20 Things Which May Happen During IVF Cycle If You Hide Something From Your Doctor

You have already chosen IVF as your Treatment Option, haven’t you? Now you just have to complete that annoying official part, – the paperwork. You take all those papers, your pen, sit down, and with utter indignation glimpse through all the papers looking for the lines with the words ‘patient’s signature’. ‘When should I read all these papers? I have no time to glance through all these papers. Why should I read them? My doctor must have explained everything. OOOOH!! how many papers I must sign...’Just these thoughts [how to sign everything in ten minutes] whirl into your mind. And you shouldn’t do like that. Before you sign all the papers (IVF Consent Forms) glimpse through these twenty hideous things Which May Occur During IVF Treatment Cycle. Because sometimes they cannot be inclusively written in those Consent Forms you would need to sign prior to starting testing and Treatment. Yes, there are at least twenty hideous things which may happen to you during testing and IVF Treatment. I wish you knew about them before you start everything. Sometimes the consequences which follow Treatment might be fatal. And you should know what may occur during the IVF cycle.

In Vitro Fertilization (IVF) is a Treatment that involves four main stages: 

1. the woman takes oral and injectable medications to stimulate the ovaries to produce follicles which are the fluid filled cysts in the ovaries that contain the oocytes; 
2. the removal of oocytes from the woman’s ovaries by an ultrasound guided procedure performed under anesthesia; 
3. the placement of the oocytes and sperm together in the laboratory to allow fertilization to occur, and; 
4. the transfer of embryos (fertilized oocytes) into the woman’s uterus.

IVF Treatment contains some risks. 

But all the risks can be minimized and the adverse consequences can be prevented. Wondering how is that possible? You must always accurately describe to your doctor all side effects of the medications you take. If you have any of below–mentioned side effects or situations, do not hesitate to call your doctor and have an extra consultation. Remember that your Treatment must be accurately monitored by your doctor. Do not use the meds without discussing them with your doctor. Do not hide your medical history from your doctor. It may lead to fatal consequences for you or/and for your unborn baby. 

IVF Treatment contains some risks. But all the risks can be minimized and the adverse consequences can be prevented if your Treatment is accurately monitored by your doctor.

1. Infertility testing may lead to surgical intervention

If the Hysterosalpingogram’s or other tests show that your Fallopian tubes are blocked, you might need a procedure called a laparoscopy. If the tests indicate that there are polyps in the uterus, Endometriosis or fibroids, scar tissue or adhesions, a previous ectopic (tubal) pregnancy (which resulted in medical intervention), the surgery can be performed prior to the Treatment cycle.

2. Side effects of the medications which are used for Ovarian Stimulation

Your doctor will prescribe you injectable hormones to stimulate your follicular growth. The purpose of giving you these medications is to mature multiple follicles. Yes, these medications increase the number of your follicles, but there is one but. As with all injectable medications, bruising, redness, swelling, or discomfort can occur at the injection site. And not only the above–mentioned ones. You may have an allergic reaction to these medications. These medications can cause side effects such as abdominal pain, dizziness, headaches, migraine, hot flashes, hypertension, nausea, vomiting, trouble breathing, pelvic pain, visual symptoms, weight gain, or weight loss. If you have severe symptoms, call your doctor, stop using this medication, and change this medication.

3. Ovarian Stimulation monitoring: bruising and bleeding of the veins

During the Ovarian Stimulation, monitoring of follicular development is performed with periodic blood hormone tests and vaginal ultrasound exams. Monitoring helps your doctor to determine the appropriate dose of the medications and the timing of the Egg Retrieval. Blood drawing may cause mild discomfort and bruising, bleeding, infection or scar at the needle sites.

4. Your Treatment cycle may be cancelled  to Oocyte [Egg] Retrieval 

Your doctor may strongly recommend you cancel your Treatment cycle prior to Oocyte [Egg] Retrieval procedure. Wondering why does that happen? If you take the medications to stimulate the ovaries, but the ultrasound monitoring or your blood draws indicate at least one the following cases, your Treatment cycle would be cancelled by your doctor: 

1. your ovaries contain a high proportion of abnormal non–growing follicles;
2. your follicles have the abnormal morphology or not developing properly;
3. your blood hormone levels are inadequate;
4. you have premature ovulation,
5. you have less than three follicles maturing simultaneously.

