Complications of Assisted Reproductive Technology

In: Infertility and Assisted Reproduction · 2008 · pp. 604–618 · doi:10.1017/cbo9780511547287.065 · W160585985
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This chapter details potential complications at each stage of assisted reproductive technology, including ovarian hyperstimulation syndrome, increased cancer risk, and damage to pelvic structures during oocyte retrieval.

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This chapter reviews complications that can occur at multiple stages of assisted reproductive technology, covering potential risks from infertility treatment through IVF/ICSI, including dangerous, potentially life-threatening events. Drawing on registry data and published reports, it frames the magnitude of ART use and notes that the long-term health consequences are not yet fully determined, while emphasizing that complications are an ongoing worldwide iatrogenic problem. A major limitation explicitly highlighted is the incomplete understanding of longer-term outcomes despite rapid adoption and rising cycle numbers. Relevance to endometriosis: the paper does not explicitly discuss endometriosis or adenomyosis as a complication determinant; it was included in the corpus due to its placement alongside the ART chapter “Endometriosis and Assisted Reproductive Technology,” but the provided text itself does not mention endometriosis or adenomyosis.

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Abstract

This chapter considers each stage of assisted reproductive technology (ART) and discusses its possible complications with options for prevention. The frequency of complications of ART varies among series and depending on whether the complications are reported in single treatment cycles or all treatment cycles. The iatrogenic condition of ovarian hyperstimulation syndrome (OHSS) is the most important complication of ovulation induction and, in its severe form, is a potentially lethal disease. Ovarian cancer and breast cancer are also associated with use of ovulation stimulating drugs. Other unusual side effects of ovulation induction include bloody ascites in a woman with endometriosis and familial Mediterranean fever, pituitary hemorrhage after clomiphene citrate, and hypophyseal hypertrophy in pregnancy after bromocriptine treatment for prolactinomia. Three main groups of complications of oocyte pick up (OPU) are: hemorrhage, pelvic infection, and damage to pelvic structures such as the bowel or ureters.
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- Frontmatter - Contents - Contributors - Foreword - Preface - Introduction - PART I PHYSIOLOGY OF REPRODUCTION - PART II INFERTILITY EVALUATION AND TREATMENT - PART III ASSISTED REPRODUCTION - 38 Medical Strategies to Improve ART Outcome: Current Evidence - 39 Surgical Preparation of the Patient for In Vitro Fertilization - 40 IVF in the Medically Complicated Patient - 41 Polycystic Ovary Syndrome and IVF - 42 Endometriosis and Assisted Reproductive Technology - 43 Evidence-Based Medicine Comparing hMG/FSH and Agonist/Antagonist and rec/Urinary hCG/LH/GnRH to Trigger Ovulation - 44 Luteal Phase Support in Assisted Reproduction - 45 Thrombophilia and Implanation Failure - 46 Intrauterine Insemination - 47 The Prediction and Management of Poor Responders in ART - 48 Oocyte Donation - 49 In Vitro Maturation of Human Oocytes - 50 Oocyte and Embryo Freezing - 51 Cryopreservation of Male Gametes - 52 The Management of Azoospermia - 53 Spermatid Injection: Current Status - 54 Optimizing Embryo Transfer - 55 Single Embryo Transfer - 56 Blastocyst Transfer - 57 Clinical Significance of Embryo Multinucleation - 58 Quality and Risk Management in the IVF Laboratory - 59 The Nurse and REI - 60 Understanding Factors That Influence the Assessment of Outcomes in Assisted Reproductive Technologies - 61 The Revolution of Assisted Reproductive Technologies: How Traditional Chinese Medicine Impacted Reproductive Outcomes in the Treatment of Infertile Couples - 62 Complications of Assisted Reproductive Technology - 63 Ectopic and Heterotopic Pregnancies Following in Vitro Fertilization - 64 The Impact of Oxidative Stress on Female Reproduction and ART: An Evidence-Based Review - 65 PGD for Chromosomal Anomalies - 66 Preimplantation Genetic Diagnosis for Single-Gene Disorders - 67 Epigenetics and ART - 68 Congenital Anomalies and Assisted Reproductive Technology - PART IV ETHICAL DILEMMAS IN FERTILITY AND ASSISTED REPRODUCTION - Index - Plate section - References from PART III - ASSISTED REPRODUCTION Published online by Cambridge University Press: 04 August 2010 Book contents - Frontmatter - Contents - Contributors - Foreword - Preface - Introduction - PART I PHYSIOLOGY OF REPRODUCTION - PART II INFERTILITY EVALUATION AND TREATMENT - PART III ASSISTED REPRODUCTION - 38 Medical Strategies to Improve ART Outcome: Current Evidence - 39 Surgical Preparation of the Patient for In Vitro Fertilization - 40 IVF in the Medically Complicated Patient - 41 Polycystic Ovary Syndrome and IVF - 42 Endometriosis and Assisted Reproductive Technology - 43 Evidence-Based Medicine Comparing hMG/FSH and Agonist/Antagonist and rec/Urinary hCG/LH/GnRH to Trigger Ovulation - 44 Luteal Phase Support in Assisted Reproduction - 45 Thrombophilia and Implanation Failure - 46 Intrauterine Insemination - 47 The Prediction and Management of Poor Responders in ART - 48 Oocyte Donation - 49 In Vitro Maturation of Human Oocytes - 50 Oocyte and Embryo Freezing - 51 Cryopreservation of Male Gametes - 52 The Management of Azoospermia - 53 Spermatid Injection: Current Status - 54 Optimizing Embryo Transfer - 55 Single Embryo Transfer - 56 Blastocyst Transfer - 57 Clinical Significance of Embryo Multinucleation - 58 Quality and Risk Management in the IVF Laboratory - 59 The Nurse and REI - 60 Understanding Factors That Influence the Assessment of Outcomes in Assisted Reproductive Technologies - 61 The Revolution of Assisted Reproductive Technologies: How Traditional Chinese Medicine Impacted Reproductive Outcomes in the Treatment of Infertile Couples - 62 Complications of Assisted Reproductive Technology - 63 Ectopic and Heterotopic Pregnancies Following in Vitro Fertilization - 64 The Impact of Oxidative Stress on Female Reproduction and ART: An Evidence-Based Review - 65 PGD for Chromosomal Anomalies - 66 Preimplantation Genetic Diagnosis for Single-Gene Disorders - 67 Epigenetics and ART - 68 Congenital Anomalies and Assisted Reproductive Technology - PART IV ETHICAL DILEMMAS IN FERTILITY AND ASSISTED REPRODUCTION - Index - Plate section - References To date nearly two million babies were born as a result of ART which is widely used all over the world for virtually all forms of infertility. The world collaboration report on ART, for the year 2000, included 460,000 in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles from forty-nine countries and total number of babies conceived through ART was between 197,000 and 220,000 (1). It is estimated that the figures in the world IVF report represent only approximately two-thirds of ART cycles performed in the world. The European registers on ART for the year 2002 by ESHRE reported 324,238 treatment cycles, which represented 12 percent increase since year 2001. In thirteen countries where all clinics reported to the register, a total of 177,429 cycles were performed in a population of 193.7 million, corresponding to 916 cycles per million inhabitants. The percentage of infants born after ART ranged from 1.3 to 4.2 percent of the total number of live births in the country (2). The long-term health consequences of this widely used technique have yet to be determined. 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