1. Risks of treatment Research projects

2. The IVF Pathway Treatment Risks
MULTIPLE PREGNANCY AND
THE ONE AT A TIME INITIATIVE
Our wish is for you to achieve a healthy pregnancy and live birth which is more likely with a single baby
Twins and more carry higher risks to mother and babies
In couples with the highest chance of success, it is not wise to take unnecessary risks by transferring more than one embryo
The final section of this presentation explains some of the risks of IVF treatment.
Generally speaking, IVF treatment is a safe process but everything has some risk and it is important that all patients are fully informed of the potential hazards of treatment.
The first and most significant risk is multiple pregnancy and the potential consequences of it. Fertility treatment has developed a bad reputation over the years for twins, triplets and more. The risks of multiple pregnancy are many, to the mother, the baby and the family unit, as well as society at large.
For the mothers, PET is 3x higher in twins, and 9x higher in triplets. The risk of GDM is increased as is the risk of CHD. Most worrying is that having a multiple pregnancy doubles the maternal mortality risk.
Multiple pregnancy risks to the baby include miscarriage, both early and late, and pre-term delivery with associated complications. Increased risk of low birth weight babies and development of CP. Neonatal death is 5x higher in twins and 9x higher in triplets compared to singleton babies.
The chance of a pregnancy overall is closely related to female age (and egg quality) and to the performance of the clinic as a whole
Our figures show that if we have two good quality blastocysts and we transfer both together, there is a 50% chance that a pregnancy will result, and a 50% chance that the pregnancy will be a multiple (twin).
If we only transfer one, the overall chance of a pregnancy is less than 1% lower (ie >49%) than if two were transferred and the chance of twinning is <1%. (single embryos will rarely split producing identical twins…)
The law permits the transfer of maximum of two embryos in women less than 40 years of age.
In women over 40 years, the maximum number permitted is 3 at any one time.
LCRM multiple pregnancy rate x (6-7)% see slide 43 success rates above
LCRM POLICY IN LINE WITH HFEA CODE OF PRACTICE:
Single embryo transfer in women under 38 years, during the first or second cycle of treatment, where the embryo development has been good overall

3. The IVF Pathway Treatment Risks
Ovarian Hyperstimulation
Syndrome (OHSS)
All patients experience a mild form of OHSS
Women at highest risk are those with polycystic ovaries
1% will get significant symptoms
We take special precautions in women at high risk
Stimulation may be abandoned
We may freeze all embryos
The second important risk of IVF treatment is ovarian hyperstimulation syndrome
All pts experience a mild form
Risk inc wth PCOS
1% significant
We are always on the lookout and can often remedy the situation to allow treatment to continue safely.
Occasionally:
stimulation may be abandoned and restarted with different dose / treatment regimen
we freeze all embryos because if you were to get pregnant with OHSS, the risks are greater
You may be prescribed additional medications such as blood thinning injections as a precaution

4. The IVF Pathway Treatment Risks
Ovarian Hyperstimulation
Syndrome (OHSS)
OHSS symptoms
Bloating
Abdominal discomfort
Nausea and vomiting
Diarrhoea
Risks of Severe OHSS
Blood clots (thrombosis)
Dehydration
Kidney problems
OHSS can feel quite unpleasant producing…..
Serious problems that may not be obvious to you include an increased risk of developing a blood clot and kidney failure. Therefore it is much safer to call and allow us to check you over than to hope you’ll feel better tomorrow…
If you suspect you may have symptoms of OHSS, please contact us directly as LCRM for advice (NOT your local hospital or GP)

5. The IVF Pathway Treatment Risks
Miscarriage
20-30% risk of miscarriage
<5% risk of miscarriage once a fetal heart has been identified
Ectopic pregnancy
If unidentified, it may burst and cause serious internal bleeding
The risk is greater when tubal problems have been identified
Other risks of treatment include:
Miscarriages: 20-30% risk of miscarriage after positive pregnancy test (same as for natural conceptions)
<5% risk of miscarriage once a fetal heart has been identified
Risk related to age, family history and whether the pregnancy is a multiple pregnancy
Ectopics: Occurs when the embryo drifts into the Fallopian tube where it implants
If unidentified, it may burst and cause serious internal bleeding
The risk is greater when tubal problems have been identified, and an early scan should be performed (6+ weeks)

6. The IVF Pathway Treatment Risks
Risks of the egg collection surgical procedure
Infection
Bleeding or internal injury
Risks of equipment failure
Service contracts and safety checks in place
Risks related to the treatment processes include:
Risk of infection is greater if you already have infected tubes or an active vaginal infection, if you have endometriosis or internal scarring involving the bowel
Both partners should undergo sexual health screening before treatment
The woman will be prescribed an antibiotic cream to use during treatment
Bleeding is extremely rare as is bowel injury
Despite all our efforts, and very very rarely, equipment failure may lead to loss of eggs or embryos.
This is a Category A incident that will be immediately notified to HFEA, LTHT and to you
There would be a thorough investigation and steps taken to prevent a recurrence
The HFEA also operates an Alert system which all clinics use to learn from serious incidents that have occurred in clinics elsewhere

7. The IVF Pathway Treatment Risks
RISKS OF INTRACYTOPLASMIC
SPERM INJECTION (ICSI)
Used worldwide for >20 years
Potential concerns regarding the risk of passing on a genetic reproductive problem
Studies so far are small and do not include effects that may be seen in older children and future generations
It is worth saying a few words about the ICSI procedure and what we know about its safety-
ICSI is an unnatural and invasive technique and may use sperm that would not otherwise be able to fertilise an egg
No clear evidence that ICSI results in more birth defects than occur with natural conception
No clear evidence giving concerns about the physical and intellectual development of ICSI children

8. The IVF Pathway Treatment Failure
POSSIBLE REASONS
Failure
to produce enough eggs
to collect eggs from ovaries
of eggs to fertilise
of embryos to divide and develop
Unexpected illness in either partner
A negative pregnancy test often results with no clear explanation
These are all
UNCOMMON
Finally, there is the ever present risk that the treatment may not work for you this time-
Sometimes the treatment process will reveal problems with egg or embryo quality which the treatment is not able to solve.
It is more common for a pregnancy not to result when everything has apparently gone well, and sometimes we may not have an explanation
In most cases we suspect that the embryos were faulty in their genetic make-up and never destined to produce a baby. This is not something we would necessarily identify in the short time the embryos are observed in the laboratory before transfer. However, it is the commonest finding when embryos are examined for their genetic detail. Genetic faults become very much more common as the eggs (woman) gets older. By the age of 43y, >90% eggs are abnormal. Unfortunately, the IVF process is not the answer for this problem, unless younger eggs are used…

9. The IVF Pathway Research
There is still so much work to do to improve the likelihood of success, and we urge that you consider participating in our research projects
Assessing male reproductive health using ejaculated sperm
Non-invasive assessment using left over semen not required for your treatment
HAB select: Hyaluronic Acid Binding sperm selection for ICSI
What is the best way to select sperm for ICSI?
Randomization into current method v. Hyaluronic Acid Binding (HAB)
Best sperm binds to naturally occurring substance “hyaluronan”
NO extra visits

10. Thank you
We hope that you have found this presentation useful, helpful and reassuring. We look forward to supporting you through your treatment and wish you the very best of luck.