5. Sometimes laparoscopy or transabdominal retrieval is necessary to retrieve the oocytes 

Oocyte Retrieval is the removal of eggs from the ovaries. A transvaginal ultrasound is used to visualize the ovaries and the egg–containing follicles within the ovaries. A long needle is guided into each follicle and the contents aspirated. The aspirated material includes follicular fluid, oocytes (eggs) and granulosa (egg–supporting) cells. Rarely the ovaries are not accessible, and laparoscopy or transabdominal retrieval is necessary.

6. If you have the pelvic infection or chronic pelvic infection, the Oocyte Retrieval procedure must be cancelled

If you have the pelvic infection, especially bacterial, the Oocyte Retrieval procedure must be cancelled. If you have or chronic pelvic infection, the Oocyte Retrieval procedure must be cancelled. Wondering why? Bacteria may be transferred into the abdominal cavity by the needle. These bacteria may cause an infection of the uterus, fallopian tubes, ovaries or other intra–abdominal organs. Treatment of infections requires the use of oral or intravenous antibiotics. Severe infections require surgery to remove infected tissue.

7. Bleeding during and after Oocyte Retrieval procedure

The needle passes through the vaginal wall and into the ovary to obtain the eggs. Vaginal wall and ovaries contain blood vessels. There are also the other blood vessels nearby. Small amounts of blood loss are common during Egg Retrieval procedure. Despite the incidence of major bleeding is less than 0.1%, you should know that major bleeding requires surgical repair and possibly loss of the ovary.

8. Trauma during Oocyte Retrieval procedure 

The risk of such trauma is low. But trauma may also happen. Despite the use of ultrasound guidance, it is possible to damage other intra–abdominal organs (the bowel, appendix, bladder, ureters, and ovary) during the Egg Retrieval. Damage to internal organs may result in surgical intervention for repair or removal of the damaged organ.

9. Failure of the Oocyte Retrieval procedure 

It is possible that the aspiration will fail to obtain any eggs, or the eggs may be abnormal, or of poor quality, and therefore, fail to produce a viable embryo.

10. What to expect after the Egg Retrieval procedure? Abdominal Pain, Cramps, and Fatigue, or even mild Ovarian Hyperstimulation Syndrome

The whole procedure takes only about 20 minutes, so you will wake up about 30 minutes later in recovery. You won’t be in any pain because they must have given you some good pain medications through the IV. But when the miracle of pain medication disappears, it not just hurts but hurts. You feel excessive fatigue, tremendous pressure, and awful cramps. Post–surgery fatigue lasts several days. Your surgery was done three days ago, but you just feel extraordinarily tired all the time after that. Post–surgery cramping also hurts. The day of the Egg Retrieval, you will experience some intense cramping and abdominal pain. They will give you pain medication, but as each day passes, you will feel the abdominal pain. And you will look 4 or 6 month pregnant. And if the medications you had taken and injected to ‘BOOST’ your follicles growth caused some mild Ovarian Hyperstimulation Syndrome, your abdomen will be filled up with fluid. Therefore, you will literally look 4 or 6 months pregnant.

11. Ovarian Hyperstimulation

The intent of giving these follicles–growth stimulation medications is to mature multiple follicles. Surely it increases the chances of having many follicles, but your ovaries become temporarily enlarged. After the Oocyte [Egg] Retrieval is performed, the ovarian follicles, which have been aspirated, can fill up with fluid and form cysts. The formation of cysts will result in ovarian enlargement. The mild Ovarian Hyperstimulation resolves without surgery in 1 or 2 weeks.

12. The Embryo Transfer can be cancelled completely because of severe Ovarian Hyperstimulation

After the Oocyte Retrieval is performed, the ovarian follicles, which have been aspirated, can fill up with fluid and form ovarian cysts. The symptoms usually resolve within 1–2 weeks without medical intervention. BUT there is still one but. Sometimes Ovarian Stimulation causes severe Ovarian Hyperstimulation. It is characterized by the development of large ovarian cysts and fluid concentration in the abdomen. Surgery may be required to remove the fluid from of the abdomen. In some cases when there is a significant risk for Ovarian Hyperstimulation, the cycle may be cancelled, or the eggs will be retrieved, and any embryos that result may be frozen.

