Side effects and risks of treatments

A. Common Side Effects

• Sensitivity, redness, and bruising at injection sites

• Local allergic reactions (itching, redness), particularly with certain estradiol patches and ganirelix (Orgalutran/Fyramadel) injections

• Nausea

• Fatigue

• Breast tenderness

• Increased vaginal secretions

B More Severe Complications

These complications are rare, occurring in fewer than 1% of cases.

• Ovarian Hyperstimulation Syndrome (OHSS)

During IVF treatment, controlled ovarian hyperstimulation is necessary to stimulate the growth of multiple follicles in the ovaries. In young women with a high ovarian reserve or those with polycystic ovary syndrome (PCOS), the risk of OHSS is higher, particularly in the event of pregnancy.

Most cases are moderate, causing abdominal bloating, pelvic discomfort, ovarian enlargement, and mild fluid accumulation in the pelvis. Management typically involves rest and thrombosis prevention (deep vein thrombosis or pulmonary embolism) through anticoagulant injections.

In very rare cases (less than 1%), OHSS can become severe, leading to dehydration, significant fluid accumulation in the abdomen, lungs, and around the heart, kidney failure, deep vein thrombosis, and pulmonary embolism.

• Adnexal Torsion

Rarely, ovarian enlargement due to stimulation treatment and multiple developing follicles can lead to adnexal torsion. This results in severe pelvic pain and requires urgent medical attention. In most cases, laparoscopic surgery is necessary to untwist the ovary and restore its blood supply.

• Ovarian Cysts

These functional cysts result from ovarian stimulation and are generally harmless. However, their size may cause discomfort or, in rare cases, adnexal torsion.

•  Thromboembolic Complications

TThe use of synthetic hormones, such as estrogen-progestogen formulations and oral estrogens, as well as elevated circulating estradiol levels due to ovarian stimulation, can induce changes in blood coagulation.

Thrombosis occurs when a blood clot obstructs a vein or artery.

The incidence of venous thromboembolic events during assisted reproduction treatment is low. According to data from the French Biomedicine Agency, the overall risk is 0.26% in pregnancies and rises to 1.78% in cases of ovarian hyperstimulation syndrome.

Risk factors include advanced maternal age, a personal history of venous thrombosis, underlying coagulation disorders (thrombophilias), and prolonged travel.

Arterial thromboembolic events are extremely rare, and their exact incidence remains unknown due to a lack of epidemiological studies. However, severe ovarian hyperstimulation syndrome is almost always a contributing factor.

The vast majority of pregnancies achieved through assisted reproductive technologies (ART) progress normally. However, as with naturally conceived pregnancies, certain obstetric complications may occur.

Common Side Effects

• Pelvic Pain: Typically moderate and manageable with standard analgesics.
  • Rare Complications
  • These occur in less than 1% of cases
• Urinary Tract Infection: May require antibiotic treatment.
• Ovarian or Intra-Abdominal Bleeding: Occurs in fewer than 0.5% of cases. In rare instances, laparoscopic surgery may be necessary. ​
• Pelvic Infections: Risk is under 0.4% and is higher in individuals with endometriosis or a history of pelvic infections (e.g., salpingitis, hydrosalpinx). Treatment may involve antibiotics or, in severe cases like pelvic abscesses, surgery.
• Injury to Adjacent Organs: Extremely rare but may involve the bladder, ureter, intestines, or pelvic blood vessels.

The vast majority of pregnancies achieved through assisted reproductive technologies (ART) progress normally. However, as with naturally conceived pregnancies, certain obstetric complications may occur.

Ectopic Pregnancy (Less than 2% of pregnancies)

An ectopic pregnancy occurs when the embryo implants outside the uterus, most commonly in a fallopian tube, and in rare cases, in the ovary or cervix.

• When detected early, medical treatment may be an option.
• In some cases, surgical intervention is necessary.

Early Miscarriage

• The risk of early miscarriage in ART pregnancies is comparable to that of the general population.
• The likelihood of miscarriage is strongly linked to maternal age, ranging from 10% to 40% for women over the age of 40.

Multiple Pregnancies

• More common after intrauterine insemination (IUI).
• Can also occur following the transfer of a single embryo that later divides into identical twins.

Other Potential Obstetric Complications

• Gestational diabetes
• Hypertension and pre-eclampsia
• Preterm birth, which may lead to respiratory or neurological complications in the newborn
• Cesarean delivery

The vast majority of pregnancies obtained by MPA evolve normally. As with pregnancies obtained naturally, however, obstetrical complications may occur.

•   Ectopic pregnancies: Less than 2% of pregnancies
  • Pregnancy develops outside the uterus, most often in a tube or, very rarely, in an ovary or cervix.
  • Treatment may be medical in forms diagnosed early, or surgical.
•   Early spontaneous miscarriage

The rate of early spontaneous miscarriage is identical to that of the general population, and is related to the woman’s age. It varies between 10% and 40% for patients over the age of 40.

•   Multiple pregnancies
  • More frequent after intrauterine insemination o
  • They may occur after transfer of a single embryo that subsequently splits.t

They may occur after transfer of a single embryo that subsequently splits.

• Gestational diabetes
• Hypertension and pre-eclampsia
• Premature delivery with risk of respiratory and neurological sequelae
• Delivery hemorrhage
• Caesarean delivery