Deadly IVF side effect is on the rise, report finds

A painful and potentially fatal condition linked to IVF is on the rise in women who have fertility treatment, figures show.

There were 156 cases of ovarian hyperstimulation syndrome, or OHSS, in 2018-19, compared to 135 the year before. 

Thought to affect a third of women who have IVF, it triggers the woman’s ovaries to swell to a dangerous size and become painful.

The report, by fertility regulator the Human Fertilisation and Embryology Authority, also found the number of serious errors was climbing.

There were 294 incidents that involved the loss or damage of embryos or sensitive personal data being sent to the wrong family – up by 60 from last year. 

There were also two major blunders in the last 12 months compared to none the previous year. One involved the wrong donor sperm being inserted into a woman. 

The number of women are being struck down by a side effect of IVF is on the rise (stock)

The error took place at the Simply Fertility clinic in Great Baddow, Chelmsford, during the woman’s third cycle of IVF in October 2018.

The other saw an incorrect gas cylinder hooked up to chamber filled with several embryos from multiple patients, resulting in their death or damage. 

The HFEA said it was looking into arranging the gas storage facilities so that mixed gases are stored in separate areas and clearly labelled.

It said it would also include a two person check before attaching cylinders to the incubators.

Sally Cheshire CBE, chair of the HFEA – a branch of the Department of Health and Social Care, said that ‘any incident is one too many’.

The statistics raise concern that clinics are giving women high doses of drugs to boost their ovaries so they produce more than the normal one egg a month.

OHSS is caused by powerful IVF drugs which stimulate the ovaries to produce extra eggs. 

WHAT IS OVARIAN HYPERSTIMULATION SYNDROME? 

Ovarian hyperstimulation syndrome (OHSS) can affect women undergoing IVF or other fertility procedures.

It occurs when they take injectable hormones to stimulate the development of eggs in the ovaries.

Too much hormone medication can cause the ovaries to become swollen and painful. In severe cases it can lead to rapid weight gain, abdominal pain, vomiting and shortness of breath.

In rare cases, OHSS occurs after taking oral fertility treatments or even just spontaneously. 

Symptoms typically begin within ten days of taking injectable medications. In mild cases they can include:

  • Moderate abdominal pain
  • Bloating or an increased waist size
  • Nausea and vomiting
  • Diarrhoea
  • Sudden weight gain of more than 6.6lbs (3kg)

These symptoms often ease within a week without treatment.

In severe cases, symptoms include:

  • Rapid weight gain of 33-44lbs (15-20kg) within five-ten days
  • Severe abdominal pain, nausea and vomiting
  • Blood clots in the legs
  • Reduced urination
  • Shortness of breath
  • Tight or enlarged abdomen

In around 1-2 per cent of cases, OHSS can be life-threatening and lead to:

  • Fluid in the abdomen or chest
  • Blood clots
  • Kidney failure
  • Ovary twisting
  • Rupture of an ovarian cyst, leading to bleeding
  • Breathing problems
  • Miscarriage
  • Death 

Severe sufferers may require IV fluids in hospital and drugs to suppress their ovarian activity.

Surgery may be necessary if an ovarian cyst bursts, as well as anticoagulants if clots have occurred.

OHSS’ exact cause is unknown but is thought to be due a hormone called HCG, which triggers the release of an egg.

Ovarian blood vessels react abnormally to HCG and begin to leak fluid, which causes swelling that can move into the abdomen. 

Source: Mayo Clinic 

In severe cases, OHSS can lead to rapid weight gain, abdominal pain, vomiting and leave victims struggling to breathe. 

The condition can also kill, although there have been no deaths from OHSS reported by clinics across the UK.

Ms Cheshire said: ‘We have done a lot of work with clinics to raise awareness of OHSS and improve the reporting of it.

‘This provides us with a picture of what is happening at clinics. We have taken steps to improve the way that clinics advise patients of the risks of OHSS and what a patient should do if they feel unwell. 

‘We also require clinics to work with local hospitals to ensure that any woman suffering from suspected OHSS is treated appropriately.’ 

Ms Chehire said: ‘The number of incidents reported remains low at less than one per cent of all treatment cycles. 

‘Incidents fall into three categories, with this year’s report showing an increasing proportion of grade B incidents. 

‘These resulted largely from greater awareness among clinics of the need to report these.’

She added: ‘To make the sector even better and safer for patients there is more work to do. 

‘It’s good news that clinics have reduced the number of minor incidents, but we’re concerned that any incident is one too many. 

‘We will continue to ensure that the whole sector learns from any clinic incident, however minor, to understand what went wrong and, crucially, that steps are taken to ensure it does not happen again.’ 

On top of the 294 serious blunders, there were 266 ‘minor errors’, which involved eggs being rendered unusable in the laboratory.

The HFEA found there were also 44 ‘near misses’, where errors which had the potential ‘to cause injury or ill health’ were narrowly avoided. 

The latest report also found that multiple births – the single biggest health risk from IVF – also reached an all-time low of 10 per cent. 

While having more than one baby is not inherently bad, it significantly increases the risk of complications for the mother and babies.

Problems associated with multiple births include miscarriages, pregnancy-related high blood pressure and gestational diabetes. 

The overall number of non-compliances per inspection has decreased each year since 2015/16 and over half of clinics had fewer areas of concern compared with their previous inspection.

Overall, there were 351 non-compliances in 2018-19, down from 457 in 2015-16. However, the HFEA said there was some room for improvement, with more non-compliances relating to medicines management being classed as major and critical.

There were 37 non-compliances in this area in 2018-19, of which six were critical and 24 were major, up from a total of 25 the year before. 

On infection control, there were 25 in 2018/19, up from 15, and there were 11 non-compliances for legal parenthood, up from six.

Legal parenthood consent is essential to enable the patient’s partner to become the legal parent of any children. 

Dr Raj Mathur, secretary of the British Fertility Society said: ‘We are pleased to see that the year-on-year increase in incident reporting continues; the fuller the picture we have, the better. 

‘Signs such as the reduction in multiple births tell us that standards are improving alongside an increase in patient numbers.

‘We will continue to work, as a community, to make improvements in the areas highlighted by the report.   

‘This report reinforces the fact that the culture of the sector is as important as the details of its successes and shortcomings; we are proud to be part of making that culture one of openness and excellence.’

Read more at DailyMail.co.uk