13. Ovarian Twisting requires surgery

Ovarian Torsion or Ovarian Twisting occurs in less than 1% of all cases but occurs. It is characterized by a fluid–filled cyst(s) in the ovary which can cause the ovary to twist on itself. This can decrease the blood supply to the ovary and result in significant lower abdominal pain. Surgery may be required to untwist or possibly remove the ovary.

14. Not all retrieved eggs can be fertilized

Not all your retrieved eggs will be mature. And fertilization is possible only in case they are mature. For example, out of the 16 collected, only 10 were mature. Out of the 10 mature, only 6 were fertilized properly and are growing. And out of those six, maybe four or three would make it to 5–day blastocyst and maybe none would. If they would all at least make it to day 3, you would have at the least one. And it may happen that none would survive. If any of them made it to day 5, they will set your Embryo Transfer appointment.

15. Not always the standard Insemination can be used for the Oocyte Fertilization 

The Embryologist will take all the eggs retrieved and toss them in a petri dish with your husband’s sperm and let them do their thing. Another option is called Intracytoplasmic Sperm Injection (ICSI), where the Embryologists manually fertilize the eggs with the sperm individually, but it is for extreme cases only. The ICSI procedure is done with the aid of a microscope and fine instruments, one single sperm is taken and injected directly into every mature oocyte. Indications for ICSI include such cases as the previous Semen Analysis demonstrating significant abnormalities, in situations where surgical aspiration of sperm from the vas deferens or testicle, or a previous IVF cycle with poor fertilization. You will know the next morning how many of your eggs have been fertilized correctly.

16. Fertilization failure

The eggs may fail to become fertilized or may be damaged precluding their ability to be fertilized. If there were only two or three mature oocytes, they may fail to become fertilized. All the immature oocytes cannot be fertilized at all.

17. The embryos may stop their development

Even if 6 of your oocytes were fertilized correctly, you know the odds of all 6 of them making it to day 5, may slim to none. If you are lucky, you will have one, and if you are super lucky, you will end up with 2 or 3 of them. Two or three perfect embryos would have meant the chance that maybe, just maybe, one of them would grow to full term. The responsible Embryologist closely monitors the development of the tiny embryos. If the embryos continue their development, then the Embryo Transfer may be prescheduled. But there is still one but… If the embryos stop their development, the Embryo Transfer will be cancelled.

18. Sometimes a uterine infection occurs after the Embryo Transfer 

Very rarely, a uterine infection may occur after the Embryo Transfer procedure. The most common symptoms associated with uterine infection are pain and fever. If you have a fever, vomiting, abdominal pain or any other symptoms develop following the Embryo Transfer, you should contact your doctor immediately.

19. Assisted Embryo Hatching contains an increased risk that an embryo splits

Your doctor may recommend that Assisted Hatching be performed on the embryos just prior to the Embryo Transfer.

After an oocyte is fertilized in the laboratory, the cells begin to divide. During this developmental stage, the embryo is contained in a layer of proteins, known as ‘the zona pellicuda’. In order to successfully implant into the uterine lining, the embryo has to hatch out of the zona pellucida and attach to the uterine wall. Assisted Hatching is a new laboratory technique that is used to make the embryo’s zona pellucida thinner and to facilitate the embryo’s hatching out of the zona pellucida. With Assisted Hatching, the Embryologist uses micromanipulation under a microscope to create a small hole in the zona pellucida. This happens on the fourth day of embryo development when the embryos contain an average of six to eight cells. But there is still several but… The embryos may be destroyed or injured precluding their ability to implant. There is an increased chance that an embryo splits and it will lead to a multiple pregnancy (usually, identical twins). Assisted Hatching may not improve your chances of being pregnant after the Embryo Transfer.

20. Cryopreservation of the embryos contains some risks

There are several techniques for Embryo Cryopreservation. The methods include ‘slow’, graduated freezing in a computerized setting, and ‘rapid’ freezing methods, called ‘Vitrification’. Current techniques deliver a high percentage of viable embryos thawed after Cryopreservation. But there can be no certainty that embryos will thaw normally, nor be viable enough to divide and eventually implant in the uterus. Cryopreservation techniques could hurt the middle–quality embryos and increase the risk of developmental abnormalities after the freezing–thawing procedures.

Remember that all these situations can be prevented if you have the regular appointments with your doctor to monitor your Treatment.