Aggressive drug therapies in IVF treatment can be harmful but this risk is usually downplayed because it doesn’t happen to most women.
However, recently a Kentucky woman developed serious complications from hormonal medications administered during her IVF cycle and again sparked discussions regarding the safety of IVF drugs. Critics are asking the industry “are IVF drugs safe?”
24-year-old Logan Andreotta was told that she made an ideal candidate for in vitro fertilization as she was young and in excellent health. But just three days into the treatment, the drugs caused an adverse reaction in her body—her ovaries swelled up with 50 eggs.
Normally a woman’s ovary releases one egg a month. In a typical IVF cycle 8-15 eggs are collected, as the ovaries are first stimulated with hormonal drugs.
With 50 eggs, Andreotta’s ovaries had four years’ worth of eggs at one time. “I felt like my insides were going to bust out of my stomach,” she told the Washington Post.
Ovarian Hyperstimulation Syndrome
What happened to Andreotta was ovarian hyper stimulation syndrome (OHSS). It is a rare complication of IVF drugs that can be potential fatal.
Unregulated prescription of these drugs, aggressive treatment protocols, and failure to report the problems when they arise, is causing concern among critics.
OHSS is a potentially life-threatening but mostly preventable complication, says the research published in the Women’s Health Journal. Different researches have also theorized that the drugs used for controlled ovarian stimulation (COS) could potentially lead to endocrine system disorders, heart disease, depression, and various other conditions but these reports remain inconclusive and debatable.
The first IVF baby was born 40 years ago, and since then over 8 million children have been born worldwide with this technology. While it is serious, OHSS is not common and perhaps that is the reason why so little in invested in serious research over this.
Industry insiders not worried
Alan Penzias, an associate professor at Harvard Medical School who chairs the practice committee of the American Society for Reproductive Medicine (ASRM), says he has been “reasonably reassured” that the drugs used in ART pose no long-term threat to the patient’s health.
“We’re at a time point when, if there were anything major, we would have seen it by now,” he said. “Fortunately, we haven’t seen anything negative.”
However, critics are concerned as OHSS is one dangerous possibility of IVF, which has even claimed a few lives. Although patients of PCOS are more prone to developing this complication, it can strike anyone who is taking medication to stimulate the ovaries to ripen multiple eggs—a fundamental step in all cases of IVF, egg donation, and egg freezing.
OHSS may not be as uncommon as the industry believes because the available data suggests that mild OHSS occurs in 20%–33% of the cases but since it only causes mild discomfort, nausea, or diarrhea in the patient, it is not considered a serious threat. Moderate degree of OHSS occurs in 3%–6% of IVF cases. The incidence of severe OHSS is small accounting for only 0.1%–2% of cycles.
Symptoms of severe OHSS
While mild and moderate OHSS does not manifest as serious symptoms but sever OHSS can require hospitalization due to one or more of the following symptoms:
- Ascites
- Dyspnea
- Hemoconcentration
- Low blood/central venous pressure
- Severe abdominal pain
- Pleural effusion
- Sudden weight gain
- Fainting
- Acute renal failure
- Arrhythmia
- Thromboembolism
- Pericardial effusion
- Respiratory distress
- Sepsis
Some research shows that severe OHSS occurs in just 0.03 percent of the cycles and doctors often rely on it. Also, the methods to identify high-risk patients have improved and many doctors advise in favor of close monitoring of the patient during ovarian stimulation.
Data collected between 2006 and 2014 shows that while IVF numbers have gone up, the number of women seeking emergency care for OHSS has significantly reduced.
Is OHSS being under-reported?
Critics are concerned that the number of OHSS cases reported by IVF clinics may not be right.
The Human Fertilization and Embryology Authority, an independent fertility regulator in the UK, launched an investigation into a discrepancy between OHSS cases reported by fertility clinics and the larger number logged in hospital admissions data.
They did not find any conclusive evidence of systematic underreporting, but they said that the data collected raises “significant concerns and questions about the safety of patients undergoing IVF.”
Geeta Nargund, a fertility specialist in Britain, is urging calling for better tracking of adverse reactions in IVF.
“I feel more concerned now than ever before,” she said. “It is extremely important that we do not make healthy women ill as a result of IVF treatment.”
Since IVF drug dosage is customized to each patient’s requirements, it is difficult to set a standard or even track the cases where doctors are being more aggressive with the drugs.
IVF drugs and cancer?
Specialists have long argued that the administration of extra estrogen—usually for around 10 days in IVF—is unlikely to have any major long-term effect on a woman’s body. However, estrogen is linked with some cancers and more research is called for.
According to the current guidelines by the American Society of Reproductive Medicine (ASRM), based on the available data, there seems to be no meaningful increased risk of invasive ovarian, breast or endometrial cancer for fertility patients. For borderline ovarian tumors, ASRM says: “several studies have shown a small increased risk.”
Women of different races, ethnicities, and ages, can react differently to IVF drugs, which makes it even more difficult to decide how safe ovarian stimulation is.
What to do in case you develop OHSS from IVF drugs?
Most women who developed OHSS say they weren’t aware of something like that and it wasn’t possible to be mentally prepared.
As soon as she developed the symptoms, Andreotta was rushed to her doctor, who aspirated a lot of fluid from her abdomen. “It was liters and liters and looked like the Coca-Cola you buy at the store — a brownish red liquid,” she recalled.
It was 4-5 bottles on the first day and 2-3 bottles on each visit after that. It took her around 4 weeks to get out of it.
Despite everything, Andreotta does not regret her decision to undergo IVF and take all those drugs. Four of her 50 eggs were viable and one of those resulted in a successful pregnancy. She had a daughter, Bonnie, who is now 4. Two years later, she conceived naturally and had another daughter, Audrey.
Andreotta’s only advice to other women seeking IVF is to immediately report any complications.
“I feel super fortunate,” she said. “They said if I kept waiting, I literally could be dead.”
Echo effects of IVF drugs
Jacob Udell, a medical intern in Canada, noted that in early 2000s a lot of women were being admitted to hospitals for congestive heart failure or other organ failure, and most of them had excess fluids in their body.
“We were perplexed. They didn’t have many risk factors, but the common theme was that they had been getting fertility medicines,” Udell recalled. “They were getting high doses and trying to get pregnant.”
This caused him and his colleagues to think if the administration of fertility drugs was injuring the lining of blood vessels, which was causing the fluids to leak out and collect in body cavity.
Although it is a possibility, nothing can be said conclusively in the absence of proper research and data. These issues could be attributed to the women’s own hormonal problems, age, and other health factors. We need to follow IVF patients more closely and conduct more research in this direction.
On our part, we must try and raise awareness and encourage women to rush back to their doctors immediately, in case they face any complications after administration of IVF drugs.