In vitro fertilization (IVF) is a medical process consisting of successive stages such as stimulating the ovaries with medication, egg retrieval, fertilization in the laboratory, and embryo transfer to the uterus. Like any medical treatment, IVF can carry some risks. These risks are not the same for every patient. The risks of IVF treatment can vary depending on age, ovarian response, comorbidities, and the protocol used.
Some risks can be reduced through pre-treatment evaluation and a personalized protocol; however, not every risk is completely predictable or eliminateable. The important thing is to accurately assess the individual's risk profile before starting treatment and to plan the protocol accordingly. Risk level is not determined by looking at a single finding; the overall picture must be considered.
It is not the right approach to gather risks under a single heading. The process consists of multiple stages, and each stage has its own specific evaluation points.
The World Health Organization’s (WHO) 2025 infertility guideline states that assisted reproductive treatments may involve risks ranging from minor side effects to serious complications. Multiple pregnancy, ovarian hyperstimulation syndrome (OHSS), infections, and treatment-related (iatrogenic) effects are among these risks.
In addition to biological risks, the psychological and financial burden of the process is also a part of the patient experience.
OHSS is a condition that occurs when the ovaries respond more strongly than expected to stimulation. The ESHRE 2025 ovarian stimulation guideline defines OHSS as a condition that is still serious today and can, in some cases, become life-threatening.
The effect of hCG has an important role in OHSS risk. The trigger injection (hCG or a similar trigger medication) given to complete the maturation of eggs may initiate this condition. When pregnancy occurs, naturally rising hCG levels may worsen late-onset OHSS. The group with increased risk is generally patients who show a high response. The same guideline defines seeing more than 18 follicles of 11 mm or larger on the day of the trigger injection, or retrieving more than 18 eggs, as a threshold for high response.
So how can the risk be reduced? The ESHRE 2025 guideline recommends using a GnRH agonist trigger instead of hCG in high-risk patients and applying a freeze-all approach, where all embryos are frozen, to minimize the risk of late-onset OHSS. Adjusting the FSH dose according to the individual patient is also included in the same guideline as a risk-reducing step.
Egg retrieval is a minor invasive procedure performed under ultrasound guidance and usually under sedation or anesthesia. As with every invasive procedure, some risks may arise with a low probability: bleeding, infection, injury to nearby organs or blood vessels, and risks related to anesthesia/sedation are among them.
The same WHO guideline lists bleeding, infection, internal organ and vascular injuries, and anesthesia-related risks as important outcomes that should be considered in this field.
Temporary complaints such as abdominal pain or bloating may occur after the procedure. Rarely, a procedure-related complication may require additional evaluation or medical attention. In such cases, early recognition can make management easier.
The most commonly discussed issue regarding pregnancy is multiple pregnancy. Transferring more than one embryo may increase the likelihood of multiple pregnancy, and multiple pregnancies may carry additional risks for both the mother and babies. The WHO guideline highlights single embryo transfer to reduce this risk. The number of embryos to be transferred is evaluated together with embryo quality, female age, and previous treatment history.
In addition, in IVF pregnancies, conditions such as ectopic pregnancy, miscarriage, preterm birth, placental problems, and pregnancy-related hypertension, which may be associated with the pregnancy itself or the underlying infertility, are monitored throughout pregnancy. This monitoring helps identify possible problems at an early stage.
Some additional tests and procedures that may be offered during IVF treatment should not be interpreted with the idea that “the more procedures are performed, the better.” The same add-on opinion document clarifies several points:
PGT-A: Obstetric and neonatal outcomes in PGT pregnancies have been reported to differ from spontaneous pregnancies in some aspects; however, findings are more complex in comparisons made with IVF/ICSI pregnancies.
In these comparisons, many confounding factors exist, such as age, infertility cause, embryo biopsy, and frozen embryo transfer. Since a clear increase in live birth rates has not been demonstrated, PGT-A is not recommended as a routine screening test for all patients.
ICSI (intracytoplasmic sperm injection): Current data do not show a clearly increased safety risk. However, it is difficult to eliminate confounding factors such as male factor infertility and the cause of infertility in these studies. Since a live birth advantage has not been proven in patients without male factor infertility, routine use is not recommended.
Whether an additional application is necessary during IVF treatment is decided according to the individual’s clinical condition
Source
World Health Organization. Guideline for the prevention, diagnosis and treatment of infertility. Geneva: World Health Organization; 2025.
The ESHRE Guideline Group on Ovarian Stimulation. Ovarian stimulation for IVF/ICSI: update 2025. Grimbergen: European Society of Human Reproduction and Embryology; 2025.
ESHRE Add-ons working group, Lundin K, Bentzen JG, Bozdag G, Ebner T, Harper J, Le Clef N, et al. Good practice recommendations on add-ons in reproductive medicine. Hum Reprod. 2023;38(11):2062-2104.
In vitro fertilization (IVF) is a medical process that can carry some risks. These risks vary depending on age, ovarian response, and the protocol used. Most risks are largely manageable with an assessment before starting treatment.
No. OHSS is more common in patients whose ovaries respond highly to stimulation. Choosing the right triggering method, adjusting the dose, and freezing all embryos if necessary can help reduce the risk.
Egg retrieval is a minor, invasive procedure usually performed under sedation or anesthesia. Risks such as bleeding, infection, injury to neighboring organs/blood vessels, and anesthesia-related complications are rare. It is important to seek medical attention immediately if you experience symptoms such as severe pain or high fever.
Current data do not show a clear superior risk in terms of safety; however, it is difficult to eliminate confounding factors in this data. Since the advantage of live birth in ICSI in patients without a male factor infertility has not been proven, its routine use is not recommended. The appropriate method is determined on a case-by-case basis.
No. Success varies even in patients with a clear indication. Outcomes such as insufficient egg retrieval, lack of fertilization, or failure to conceive are possible; these outcomes also guide the planning of subsequent steps.
Severe abdominal pain, shortness of breath, rapid weight gain and abdominal swelling, decreased urination, heavy bleeding, high fever, fainting, or unilateral leg swelling should prompt prompt consultation. Some of these symptoms may be related to severe OHSS or a procedure-related complication.
Note: This content is for general informational purposes only and does not replace diagnosis or treatment. A physician evaluation is required for personal diagnosis and treatment planning.
