The advantage of any medical procedure must be balanced against the possible side effects and risks. The same applies to in-vitro fertilisation (IVF).

Because the IVF process involves various stages, patients can experience different side effects at different times.

1. The drugs used in IVF treatment can cause side effects such as mood swings and headaches. Besides side effects, risks are also associated with the use of these drugs. Because you are going to use drugs that have to stimulate the ovaries to produce several eggs, the ovaries may overreact. This can be assessed by ultrasound checks, as a result of which either too many follicles are seen or the ovaries have increased greatly in size. It is possible that, in the period following the puncture, the ovaries will be even more disturbed and release fluid into the abdominal cavity. This is called overstimulation. Fluid is released into the abdomen, which can lead to complaints of stomach ache, nausea, vomiting, serious weight gain (> 1 kg/day), breathlessness and reduced urine production (ovarian hyperstimulation syndrome, or OHSS). In severe cases, fluid may accumulate in the lungs causing breathing difficulties. If an ultrasound scan shows that the ovaries are overreacting, the treatment is stopped. If the reaction is still acceptable, but there is a risk of overstimulation, you will be given separate instructions. If any of the symptoms described above occur, you must contact your doctor directly. The doctor will perform an ultrasound scan to determine the size of the ovaries and to see if there are cysts (fluid-filled blisters) in them. The doctor will also look to see if there is free fluid in the abdominal cavity and carry out blood tests. Generally you should wait, rest and drink plenty of fluid, although admission to hospital may be required once in a while.
   
   
2. Although the risks of the rupture are slight, occasionally haemorrhage or very rarely infections can occur. Organs in the vicinity of the ovaries, such as the bladder or the intestines, are rarely damaged during the puncture.
   
   
3. Although the work on egg cells, sperm and embryos is done with the greatest care in the laboratory, IVF remains the work of humans - and subject to human error. Fortunately human errors are made very rarely.
   
   
4. There is a chance of a multiple pregnancy. A strict transfer policy is operated in order to maximise the chance of a pregnancy but minimise the chances of a multiple pregnancy. In Singapore, a maximum of three embryos is transferred. Even if a single embryo is transferred, a (single-egg) twin can result, just as in a natural course of events. If two embryos are replaced, the chances of having twins are 25% and for triplets 1%, which is why the risk of complications as a result of multiple pregnancies (such as miscarriage, premature birth or diabetes) is kept as low as possible.
   
   
5. While a positive pregnancy test is a promising sign of a successful treatment, pregnancy goes wrong in approximately 25% of cases. There is a 20% chance of a miscarriage and a 5% chance of an ectopic pregnancy.
   
   
6. At the present time, no increased risks have been demonstrated in the incidence of hereditary defects in children conceived through IVF. If there is an indication of this, for example, the age of the woman (36 years or older), or hereditary defects in the family, prenatal diagnoses can be carried out.
   
   
7. Finally, the IVF process can be psychologically stressful. Patients are well advised to take steps to reduce stress, such as keeping good health, using relaxation techniques and seeking help and support from family or professionals.