Risks Of ICSI

Risks of IVF-ICSI include general risks of IVF as well as the specific risks related to the micromanipulation procedure of ICSI. One of the most significant risks associated with stimulation of the ovaries is the ovarian hyperstimulation syndrome (OHSS). This can manifest as massive ovarian enlargement, peritoneal irritation due to follicular rupture or hemorrhage, ovarian torsion, ascites, pleural effusion, oliguria, electrolyte imbalance, hypercoagulability3l I and sometimes death36 . The syndrome occurs in a moderate form for 3-4% percent of initiated cycles, and in a severe form for 0. 1-0.2 % of the populatioe undergoing controlled ovarian hyperstimulation. Other reported complications of ovarian hyperstimulation are pituitary hemorrhage, endometriotic bloody ascites, and genital cancer. Complications of ovarian retrieval have been reported for transvaginal aspiration as well as laparoscopic aspiration. Complications associated with wmsvaginal aspiration have been reported to occur in 0.3-3 percent of cases and include bleeding, pelvic infections, and abdominal viscera perforation . Laparoscopic complications include hemorrhage, intestinal perforation, infection, and carbon dioxide embolism. The laparoscopic risks are no higher in ovarian retrieval procedures than in other laparoscopic applications.

Finally, pregnancies resulting from ovarian stimulation are at risk for spontaneous abortion, ectopic pregnancy, and multiple gestational. The rate of spontaneous abortion after achieving a biochemical pregnancy with assisted reproduction is approximately 25 percent. These losses are attributed to advanced maternal age and the associated increased prevalence of chromosomal abnormalities, a higher rate of pregnancy loss due to multiple gestations, and early recognition of these pregnancies due to close monitoring. After achieving a clinical pregnancy, the chance of a spontaneous abortion occurring for IVF-ICSI cycles ranges from 10-16%. Fctopic pregnancies occur in up to 3-5.5 % of gestational cycles and can be life threatening. The etiology is usually pelvic adhesions and tubal damage from pelvic inflammatory disease or previous surgery. Multifetal pregnancies occur in 22 percent of cases of IVF with embryo transfer, and 44 to 46 percent of IVF/ICSI cases. Multifetal pregnancies are considered a complication of assisted reproductive techniques because of the associated increased incidence of preeclampsia, placenta previa, placental abruption, premature rupture of membranes, and postpartum hemorrhage. Most importantly, multiple gestations are almost universally associated with prematurity and the associated complications to offspring, including cerebral palsy and intracranial hemorrhage with mental retardation or blindness. To prevent multifetal pregnancies and their attendant complications, it would be preferable to avoid assisted reproduction unless it is specifically indicated, and limit the number of embryos transferred. Where there is government regulation of IVF, including England, Australia and France, transfer of only 3 embryos is allowed and multifetal pregnancies are less commoe. Unfortunately, there is significant pressure to transfer more than three embryos by couples in the United States who are desperate to conceive. In general, for women less than 35 years of age, only 3 embryos should be transferred.