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Complications of ART and Associated Early Pregnancy Problems

  • Lukasz T. Polanski
  • Miriam N. BaumgartenEmail author
Chapter

Abstract

A healthy, term live birth following assisted reproduction in the most desired outcome. However, during the various phases of treatment, complications may arise. In this chapter, we present an up-to-date knowledge of ART associated complications, their prevalence and means of diagnosis. Described risks are related to ovarian stimulation, oocyte retrieval, as well as early pregnancy. Over-response and development of potentially life threatening ovarian hyperstimulation syndrome is related to ovarian stimulation with gonadotropins. Oocyte retrieval can be followed by bleeding and injury to the internal pelvic organs. Once pregnancy establishes, the risk of miscarriage and ectopic pregnancy occurs. ART complication associated with long term implications for the couple and the offspring is development of a multiple pregnancy. It is important to be aware of the potential serious complications that may arise during ART. These should be weighed against potential benefits and couples counselled accordingly.

Keywords

IVF Complications Ovarian hyperstimulation syndrome (OHSS) Multiple pregnancy 

References

  1. 1.
    Klemetti R, Gissler M, Hemminki E. Comparison of perinatal health of children born from IVF in Finland in the early and late 1990s. Hum Reprod. 2002;17(8):2192–8.CrossRefPubMedGoogle Scholar
  2. 2.
    Williams C, Sutcliffe A. Infant outcomes of assisted reproduction. Early Hum Dev. 2009;85(11):673–7.CrossRefPubMedGoogle Scholar
  3. 3.
    Isaksson R, Gissler M, Tiitinen A. Obstetric outcome among women with unexplained infertility after IVF: a matched case–control study. Hum Reprod. 2002;17(7):1755–61.CrossRefPubMedGoogle Scholar
  4. 4.
    Talaulikar VS, Arulkumaran S. Reproductive outcomes after assisted conception. Obstet Gynecol Surv. 2012;67(9):566–83.CrossRefPubMedGoogle Scholar
  5. 5.
    Talaulikar VS, Arulkumaran S. Maternal, perinatal and long-term outcomes after assisted reproductive techniques (ART): implications for clinical practice. Eur J Obstet Gynecol Reprod Biol. 2013;170(1):13–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Vloeberghs V, et al. Ovarian hyperstimulation syndrome and complications of ART. Best Pract Res Clin Obstet Gynaecol. 2009;23(5):691–709.CrossRefPubMedGoogle Scholar
  7. 7.
    Golan A, et al. Ovarian hyperstimulation syndrome: an update review. Obstet Gynecol Surv. 1989;44(6):430–40.CrossRefPubMedGoogle Scholar
  8. 8.
    Brinsden PR, et al. Diagnosis, prevention and management of ovarian hyperstimulation syndrome. Br J Obstet Gynaecol. 1995;102(10):767–72.CrossRefPubMedGoogle Scholar
  9. 9.
    European Society of Human Reproduction (ESHRE). Special Interest Group (SIG) guidelines on ovarian hyperstimulation syndrome (OHSS). 2005. Available from: http://www.eshre.com/emc.
  10. 10.
    Vlahos NF, Gregoriou O. Prevention and management of ovarian hyperstimulation syndrome. Ann N Y Acad Sci. 2006;1092:247–64.CrossRefPubMedGoogle Scholar
  11. 11.
    Soares SR, et al. Targeting the vascular endothelial growth factor system to prevent ovarian hyperstimulation syndrome. Hum Reprod Update. 2008;14(4):321–33.CrossRefPubMedGoogle Scholar
  12. 12.
    Navot D, Bergh PA, Laufer N. Ovarian hyperstimulation syndrome in novel reproductive technologies: prevention and treatment. Fertil Steril. 1992;58(2):249–61.CrossRefPubMedGoogle Scholar
  13. 13.
    Aboulghar MA, Mansour RT. Ovarian hyperstimulation syndrome: classifications and critical analysis of preventive measures. Hum Reprod Update. 2003;9(3):275–89.CrossRefPubMedGoogle Scholar
  14. 14.
    Royal College of Obstetricians and Gynaecologists (RCOG). The management of ovarian hyperstimulation syndrome. Green-top Guideline. 2006;5:1–11.Google Scholar
  15. 15.
    Mathur RS, et al. Distinction between early and late ovarian hyperstimulation syndrome. Fertil Steril. 2000;73(5):901–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Delvigne A, Rozenberg S. Epidemiology and prevention of ovarian hyperstimulation syndrome (OHSS): a review. Hum Reprod Update. 2002;8(6):559–77.CrossRefPubMedGoogle Scholar
