Women at risk of fertility treatment complications

An alarming number of women are being left critically ill by horrifying complications from their fertility treatment amid evidence Melbourne clinics are under reporting their rates of dangerous incidents.

Women are being left critically ill by horrifying complications of their fertility treatment amid evidence Melbourne clinics are under reporting their rates of dangerous incidents.

Dozens of women have suffered ovarian hyperstimulation syndrome, which can be potentially life-threatening in severe cases, while undergoing routine treatments to supercharge their fertility, a Herald Sun investigation has uncovered.

Safety concerns have been raised with the Andrews Government which is poised to respond with tougher reporting measures to make fertility clinics more accountable and cut the danger to women.

The Andrews Government is poised to make fertility clinics more accountable and cut the danger to women.

At least one Melbourne-based IVF clinic has been questioned in recent months after medical authorities were alerted to a “peak” in the rate of its patients suffering OHSS, prompting an overhaul of its practices.

It can also be revealed the extent of women attending public hospitals with complications from hyperstimulation is more than double the rates officially disclosed by lucrative private clinics.

The Royal Women’s Hospital’s emergency department alone treated almost 70 women for OHSS in the 14 months up to September 2019 — including more than 30 who had to be admitted for treatment.

Despite further patients attending hospitals including Monash Medical Centre and the Mercy Hospital for Women, the Victorian Assisted Reproductive Treatment Authority has received only 33 reports from clinics notifying them of patients with the dangerous condition this financial year.

With Victorian women undergoing more than 9000 stimulated fertility cycles a year VARTA chief executive officer Louise Johnson said the rate of OHSS remains low at just .5 per cent, but conceded improved reporting was needed to identify those most at risk and prevent severe illnesses.

“There is a gap in the data and, certainly from a Victorian perspective, we want to know about clinical incidents where patients are effected significantly,” Ms Johnson said.

“We have been following up with some clinics to check that they understand about their reporting obligations under the conditions of registration in Victoria.

“In situations where it appears there is a higher level of reporting occurring from one particular clinic we ask lots of questions. In some instances of that questioning we’ve seen a huge improvement in the level of OHSS occurring at a clinic.”

OHSS can occur as a consequence of injectable hormone medications used to increase the number of eggs a woman produces during fertility treatment. While mild cases result in pain, bloating and nausea, complications from severe cases can lead to blood clots, breathing problems, kidney failure, fluid build up in the chest and, in rare cases, death.

An independent Review of Assisted Reproductive Treatment commissioned by the Andrews Government was completed last month and raises serious concerns about the frequency and danger of OHSS.

The new rules will force all clinics to provide centralised data about the true instances and danger of hyperstimulation.

A key recommendation of the report, to be adopted by the government, will force all clinics to provide centralised data about the true instances and danger of hyperstimulation.

Sources within the state’s fertility industry believe clinics pushing patients to undergo back-to-back fertility treatments for economic reasons, rather than spacing treatments out, was leading to many of the cases.

It is understood a Victorian clinic scaled back its reliance on back-to-back treatments among a range of measures introduced after VARTA and other watchdogs raised concerns about its high instances of OHSS.

In one horror case detailed today a woman desperate for a child spent days in intensive care and weeks in hospital as her body swelled with fluid and organs were in danger from her overstimulated system.

Other cases of OHSS uncovered by the Herald Sun include;

A WOMAN who was revived by paramedics before spending 10 days fighting for life in intensive care as her organs shut down;

A THREE-week hospital fight to save another woman;

OTHER women who received treatment at home after attending hospital emergency departments in agonising pain; and

CLAIMS hospital emergency departments are used as dumping grounds for OHSS patients because their own clinics do not provide care when complications arise.

RWH IVF specialist Asoc Prof Kate Stern said Victoria’s fertility clinics had very robust protocols to report and treat OHSS, however their interpretations about the severity of incidents that should be reported varied.

Having polycystic ovary syndrome, a large number of follicles, a low body weight, being under 30 or having had previous episodes of OHSS all leave a woman at higher risk of OHSS and lead to clinics taking a more cautious approach to their treatment.

But in many other instances Assoc Prof Stern said there is no indication a woman will experience the condition until she undergoes fertility treatment.

“I welcome having a centralised data base with greater clarity so we can be reassured the data is correct and we can audit,” Assoc Prof Stern said.

“Even though advances have revolutionised the practise of IVF and brought the risk down enormously, there is going to be this subset of patients for whom this medication won’t work, so they are at more risk.

“There also will also be other patients who unexpectedly develop hyperstimulation (so) we will never be able to say we can get rid of it completely.

“We are causing hyperstimulation because we don’t want just one egg, we want multiple.

“One patient might have 10 eggs and have terrible symptoms of hyperstimulation and another will have 30 and have no symptoms.

“Occasionally there will be cases that creep up.”

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