Introduction: Informed Consent and Honest Conversation
Every medical treatment involves a risk-benefit calculation. IVF is no exception. For the vast majority of patients, the benefits of IVF — the possibility of a much-wanted child — far outweigh the risks. But informed consent requires that both sides of this calculation are clearly understood.
At PSFC OMR, Chennai, we believe that honest, transparent communication about IVF risks is part of the care we owe our patients. This guide provides a clear overview of the known risks associated with IVF, alongside the evidence on how they are minimised.
Risk 1: Ovarian Hyperstimulation Syndrome (OHSS)
OHSS is the most clinically significant risk associated with ovarian stimulation. It occurs when the ovaries respond excessively to fertility medications, leading to enlarged ovaries, fluid accumulation in the abdomen, and in severe cases, complications affecting breathing and circulation.
| Severity | Symptoms | Management |
| Mild | Bloating, mild abdominal discomfort, nausea | Rest, hydration, monitoring |
| Moderate | More significant bloating, nausea, reduced urine output | Medical monitoring, sometimes IV fluids |
| Severe | Significant fluid accumulation, breathing difficulty, blood clots | Hospital admission, drainage procedure |
Modern IVF protocols have substantially reduced OHSS rates. Key strategies include using GnRH antagonist protocols, triggering with a GnRH agonist instead of hCG in high-risk patients, and elective freezing of all embryos (freeze-all strategy) rather than a fresh transfer in cases of excessive response.
💡 Tip: Patients who are identified as high-risk for OHSS before stimulation begins — for example, those with PCOS or high antral follicle counts — will be managed with a modified protocol from the outset.
Risk 2: Multiple Pregnancy
Multiple pregnancy — twins or higher-order — carries significantly elevated risks for both mother and babies, including preterm birth, low birth weight, gestational diabetes, and pre-eclampsia. As detailed in our dedicated guide on IVF and multiple pregnancies, modern practice now strongly favours single embryo transfer (eSET) to minimise this risk.
Risk 3: Ectopic Pregnancy
Ectopic pregnancy — where the embryo implants outside the uterine cavity, most commonly in the fallopian tube — occurs in approximately 2 to 5 percent of IVF pregnancies. This rate is slightly higher than in natural conception, reflecting the underlying tubal factor that often contributes to the need for IVF.
Early ultrasound confirmation of intrauterine pregnancy — typically performed at 6 to 7 weeks of gestation — is standard practice after IVF. Ectopic pregnancy is a medical emergency and requires immediate management, either with medication or surgery.
Risk 4: Miscarriage
Miscarriage rates in IVF reflect the same age-related patterns as in natural conception — they are higher for older women and lower for younger women. IVF itself does not increase the risk of miscarriage beyond what would be expected for a woman of the same age conceiving naturally. The use of Preimplantation Genetic Testing (PGT-A) to select chromosomally normal embryos can reduce miscarriage rates in appropriate candidates.
Risk 5: Risks Associated With Egg Collection
Egg collection is a minor surgical procedure performed under ultrasound guidance and sedation. Risks are uncommon but include:
- Bleeding from the ovaries or surrounding structures — usually minor and self-limiting
- Pelvic infection — minimised with antibiotic prophylaxis
- Injury to adjacent structures (bladder, bowel, blood vessels) — very rare with experienced practitioners
- Anaesthetic risks — managed by experienced anaesthetists with standard monitoring
Risk 6: Long-Term Health Risks
Extensive research has examined whether IVF is associated with increased long-term health risks for women, including ovarian cancer, breast cancer, and cardiovascular disease. The current evidence does not support a clinically significant increase in these risks attributable to IVF itself. The hormones used in stimulation are temporary, and their levels return to baseline rapidly after the treatment cycle ends.
It is important to note that infertility itself — independent of IVF treatment — has been associated with some increased health risks. Ongoing health monitoring and lifestyle optimisation remain important for all patients, with or without fertility treatment.
Risks for Babies Born Through IVF
The majority of children born through IVF are healthy. However, the data shows a slightly elevated rate of some birth defects compared to naturally conceived children. The absolute risk increase is small, and the causes are likely multifactorial — including the underlying fertility conditions that led to IVF, rather than the IVF procedure itself.
Singleton pregnancies achieved through IVF carry risks comparable to natural singleton pregnancies. The elevated risks in IVF-related births are largely attributable to multiple pregnancies — another reason why eSET is strongly recommended.
Conclusion
The risks associated with IVF are real and worth understanding — but they must be considered in proportion. Modern IVF, delivered by experienced clinicians in well-equipped laboratories, has a strong safety profile. The risks of untreated infertility — including the emotional and relational toll of prolonged unsuccessful attempts to conceive — are also part of the equation.
At PSFC OMR, Chennai, every treatment plan is designed with both efficacy and safety as primary considerations. Your risk profile is assessed individually, and your protocol is tailored accordingly.
FAQs
How common is OHSS with modern IVF protocols?
Severe OHSS now affects fewer than 1 to 2 percent of IVF cycles in centres using modern antagonist protocols and individualised dosing. Mild OHSS is more common but usually resolves without intervention.
