Problems Encountered in In Vitro Fertilization (IVF) Treatment

Problems Encountered During IVF Treatment

• Cancellation of treatment: Treatment may be cancelled for reasons such as the patient not responding as expected, or an insufficient number of follicles developing.
• Failure to retrieve eggs: Especially in older women with low ovarian reserve, even when follicles reach adequate size, no eggs may be found during egg retrieval.
• Failure to find sperm: In 40% of patients undergoing TESE, no sperm can be found, and the treatment must be cancelled.
• Failure of fertilization: Although the eggs and sperm are normal, fertilization may not occur in some eggs. The fertilization rate is around 70%.
• Arrest of embryo development: Embryos are monitored daily by laboratory staff according to their development and division characteristics. Embryo quality is tracked during this follow-up. In some cases, embryos may fail to develop by day 3 or day 5.
• Difficulty with transfer: In some cases, the transfer can be very difficult due to the anatomical structure of the woman's genital organs. In such cases, the chance of pregnancy decreases.
• Bleeding before the pregnancy test: Bleeding before the test day reduces the chance of pregnancy, but it does not necessarily mean pregnancy has not occurred.

Ovarian Hyperstimulation Syndrome (OHSS)

OHSS is the most significant complication of IVF treatment. It generally occurs in young women with polycystic ovary syndrome and good ovarian reserve. The likelihood of the severe form occurring is around 5%. The medications used to stimulate the ovaries can carry a risk of an excessive response. During ovarian stimulation, there is a fine balance between obtaining an adequate number of eggs and overstimulation. Dose adjustment is not always possible. In cases of overstimulation, reducing the dose of ovarian stimulation medications and, if necessary, stopping medication use for a day or longer can prevent estrogen levels from rising excessively. In addition, not administering the hCG trigger injection before egg retrieval can help prevent this syndrome from developing. The occurrence of pregnancy causes the syndrome to develop more severely.

Symptoms of Ovarian Hyperstimulation Syndrome (OHSS)

• Increase in ovarian size
• Abdominal pain, bloating sensation, shortness of breath, decreased urine output
• Fluid accumulation in the abdominal cavity
• Clotting disorders
• Fluid accumulation in the chest cavity

Preventing the Syndrome

The egg retrieval procedure can be cancelled, in which case the condition does not develop. When cancellation of egg retrieval is not desired, the following approaches may be used:

• The hCG dose can be reduced
• Special fluids can be administered during egg retrieval (HSA, HES)
• After the eggs are retrieved and fertilized, all embryos can be frozen. Certain medications given during this period can prevent the syndrome from developing with 80-90% probability.
• If embryo transfer is to proceed, the number of embryos transferred should be reduced. It is preferable to transfer 1, or at most 2, embryos. The syndrome is more severe in multiple pregnancies.

Treatment

The mild form of the syndrome does not require hospitalization. Salt and fluid restriction is required. Daily weight and abdominal circumference measurements are important. The doctor should be notified if there is an increase in abdominal circumference of more than 3 cm within a day, an increase in body weight of more than 2 kg within a day, a decrease in urine output, or the appearance of symptoms such as shortness of breath. In severe cases of the syndrome, hospitalization and treatment are required. During treatment, administering intravenous fluids and draining the fluid accumulated in the abdomen with a needle (paracentesis) positively affects the course of the condition. In some cases, the hospital stay can extend to 2-3 weeks. Cases requiring 10-15 paracentesis procedures have been reported. The syndrome regresses within a short time in patients who do not become pregnant. In pregnant women, however, the process can be prolonged.