  17. 17.
    Lee TH, et al. Serum anti-Mullerian hormone and estradiol levels as predictors of ovarian hyperstimulation syndrome in assisted reproduction technology cycles. Hum Reprod. 2008;23(1):160–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Jayaprakasan K, et al. Prediction of in vitro fertilization outcome at different antral follicle count thresholds in a prospective cohort of 1,012 women. Fertil Steril. 2012;98(3):657–63.CrossRefPubMedGoogle Scholar
  19. 19.
    Zhao JZ, et al. In vitro maturation and fertilization of oocytes from unstimulated ovaries in infertile women with polycystic ovary syndrome. Fertil Steril. 2009;91(6):2568–71.CrossRefPubMedGoogle Scholar
  20. 20.
    D’Angelo A, Amso N. Embryo freezing for preventing ovarian hyperstimulation syndrome. Cochrane Database Syst Rev. 2007;3, CD002806.Google Scholar
  21. 21.
    Aboulghar M, Evers JH, Al-Inany H. Intravenous albumin for preventing severe ovarian hyperstimulation syndrome: a Cochrane review. Hum Reprod. 2002;17(12):3027–32.CrossRefPubMedGoogle Scholar
  22. 22.
    Baumgarten M, et al. Do dopamine agonists prevent or reduce the severity of ovarian hyperstimulation syndrome in women undergoing assisted reproduction? A systematic review and meta-analysis. Hum Fertil (Camb). 2013;16(3):168–74.CrossRefGoogle Scholar
  23. 23.
    Al-Inany HG, Abou-Setta AM, Aboulghar M. Gonadotrophin-releasing hormone antagonists for assisted conception: a Cochrane review. Reprod Biomed Online. 2007;14(5):640–9.CrossRefPubMedGoogle Scholar
  24. 24.
    Abbara A, et al. Efficacy of Kisspeptin-54 to trigger oocyte maturation in women at high risk of ovarian hyperstimulation syndrome (OHSS) during in vitro fertilization (IVF) therapy. J Clin Endocrinol Metab. 2015;100(9):3322–31.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Evbuomwan IO, Davison JM, Murdoch AP. Coexistent hemoconcentration and hypoosmolality during superovulation and in severe ovarian hyperstimulation syndrome: a volume homeostasis paradox. Fertil Steril. 2000;74(1):67–72.CrossRefPubMedGoogle Scholar
  26. 26.
    Maslovitz S, et al. Renal blood flow alteration after paracentesis in women with ovarian hyperstimulation. Obstet Gynecol. 2004;104(2):321–6.CrossRefPubMedGoogle Scholar
  27. 27.
    Levin I, et al. Effect of paracentesis of ascitic fluids on urinary output and blood indices in patients with severe ovarian hyperstimulation syndrome. Fertil Steril. 2002;77(5):986–8.CrossRefPubMedGoogle Scholar
  28. 28.
    Meldrum DR, et al. Prospective characterization and selective management of the abdominal compartment syndrome. Am J Surg. 1997;174(6):667–72; discussion 672–3.CrossRefPubMedGoogle Scholar
  29. 29.
    Abuzeid MI, et al. Pigtail catheter for the treatment of ascites associated with ovarian hyperstimulation syndrome. Hum Reprod. 2003;18(2):370–3.CrossRefPubMedGoogle Scholar
  30. 30.
    Wikland M, Enk L, Hamberger L. Transvesical and transvaginal approaches for the aspiration of follicles by use of ultrasound. Ann N Y Acad Sci. 1985;442:182–94.CrossRefPubMedGoogle Scholar
  31. 31.
    Bennett SJ, et al. Complications of transvaginal ultrasound-directed follicle aspiration: a review of 2670 consecutive procedures. J Assist Reprod Genet. 1993;10(1):72–7.CrossRefPubMedGoogle Scholar
  32. 32.
    Ludwig AK, et al. Perioperative and post-operative complications of transvaginal ultrasound-guided oocyte retrieval: prospective study of >1000 oocyte retrievals. Hum Reprod. 2006;21(12):3235–40.CrossRefPubMedGoogle Scholar
  33. 33.
    Bodri D, et al. Complications related to ovarian stimulation and oocyte retrieval in 4052 oocyte donor cycles. Reprod Biomed Online. 2008;17(2):237–43.CrossRefPubMedGoogle Scholar
  34. 34.
    Dessole S, et al. Blood loss following noncomplicated transvaginal oocyte retrieval for in vitro fertilization. Fertil Steril. 2001;76(1):205–6.CrossRefPubMedGoogle Scholar
  35. 35.
    Akman MA, et al. Perforated appendicitis and ectopic pregnancy following in-vitro fertilization. Hum Reprod. 1995;10(12):3325–6.PubMedGoogle Scholar
