Complications In IVF And ICSI Cycle

Hello everyone.

My name is Dr. Kaushal Samir Kadam. The topic that we are going to discuss today is complications in IVF and ICSI cycle. So, what we are all worried about in these days is if we are undergoing an IVF, ICSI cycle what do we need to be aware of? What are our fears in undergoing the IVF or ICSI cycle? Two most important complications that I would be telling you about today is ovarian hyperstimulation which is often termed as OHSS and multiple gestations. Ovarian hyperstimulation again is of three categories: mild, moderate and severe. Whilst your fertility physician is definitely going to desire a mild to moderate hyperstimulation so that he can get a good number of eggs, severe is something that we all do not want. Of course, the chances of severe hyperstimulation in today's generation is very very low. It's just about 0.1-2%. What we do is as fertility physicians do close monitoring when we are doing your IVF or ICSI cycle.

Patients who are more likely to go into ovarian hyperstimulation are those who have polycystic ovaries as these are the patients who have a tendency to form a larger number of eggs. Typically, in ovarian hyperstimulation what happens is your ovaries become bulky and there is quite a bit of fluid that collects. But these days fertility physicians now have newer protocols whereby they are able to completely prevent you from going into ovarian hyperstimulation. What they do is the trigger injection that we spoke about in my earlier lectures typically being used as hCG or human chorionic gonadotropin is replaced by an agonist trigger. In doing so the hormonal levels drop down and thus your chances of going into ovarian hyperstimulation reduce. In severe hyperstimulation cases, patients may require admission. Most of the times the doctors are able to control this hyperstimulation just on an outpatient basis. We can control this by making you drink lots of water, administering medication like cabergoline which helps in preventing the fluid from accumulating in your abdominal cavity.

Also, they may think of administering haemaccel or pines i.v. pines by admitting you from morning to evening and then discharging you. So, most of the time that fertility physicians they'll call you into his/her office, do some blood test to confirm if you are going into severe hyperstimulation, administer mainly saline infusion over a prolonged period of time to take care of this situation. Most of the patients do well within a week from this therapy. But of course, to completely avoid this hyperstimulation, your physician may advise you to freeze all the embryos and not do a transfer. The chances of you going into hyperstimulation really increase if you do undertake an embryo transfer and if your hCG levels go high. But without administering or without undergoing an embryo transfer the chances for you getting pregnant become negligible and thus you finally get your periods and you are back to normal.

Your physician will then plan for a frozen embryo transfer for you and this way you can completely negate your chances for undergoing severe hyperstimulation. The next complication multiple gestations. This is very common as we see in IVF and ICSI cycles but mind you this can be controlled. Again, this is just simply controlled by you having a discussion with your physician at the time of embryo transfer, discussing how many embryos you wish to the implant. Thus, if you make it very clear to your fertility physician that you want to just a singleton pregnancy then he will consider transferring a maximum of 1 D5 embryo and maybe 2 of D3 embryos. So, friends as we all know these conditions are now completely under our control and under the control of the fertility physician so you can definitely take care by working together with your fertility physician and avoiding these complications completely.

Thanks!