In the United States from 2000 to 2011, IVF procedures were associated with low complication risks, according to a study published in the January 6 issue of JAMA.
Use of assisted reproductive technology (ART), predominently IVF, continues to increase in the United States and globally. In an effort to improve patient safety, stimulation protocols have become less aggressive, oocyte retrieval has transitioned from laparoscopic to transvaginal, and overall pregnancy rates have improved. However, limited data exist regarding the incidence of maternal complications.
Jennifer F. Kawwass, MD, Emory University School of Medicine, Atlanta, Georgia, and colleagues examined the incidence and trends in reported patient and donor complications in fresh ART cycles using the US Centers for Disease Control and Prevention National ART Surveillance System (NASS), a federally mandated reporting system.
Reported complications (defined as having been directly related to ART and occurring within 12 weeks of cycle initiation) include infection, hemorrhage requiring transfusion, moderate or severe ovarian hyperstimulation syndrome (OHSS), medication adverse event, anesthetic complication, hospitalization, patient death within 12 weeks of stimulation, and other complications.
Among 1,135,206 cycles, the most commonly reported patient complications were OHSS (peak of 153.5/10,000 cycles) and hospitalizations (peak of 34.8/10,000 cycles); rates of other complications remained at 10/10,000 cycles. Rates declined from 2000 to 2011 for reported medication adverse events and hospitalizations; no other significant trends were detected among reported infections, hemorrhages, OHSS, severe OHSS, anesthetic-related complications, and deaths within 12 weeks of stimulation start or during pregnancy.
A total of 58 deaths were reported (18 stimulation related and 40 maternal deaths prior to infant birth). The maternal death rate ranged from 1.6 per 100,000 live births conceived through ART in 2008 to 14.2 in 2004. Reported complications following donor ART cycles were less frequent and none showed a significant trend. No donor deaths were reported (13 maternal deaths prior to infant birth were reported among egg donor recipients).
“Increased awareness of the most common complication, OHSS, may prompt additional study to characterize predictors of this and other adverse events to inform the development of effective approaches necessary to decrease complication occurrence,” the authors wrote.
At RPMG we have significantly reduced the risk of OHSS by using a Lupron co-trigger, rather than high dose hCG alone, in patients we suspect may be likely to develop severe OHSS.