Problems Encountered During IVF Treatment
- Cancellation of treatment: Treatment may be cancelled due to insufficient response to stimulation or inadequate follicle development.
- No oocytes retrieved: Especially in women of advanced age or with low ovarian reserve, no eggs may be obtained despite adequate follicle growth.
- No sperm found: In approximately 40% of patients undergoing TESE, no sperm can be retrieved, leading to treatment cancellation.
- Failure of fertilization: Even when eggs and sperm appear normal, fertilization may not occur in some cases. The average fertilization rate is around 70%.
- Arrested embryo development: Embryos are monitored daily in the laboratory. In some cases, embryos may stop developing before day 3 or day 5.
- Difficult embryo transfer: Anatomical conditions of the female reproductive tract may make embryo transfer technically difficult, reducing pregnancy success.
- Bleeding before pregnancy test: Bleeding before the test day may reduce pregnancy chances, but it does not always indicate treatment failure.
Ovarian Hyperstimulation Syndrome (OHSS)
OHSS is one of the most important complications of IVF treatment. It is more commonly seen in young women with polycystic ovary syndrome and good ovarian reserve. The risk of severe OHSS is approximately 5%. Ovarian stimulation medications may cause an excessive ovarian response. Maintaining the balance between adequate egg retrieval and overstimulation can be challenging. Dose adjustments may not always be sufficient. In cases of excessive stimulation, reducing or temporarily stopping ovarian stimulation drugs can help prevent excessive estrogen elevation. Additionally, withholding the hCG trigger injection before egg retrieval may prevent OHSS. If pregnancy occurs, the severity of OHSS may increase.
Symptoms of Ovarian Hyperstimulation Syndrome (OHSS)
- Enlargement of the ovaries
- Abdominal pain, bloating, shortness of breath, decreased urine output
- Fluid accumulation in the abdominal cavity
- Coagulation disorders
- Fluid accumulation in the chest cavity
Prevention of the Syndrome
Egg retrieval may be cancelled to prevent the development of OHSS. If cancellation is not preferred:
- The hCG dose may be reduced
- Special fluids (HSA, HES) may be administered during egg retrieval
- All embryos may be frozen after fertilization. With appropriate medications, OHSS can be prevented in 80–90% of cases.
- If embryo transfer is planned, the number of embryos should be limited. Preferably, 1 or a maximum of 2 embryos should be transferred, as OHSS is more severe in multiple pregnancies.
Treatment
Hospitalization is usually not required for mild OHSS. Salt and fluid intake should be restricted. Daily weight and abdominal circumference measurements are important. A daily abdominal increase of more than 3 cm, weight gain exceeding 2 kg in one day, reduced urine output, or shortness of breath should prompt immediate medical attention. Severe cases require hospitalization. Intravenous fluids and drainage of abdominal fluid (paracentesis) significantly improve outcomes. Hospital stays may last 2–3 weeks in severe cases, and repeated paracentesis may be required. OHSS resolves more quickly in non-pregnant patients, while symptoms may persist longer if pregnancy occurs.