Most IVF cycles go without serious problems, but there are real risks. The main ones are ovarian hyperstimulation syndrome (OHSS), multiple pregnancy, complications of egg collection, and ectopic pregnancy. Knowing the warning signs helps you get help early.
Why it is worth knowing the risks
IVF is a well-established treatment, and most cycles do not lead to serious problems. But it does involve medicines and procedures that carry risks. A good clinic will explain them before you start and tell you what it does to reduce them. Knowing the warning signs means you can act quickly if something is not right.
Ovarian hyperstimulation syndrome (OHSS)
OHSS happens when the ovaries over-respond to the stimulation hormones. They become swollen, and fluid can leak from blood vessels into the tummy and, rarely, the chest.
It usually appears in the days after egg collection, or later if a pregnancy starts, because pregnancy hormones can make it worse.
| Mild to moderate OHSS | Severe OHSS |
|---|---|
| Bloating and a swollen tummy | Severe tummy pain and marked swelling |
| Mild tummy pain | Feeling or being very sick, unable to keep fluids down |
| Nausea | Breathlessness |
| Passing very little, dark urine | |
| Rapid weight gain over a day or two | |
| Leg swelling, or pain in the calf or chest |
Mild OHSS is common and usually settles by itself with rest, fluids and pain relief your clinic advises. Severe OHSS is uncommon, but it can be serious and may need hospital care.
Who is more likely to get it
OHSS is more likely in people who produce many follicles, such as many people with PCOS, those with a high egg reserve (high AMH or many follicles on a scan), and those who have had OHSS before.
How clinics reduce the risk
Clinics use several approaches, chosen for each person:
- adjusting the type and dose of stimulation medicines and monitoring closely
- choosing a different trigger injection, which can lower the risk in people at high risk
- freezing all embryos and delaying transfer to a later cycle, so pregnancy hormones do not worsen OHSS
- occasionally cancelling a cycle if the response is too strong
Caution. Severe tummy pain, breathlessness, passing very little urine, or fainting after egg collection need urgent care. Call 112 or go to the nearest hospital. Do not wait for your next clinic appointment.
Multiple pregnancy
Transferring more than one embryo increases the chance of twins or triplets. Multiple pregnancies carry higher risks, including miscarriage, high blood pressure and diabetes in pregnancy, premature birth and low birth weight.
The safest way to reduce this is single embryo transfer: placing one embryo at a time and freezing any others for later. Many guidelines now encourage this, especially for younger people and those with good-quality embryos. Ask your clinic what it suggests for you and why.
Risks of egg collection
Egg collection is a short procedure under sedation, and serious problems are rare. Possible complications include:
- bleeding from the vagina or, rarely, inside the tummy
- infection in the pelvis
- injury to nearby organs, such as the bowel, bladder or blood vessels, which is rare
- a reaction to the sedation or anaesthetic
Mild cramping and spotting for a day or two are normal. Pain that gets worse, fever, or feeling faint are not.
Ectopic pregnancy
An ectopic pregnancy is one that grows outside the uterus, usually in a fallopian tube. Even though the embryo is placed in the uterus, ectopic pregnancy can still happen after IVF, and the risk is a little higher than with natural conception.
Warning signs include pain on one side of the tummy, vaginal bleeding or brown discharge, pain in the tip of the shoulder, and feeling faint. An early scan after a positive test helps confirm where the pregnancy is.
Good to know. Asking about risks is not being negative. It is part of informed consent, and under the ART (Regulation) Act, 2021, clinics must have your written informed consent before treatment.
Other things to be aware of
Stimulation medicines can cause short-term side effects such as bloating, headaches and mood changes. There is also a small risk of blood clots, which is higher with OHSS. The emotional strain of treatment is a risk too. If you are struggling, Tele-MANAS offers free mental-health support 24x7 on 14416 or 1-800-891-4416.
When to see a doctor
Contact your clinic the same day if you have increasing bloating, tummy pain, nausea, a fever, or any bleeding after a positive pregnancy test. Call 112 or go to the nearest hospital straight away if you have severe tummy pain, breathlessness, chest pain, a swollen and painful leg, very little urine, heavy bleeding, shoulder-tip pain, or you faint.
Sources
This is general information, not medical advice. It can't account for your history. Please talk to a doctor about your own situation. Medical disclaimer
Severe pain, heavy bleeding or fainting? Call 112 or go to the nearest hospital.