In vitro fertilization (IVF) is becoming more common in the U.S., with approximately 4 in 10 people having either used a fertility treatment or knowing someone who has.
Before you commit to a fertility treatment such as IVF, it’s good to know the risks and complications you may face. That way, you can bring any questions and concerns to your doctor.
Here’s what you need to be prepared for when you try IVF.
IVF Medication Side Effects
A key part of the IVF process involves taking medications that adjust your hormones and stimulate your ovaries. These can often cause side effects such as:
- Bloating
- Bruising and soreness from the needle
- Tender breasts
- Heavy vaginal discharge
- Fatigue
- Nausea
- Vomiting
- Headache
- Mood swings
Tell your doctor if you experience any of these side effects so they can help you manage them.
Ovarian Hyperstimulation Syndrome (OHSS)
Sometimes, your ovaries can overreact to medications you take during IVF. This can cause them to swell and leak fluid into your belly. You may be at higher risk of OHSS if you’re Black, although doctors don’t understand why.
Mild OHSS can cause symptoms such as:
- Belly pain or nausea
- Bloating
- Slight weight gain
Severe OHSS can lead to:
- Sudden weight gain (more than 2.2 pounds in 24 hours)
- Intense cramping
- Not urinating as much as usual
- Swollen belly
- Trouble breathing
- Blood clots
OHSS symptoms usually start within a week or two of starting IVF medication.
Egg Retrieval Damage From IVF
IVF requires eggs to be removed from your ovaries. To do that, your doctor inserts a long, thin needle through your vagina into your ovaries. An ultrasound helps guide it into your ovarian follicles (small fluid-filled sacs in your ovaries) and the eggs are retrieved.
You’ll be given anesthesia so you don’t feel any pain. But the risks of this procedure include:
- Belly or pelvic pain
- Damage to your bladder, bowels, or other organs near your ovaries
- Blood vessel damage
- Pelvic infection
Any pain after egg retrieval can often be managed with an over-the-counter pain reliever. It should go away in a day or two. Organ damage and infections are not common. But if you have either, you may need emergency surgery.
Ovarian Torsion in IVF
It’s rare, but your ovaries or fallopian tubes can become twisted during the IVF process. Called ovarian torsion, this cuts off blood supply to the area. If not treated right away, you could lose function of your ovaries.
Ovarian torsion is more likely to happen after your eggs are retrieved, but you’re also at risk after you start your medication.
The symptoms include:
- On-and-off cramps that become intense pelvic pain
- Upset stomach
- Vomiting
Ovarian torsion is a medical emergency. You’ll need surgery as soon as possible.
Pregnancy Complications and IVF
Going through IVF could make you more likely to have:
More than one baby (twins, triplets, etc). Technology advances have made this less likely to happen. Multiple births from IVF decreased from 23.8% in 2007-2008 to 8.4% in 2021-2022.
Ectopic pregnancy. A fertilized egg sometimes attaches outside of your uterus by mistake. It can’t develop normally and will need to be removed. If not, it could cause life-threatening complications.
Heterotopic pregnancy. Rarely, one embryo can develop outside of your uterus while another embryo develops inside of it. If this happens, you’ll need to see a maternal-fetal specialist who can help you understand the next steps to take.
High blood pressure during pregnancy. You’re more likely to have preeclampsia when you get pregnant through IVF, especially if you use donor eggs and frozen embryos.
Gestational diabetes. One study found that the risk of getting diabetes while pregnant is five times higher when you use IVF. That can lead to other health issues, like preeclampsia and depression. Your baby’s health can be affected, too.
Placenta previa. IVF can raise your chances that your placenta will grow to cover your cervix, the opening of your uterus. This can cause severe bleeding and affect the growth of your baby. If it doesn’t resolve itself, you won’t be able to have a natural birth. Your baby will need to be delivered by cesarean section (C-section).
Placental abruption. This is when your placenta comes loose from your uterus before you give birth. It can cause heavy bleeding and put your baby at risk. One study found that placental abruption is 42% more likely to happen when you use a fertility treatment to get pregnant. If you’re Hispanic, your risk may be even higher.
Preterm birth. When you conceive by IVF, you’re more likely to give birth before 37 weeks than people who conceived naturally. This could be because you’re also likely to be carrying more than one baby.
Low birth weight. Your child is 9% more likely to be born small, but it’s unclear of the direct role that IVF treatments play. One study linked low birth weight to many other factors, including your baby’s genetic traits.
