Saturday, May 09, 2015

Emergencies and Complications in IVF

IVF treatment is generally pretty straightforward. Most patients are young and healthy, and the entire treatment largely runs seamlessly as planned. This is also why most IVF cycles are uneventful and there are no hurdles or potholes along the way. However, at times certain emergencies may arise and patients need to be aware of them.

Ovarian hyperstimulation syndrome or OHSS is the most common IVF emergency. This occurs when the patient grows excessive follicles. If the doctor is not aware about how this problem has to be tackled, the patient can end-up with severe hyperstimulation; this can be a life-threatening condition. The good news is that hyperstimulation is a preventable problem and a knowledgeable doctor will also be able to treat it effectively. 

The Ectopic Pregnancy Problem

The other medical emergency that IVF clinics have to deal with is ectopic pregnancy. Even though the embryos are transferred into the uterus in an IVF cycle, there are times when these tend to move out of the uterus in a random way into the fallopian tube; this results in an ectopic pregnancy.

In any good clinic, there is routine active monitoring of hCG levels. This is done to make sure that the pregnancy is in the right location. If an ectopic gets diagnosed in a timely manner, it's not difficult to treat this medically. A methotrexate injection is given- this kills the ectopic pregnancy. The problem arises when the diagnosis is missed or delayed.  This is when the ectopic pregnancy may rupture and this can be life threatening.

Multiple Pregnancies

In the past, a high order multiple pregnancy was a very common complication of IVF. This was because doctors transferred just too many embryos. This was the only way they could inflate their success rates and market themselves better. However, this complication can be prevented by restricting the number of embryos we transfer.

Other rare complications

At times, in the course of egg collection there can be complications such as vaginal bleeding or infection. When you opt to get your IVF done at a good and well-established clinic, this is more of a rarity.

Technical Difficulties

One emergency that is quite vexing is that of a difficult embryo transfer. In this, the doctor faces technical difficulty in depositing the embryos via the cervix into the uterus. This could be because of cervical stenosis. This condition is related to the narrowing of the cervix. Some women are born with a narrow cervical canal. However, in most cases, it’s on account of a procedure like cone biopsy or a LEEP, where the cervix is operated and it becomes narrow. In some instances, the doctor is unable to deposit the embryos because the cervical canal is sharply angulated. This situation can be very distressing for the doctor as well as the patient; a difficult embryo transfer does reduce the success rates. This is why many clinics routinely do a dummy embryo transfer first, to prevent this situation from arising.

Empty follicle syndrome

This is an emergency for the doctor, because he is not able to collect any eggs from the follicles during the egg retrieval surgery.

Finally, the most common emergencies are the emotional ones

The Emotional Factor

Sometimes, when patients find that their beta hCG is negative and the IVF cycle has failed, they break down. An empathetic doctor is able to manage this expertly and will also provide patients a shoulder to cry on. He will explain to them that it's more important that they focus on the long-term perspective, rather than get disheartened because one cycle has failed.

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