incidence is unknown. Severe ovarian hyperstimulation syndrome is almost always present.

Ovarian puncture is performed vaginally, under ultrasound control, and involves few technical difficulties.

However, like any surgical procedure, it may entail certain side effects and risks.

• Pelvic pain, usually moderate and soothed by conventional analgesics
• Urinary tract infection
• Ovarian or intra-peritoneal bleeding
  • Risk less than 0.5% of cases
  • May rarely require laparoscopic surgery
•   Pelvic infections
  • Risk less than 0.4% of cases
  • Favored by the existence of endometriosis or a history of pelvic infections (salpingitis, hydrosalpinx)
  • May require treatment with antibiotics, or even surgery in the case of pelvic abscesses
•   Injury to neighbouring organs: exceptional
  • Bladder
  • Ureter
  • Intestine
  • Pelvic blood vessels

Embryo transfer or intrauterine insemination is a simple procedure that does not require general anesthesia and is virtually painless.

Very rarely, however, pelvic cramps or slight bleeding may occur as the catheter passes through the uterine cavity.

Exceptionally, cases of uterine infection (endometritis) have been reported, requiring antibiotic treatment.

The vast majority of pregnancies obtained by MPA evolve normally. As with pregnancies obtained naturally, however, obstetrical complications may occur.

•   Ectopic pregnancies: Less than 2% of pregnancies
  • Pregnancy develops outside the uterus, most often in a tube or, very rarely, in an ovary or cervix.
  • Treatment may be medical in forms diagnosed early, or surgical.
•   Early spontaneous miscarriage

The rate of early spontaneous miscarriage is identical to that of the general population, and is related to the woman’s age. It varies between 10% and 40% for patients over the age of 40.

•   Multiple pregnancies
  • More frequent after intrauterine insemination o
  • They may occur after transfer of a single embryo that subsequently splits.t

They may occur after transfer of a single embryo that subsequently splits.

• Gestational diabetes
• Hypertension and pre-eclampsia
• Premature delivery with risk of respiratory and neurological sequelae
• Delivery hemorrhage
• Caesarean delivery