What is the greatest medical complication with IVF?

What is the greatest medical complication with IVF

In vitro fertilization (IVF) is a complex set of procedures used to aid fertility or prevent genetic problems and assist in the conception of a child. 

IVF involves removing mature eggs from the ovaries and fertilizing them in a lab with sperm. The uterus receives the fertilized egg (embryo) or eggs (embryos). IVF cycles last for around three weeks in total. When these processes are divided into separate steps, the process can sometimes take longer. 

IVF success rates are influenced by a variety of variables, including female age and the underlying reason of  infertility. IVF can also be costly, intrusive, and time-consuming. 

IVF has some potential complications and OHSS is the greatest of these.

What is OHSS?

Ovarian hyperstimulation syndrome is an exaggerated response to excess hormones. It usually occurs in women taking injectable hormone medications to stimulate egg development in the ovaries. The ovaries become uncomfortable and swollen as a result of ovarian hyperstimulation syndrome (OHSS). 

Women undergoing in vitro fertilization (IVF) or ovulation induction using injectable medications are at risk for developing OHSS. Less typically, OHSS happens during reproductive procedures that use oral medicines like clomiphene. 

The severity of the condition will determine how it is treated. While mild cases of OHSS could go away on their own, more severe occurrences might necessitate hospitalization and extra care. (1)

How severe can OHSS be?

There are three levels of OHSS: mild, moderate, and severe. In vitro fertilization with regulated ovarian stimulation causes minor OHSS symptoms in one out of every three women (IVF). Modest nausea, mild abdominal bloating, and fluid-related weight gain are some of these symptoms. 

These symptoms are often more prevalent in women with moderate OHSS. Severe OHSS causes a woman’s inability to retain fluids and frequent vomiting. The abdominal swelling causes them severe discomfort. They can experience breathing difficulties and blood clots in the legs. 

Ovarian enlargement characterizes every instance of OHSS. An indication of the severity of OHSS is the size of the ovary. If symptoms are present, a transvaginal or abdominal ultrasound may be done to measure the size of the ovary and the amount of fluid collected. (2)

What other complications can occur with severe OHSS? 

OHSS complications can be quite harmful. If you drink too much fluid, you could get dehydrated and experience an increase in abdominal pressure. Blood clots may develop in the blood vessels as a result of these issues. Your lungs and other vital organs could become the destination of blood clots. This may pose a life-threatening situation. 

By identifying the warning signs, symptoms, and laboratory evidence of deteriorating OHSS and seeking the necessary care, these consequences are typically avoidable. (3)

How is OHSS prevented?

To lessen your risk of getting ovarian hyperstimulation syndrome, you will require a specific plan for your fertility medications. Each treatment cycle should be closely monitored by your healthcare professional.

There are several methods to  avoid OHSS: 

  • Medication modification 

Your doctor will use the least amount of gonadotropins necessary to stimulate your ovaries and start ovulation. 

  • Adding medicine

Some medications appear to lower the risk of OHSS without reducing the likelihood of conception.

  • Coasting

If your estrogen levels are high or you have many developed follicles, your provider may ask you to discontinue the injectables and wait a few days before administering ovulation-inducing hCG.

  • Avoiding using an hCG trigger shot

Because OHSS usually develops after an hCG trigger injection is given, alternatives to hCG for triggering have been developed using GnRH agonists such as leuprolide (Lupron) as a way to prevent or limit OHSS.

  • Freezing embryos

If you are undergoing IVF, all follicles (mature and immature) can be removed from your ovaries to reduce the chance of OHSS. Mature follicles are fertilized and frozen, and your ovaries are allowed to rest. (4)

Who is most at risk for OHSS?

This condition emerges primarily among certain demographics due to a variety of risk factors. Firstly, age plays a critical role. Young women, especially those below the age of 35, exhibit a heightened sensitivity to fertility treatments. Their ovaries respond more vigorously, thereby elevating their susceptibility to OHSS.

Moreover, individuals diagnosed with Polycystic Ovary Syndrome (PCOS) find themselves at an increased risk. The inherent abundance of follicles within their ovaries predisposes them to excessive stimulation from fertility medications. Additionally, the quantity of eggs retrieved during IVF signals a risk factor. Specifically:

  • A high count of eggs retrieved suggests an intense reaction to the fertility drugs, amplifying the OHSS risk.

Furthermore, a personal history of OHSS significantly raises the likelihood of recurrence in subsequent IVF cycles. Finally, the dosage of fertility medication constitutes a pivotal risk factor. Essentially, administering higher doses to induce ovulation correlates with a pronounced risk of developing OHSS. Hence, these factors collectively delineate the populations most vulnerable to this IVF-related complication.


Govaerts, I., Devreker, F., Delbaere, A., Revelard, P. H., & Englert, Y. (1998). Short-term medical complications of 1500 oocyte retrievals for in vitro fertilization and embryo transfer. European Journal of Obstetrics & Gynecology and Reproductive Biology, 77(2), 239-243.

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