  36. 36.
    Roest J, et al. The incidence of major clinical complications in a Dutch transport IVF programme. Hum Reprod Update. 1996;2(4):345–53.CrossRefPubMedGoogle Scholar
  37. 37.
    Sauer MV. Defining the incidence of serious complications experienced by oocyte donors: a review of 1000 cases. Am J Obstet Gynecol. 2001;184(3):277–8.CrossRefPubMedGoogle Scholar
  38. 38.
    Fugita OE, Kavoussi L. Laparoscopic ureteral reimplantation for ureteral lesion secondary to transvaginal ultrasonography for oocyte retrieval. Urology. 2001;58(2):281.Google Scholar
  39. 39.
    Sharpe K, et al. Transvaginal oocyte retrieval for in vitro fertilization complicated by ovarian abscess during pregnancy. Fertil Steril. 2006;86(1):219.e11–3.CrossRefGoogle Scholar
  40. 40.
    Kelada E, Ghani R. Bilateral ovarian abscesses following transvaginal oocyte retrieval for IVF: a case report and review of literature. J Assist Reprod Genet. 2007;24(4):143–5.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Serour GI, et al. Complications of medically assisted conception in 3,500 cycles. Fertil Steril. 1998;70(4):638–42.CrossRefPubMedGoogle Scholar
  42. 42.
    Gorkemli H, Camus M, Clasen K. Adnexal torsion after gonadotrophin ovulation induction for IVF or ICSI and its conservative treatment. Arch Gynecol Obstet. 2002;267(1):4–6.CrossRefPubMedGoogle Scholar
  43. 43.
    Mashiach S, et al. Adnexal torsion of hyperstimulated ovaries in pregnancies after gonadotropin therapy. Fertil Steril. 1990;53(1):76–80.CrossRefPubMedGoogle Scholar
  44. 44.
    Fleischer AC, Brader KR. Sonographic depiction of ovarian vascularity and flow: current improvements and future applications. J Ultrasound Med. 2001;20(3):241–50.PubMedGoogle Scholar
  45. 45.
    Grady R, et al. Elective single embryo transfer and perinatal outcomes: a systematic review and meta-analysis. Fertil Steril. 2012;97(2):324–31.CrossRefPubMedGoogle Scholar
  46. 46.
    Katalinic A, et al. Pregnancy course and outcome after intracytoplasmic sperm injection: a controlled, prospective cohort study. Fertil Steril. 2004;81(6):1604–16.CrossRefPubMedGoogle Scholar
  47. 47.
    Raber W, et al. Thyroxine treatment modified in infertile women according to thyroxine-releasing hormone testing: 5 year follow-up of 283 women referred after exclusion of absolute causes of infertility. Hum Reprod. 2003;18(4):707–14.CrossRefPubMedGoogle Scholar
  48. 48.
    Ehrmann DA. Polycystic ovary syndrome. N Engl J Med. 2005;352(12):1223–36.CrossRefPubMedGoogle Scholar
  49. 49.
    Sutcliffe AG, Ludwig M. Outcome of assisted reproduction. Lancet. 2007;370(9584):351–9.CrossRefPubMedGoogle Scholar
  50. 50.
    Pezeshki K, et al. Bleeding and spontaneous abortion after therapy for infertility. Fertil Steril. 2000;74(3):504–8.CrossRefPubMedGoogle Scholar
  51. 51.
    Wang JX, Norman RJ, Wilcox AJ. Incidence of spontaneous abortion among pregnancies produced by assisted reproductive technology. Hum Reprod. 2004;19(2):272–7.CrossRefPubMedGoogle Scholar
  52. 52.
    Ludwig M, et al. Heterotopic pregnancy in a spontaneous cycle: do not forget about it! Eur J Obstet Gynecol Reprod Biol. 1999;87(1):91–3.CrossRefPubMedGoogle Scholar
  53. 53.
    Kennedy, R. Risks and complications of assisted conception. British Fertility Society Factsheet 2005 [cited 2012 01.10.2012]. Available from: http://www.britishfertilitysociety.org.uk/public/factsheets/docs/BFS-risksandcomplicationsofassistedconception.pdf.
  54. 54.
    Winder S, Reid S, Condous G. Ultrasound diagnosis of ectopic pregnancy. Australas J Ultrasound Med. 2011;14(2):29–33.CrossRefGoogle Scholar
  55. 55.
    Noci I, et al. Interference of exogenous HCG on pregnancy tests. Acta Eur Fertil. 1987;18(6):391–3.PubMedGoogle Scholar
  56. 56.
    Fauser BC, Devroey P, Macklon NS. Multiple birth resulting from ovarian stimulation for subfertility treatment. Lancet. 2005;365(9473):1807–16.CrossRefPubMedGoogle Scholar
  57. 57.
    Blickstein I. Estimation of iatrogenic monozygotic twinning rate following assisted reproduction: pitfalls and caveats. Am J Obstet Gynecol. 2005;192(2):365–8.CrossRefPubMedGoogle Scholar
