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Cycle cancellation:
Cycles may be cancelled if the patient responds poorly or follicle development is not adequate.
Failure to retrieve oocytes:
OPU may fail to find any oocytes despite adequate number of follicles.
Failure in fertilization:
Fertilization rate is around 70% with normal sperm and egg.
Difficulty in transfer:
Difficult embryo transfer is associated with lower pregnancy rates.
Failure in sperm retrieval:
TESE fails to retrieve any sperms in 40% of cases.
Bleeding before pregnancy test:
Although a bleeding before the pregnancy test decreases the chance of a pregnancy, this does not mean for sure that a pregnancy did not occur.
Ovarian Hiperstimulation syndrome (OHSS)
OHSS is the most important complication of IVF procedures. It is usually seen among women with PCOS. 5% of OHSS cases are severe. An excessive response to the ovulation induction agents is the etiology. When the syndrome is suspected, gonadotrophin dose should be decreased or ceased for a couple of days. The syndrome does not occur in the absence of hCG injection (Pregnyl, Profazi, Choragon, Ovitrelle). If a pregnancy occurs, the syndrome is usually more severe.
Common findings:
• Increase in the size of ovaries
• Abdominal pain, dyspnea, oliguria
• Ascites
• Coagulation disorders
• Pleural effusion
Prevention of the syndrome:
• OPU may be cancelled
• Dose of hCG may be lowered
• Special fluids may be used during OPU (HSA, HES)
• All embryos may be freezed.
• Number of embryos transferred should be kept minimum. A multiple pregnancy makes the syndrome worse.
Treatment:
Mild syndrome does not require hospitalization. Restriction of water and salt intake is recommended. Daily weight and abdominal circumference measurements are important.
An increase of more than 3 cm/day in abdominal circumference, an increase of more than 2 kg/day, oliguria and dyspnea are warning signs and your doctor should be aware.
Severe OHSS requires hospitalization. Intravenous hydration and paracentesis can reverse the bad situation. 2 to 3 weeks of hospitalization may be required. Cases requiring 10 to 15 paracentesis have been reported.
Patients who fail to get pregnant recover quickly but presence of a pregnancy may worsen OHSS.
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