Congenital disabilities. Babies born through fertility treatments are slightly more likely to have issues with their heart or gastrointestinal tract, but more research needs to be done to understand why. Whether you conceive through IVF or not, the biggest risk factor of your child being born with congenital disabilities is your age.
Pregnancy loss. This happens in 12.5% of pregnancies from IVF. Many things can play a part, including your age, your body mass index (BMI), and how embryos are transferred through the IVF process.
Myths About IVF Risks and Complications
Here are some rumors about IVF you might have heard that aren’t true.
IVF causes ovarian cancer.
False. Old research linked fertility medicines to an increased risk of ovarian cancer. Newer, more accurate studies show that this is not the case.
IVF risks are the same at every age.
False. Even if you use donor eggs, the age of your uterus matters. Research shows that your risk of IVF failure and pregnancy loss increases by 4.2% every year after you turn 40.
Trans men can’t use IVF.
False. For instance, one study found that using gender-affirming hormone therapy in the past didn’t prevent trans men from getting pregnant with fertility treatments like IVF.
How to Talk to Your Doctor About IVF Risks
When you’re thinking about IVF, it’s important to find a fertility specialist who respects your unique needs and offers support. During your first visit, ask questions about what you can expect as you go through the process.
These questions might include:
- Can you tell me why you think this treatment is the right choice for me?
- What success rate does it have for people like me?
- How will my age affect the outcome?
- What physical or emotional risks could I face?
- What lifestyle changes can I make to try to avoid complications?
- What are my chances of having a multiple pregnancy?
- How can I contact you if I have questions or concerns? Can I reach you after hours?
- Where can I get more information about IVF risks?
Show Sources
Photo Credit: iStock/Getty Images
SOURCES:
Pew Research Center: “A growing share of Americans say they’ve had fertility treatments or know someone who has.”
CDC: “Preterm Birth.”
American Society for Reproductive Medicine: “In Vitro Fertilization (IVF): What Are the Risks?”
Mount Sinai Fertility: “A Guide: Understanding Fertility Medications,” “Questions to Ask Your Care Team About Your Fertility.”
Cleveland Clinic: “Ovarian Hyperstimulation Syndrome (OHSS).”
Case Reports in Women's Health: “Ovarian torsion during ovarian stimulation prior to trigger followed by successful oocyte retrieval: A case report.”
Yale Medicine: “Ovarian Torsion,” “In Vitro Fertilization (IVF),” “Placenta Previa.”
International Journal of Surgery Case Reports: “Post IVF heterotopic pregnancy with one in cervix and one in uterus. Successful delivery after termination of the cervical pregnancy with intraamniotic feticide.”
Mayo Clinic: “Ectopic Pregnancy,” “In Vitro Fertilization (IVF),” “Placental Abruption,” “Ovarian hyperstimulation syndrome.”
Hypertension: “Increased Preeclampsia Risk and Reduced Aortic Compliance With In Vitro Fertilization Cycles in the Absence of a Corpus Luteum.”
European Journal of Obstetrics & Gynecology and Reproductive Biology: “Multiple births from medically assisted reproduction: contribution of different types of procedures and trends over time.”
Clinical Diabetes and Endocrinology: “Potential risk of gestational diabetes mellitus in females undergoing in vitro fertilization: a pilot study.”
JAMA Network Open: “Risks of Placental Abruption and Preterm Delivery in Patients Undergoing Assisted Reproduction.”
Rutgers Health: “Study Reveals Doubled Risk of Preterm Birth for IVF Pregnancies.”
Obstetrics & Gynecology: “Medically Assisted Reproduction Treatment Types and Birth Outcomes: A Between-Family and Within-Family Analysis.”
University of Utah Health: “Low Birth Weight Among IVF Children Not Linked to IVF Treatments.”
Reproductive Biology and Endocrinology: “Influencing factors of pregnancy loss and survival probability of clinical pregnancies conceived through assisted reproductive technology.”
F&S Reports: “Fertility treatment outcomes in transgender men with a history of testosterone therapy.”
Fertility and Sterility: “Factors associated with ovarian hyperstimulation syndrome (OHSS) and its effect on assisted reproductive technology (ART) treatment and outcome,” “Advanced maternal age was associated with an annual decline in reproductive success despite use of donor oocytes: a retrospective study.”
Maternal-Fetal Medicine: “Pregnancy Outcomes Associated with Ovarian Hyperstimulation Syndrome: A Retrospective Cohort Study of Infertile Women.”
Translational Andrology and Urology: “Fertility concerns of the transgender patient.”
National Institute for Health and Care Excellence: “Fertility Problems: Assessment and Treatment: Questions to Ask.”