  58. 58.
    Vela G, et al. Monozygotic pregnancies conceived by in vitro fertilization: understanding their prognosis. Fertil Steril. 2011;95(2):606–10.CrossRefPubMedGoogle Scholar
  59. 59.
    Vitthala S, et al. The risk of monozygotic twins after assisted reproductive technology: a systematic review and meta-analysis. Hum Reprod Update. 2009;15(1):45–55.CrossRefPubMedGoogle Scholar
  60. 60.
    Wilcox L, et al. Assisted reproductive technologies: estimates of their contribution to multiple births and newborn hospital days in the United States. Fertil Steril. 1996;65(2):361–6.CrossRefPubMedGoogle Scholar
  61. 61.
    Milki AA, et al. Incidence of monozygotic twinning with blastocyst transfer compared to cleavage-stage transfer. Fertil Steril. 2003;79(3):503–6.CrossRefPubMedGoogle Scholar
  62. 62.
    HFEA. Improving outcomes for fertility patients: multiple births. 2011 [cited 2012 15.10.2012]. Available from: http://www.hfea.gov.uk/docs/2011-12-01_-_Multiple_Births_Publication_2011_-_Rationalising_Register_Data_-_FINAL_1.2.DOC.pdf.
  63. 63.
    Janvier A, Spelke B, Barrington KJ. The epidemic of multiple gestations and neonatal intensive care unit use: the cost of irresponsibility. J Pediatr. 2011;159(3):409–13.CrossRefPubMedGoogle Scholar
  64. 64.
    Joy J, McClure N, Cooke IE. A comparison of spontaneously conceived twins and twins conceived by artificial reproductive technologies. J Obstet Gynaecol. 2008;28(6):580–5.CrossRefPubMedGoogle Scholar
  65. 65.
    Morcel K, et al. Perinatal morbidity and mortality in twin pregnancies with dichorionic placentas following assisted reproductive techniques or ovarian induction alone: a comparative study. Eur J Obstet Gynecol Reprod Biol. 2010;153(2):138–42.CrossRefPubMedGoogle Scholar
  66. 66.
    McDonald SD, et al. Preterm birth and low birth weight among in vitro fertilization singletons: a systematic review and meta-analyses. Eur J Obstet Gynecol Reprod Biol. 2009;146(2):138–48.CrossRefPubMedGoogle Scholar
  67. 67.
    Vilska S, et al. Mental health of mothers and fathers of twins conceived via assisted reproduction treatment: a 1-year prospective study. Hum Reprod. 2009;24(2):367–77.CrossRefPubMedGoogle Scholar
  68. 68.
    Society of Obstetricians annd Gynaecologists of Canada, Okun N, Sierra S. Pregnancy outcomes after assisted human reproduction. J Obstet Gynaecol Can. 2014;36(1):64–83.Google Scholar
  69. 69.
    Skiadas CC, et al. Spontaneous reduction before 12 weeks’ gestation and selective reduction similarly extend time to delivery in in vitro fertilization of trichorionic-triamniotic triplets. Fertil Steril. 2011;95(2):596–9.CrossRefPubMedGoogle Scholar
  70. 70.
    Stone J, et al. Contemporary outcomes with the latest 1000 cases of multifetal pregnancy reduction (MPR). Am J Obstet Gynecol. 2008;199(4):406.e1–4.CrossRefGoogle Scholar
  71. 71.
    Calhoun KC, et al. Evaluating the association between assisted conception and the severity of preeclampsia. ISRN Obstet Gynecol. 2011;2011:928592.CrossRefPubMedPubMedCentralGoogle Scholar
  72. 72.
    Healy DL, et al. Prevalence and risk factors for obstetric haemorrhage in 6730 singleton births after assisted reproductive technology in Victoria Australia. Hum Reprod. 2010;25(1):265–74.CrossRefPubMedGoogle Scholar
  73. 73.
    Reefhuis J, et al. Assisted reproductive technology and major structural birth defects in the United States. Hum Reprod. 2009;24(2):360–6.CrossRefPubMedGoogle Scholar
  74. 74.
    Basso O, Olsen J. Subfecundity and neonatal mortality: longitudinal study within the Danish national birth cohort. BMJ. 2005;330(7488):393–4.CrossRefPubMedPubMedCentralGoogle Scholar
  75. 75.
    Leunens L, et al. Follow-up of cognitive and motor development of 10-year-old singleton children born after ICSI compared with spontaneously conceived children. Hum Reprod. 2008;23(1):105–11.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Department of Obstetrics and GynaecologyAddenbrooke’s HospitalCambridgeUK

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