Woman dies while undergoing IVF: 23-year-old Indian mother suffers rare complication which sent ovaries into overdrive and shut down her lungs
- A 23-year-old in India died ‘suddenly’ while doctors were collecting her eggs
- The women appeared healthy when she went to hospital for the procedure
- However, her heart stopped beating when doctors began to retrieve her eggs
A mother undergoing IVF died after suffering an extremely rare side effect, medics have revealed.
The unidentified 23-year-old, from Delhi in India, died ‘suddenly’ while doctors were collecting her eggs.
The woman, who was married for seven years and had a four-year-old daughter born naturally, appeared healthy when she went to hospital for the procedure.
However, her heart stopped beating when fertility doctors tried to retrieve her eggs. They were unable to resuscitate her.
A post-mortem revealed she died from ovarian hyperstimulation syndrome (OHSS) — a complication that affects one in three women undergoing IVF.
Sarah Norcross, director of fertility charity Progress Educational Trust, told MailOnline that the risk of death from OHSS is ‘vanishingly rare’.
Fewer than one per cent of cases end up as severe, data suggests.
The condition causes women’s ovaries to expand dangerously and in severe cases can leave victims fighting to breathe with blood clots in their lungs.
The unidentified 23-year-old, from Delhi in India, died ‘suddenly’ in hospital while doctors were collecting her eggs. The women, who had been married for seven years and had a four-year-old daughter that was born naturally, appeared healthy when she went to hospital for the procedure
Writing in the journal Autopsy and Case Reports, doctors said the patient’s medical history and test results all indicated she was a ‘healthy young woman’ before starting IVF.
She began ovarian stimulation, the first step in IVF, which involves taking hormones to boost the number of eggs their ovaries produce.
This is done so doctors can collect as many eggs as possible to fertilise, which increases the choice of embryos that can be implanted.
After 11 days, the patient attended hospital for egg collection — the next physical step of the IVF journey.
Dr Swati Tyagi and her team wrote that her blood pressure and pulse rate were healthy.
She was sedated for the procedure, which usually takes 15 to 20 minutes, in which doctors performed an ultrasound and began collecting eggs from her ovaries using a needle.
But after an egg was taken from the right ovary, the patient’s blood pressure, heart rate and oxygen levels dropped.
Doctors immediately abandoned the procedure but could not detect her heartbeat.
They began CPR, injected her with drugs in an attempt to restart her heart and used a defibrillator.
But her heartbeat remained flat throughout and she could not be revived.
Medics performed an autopsy due to the sudden nature of her death. It showed that her ovaries — typically 3cm in size — were around three times larger than they should have been.
She had nine to 10 enlarged follicles on the wall of each ovary and there was fluid around her abdomen and lungs — a tell-tale signs of OHSS.
Experts concluded that she had died of an acute pulmonary edema — a build-up of fluid in the lungs that is caused by a blood clot and makes it difficult to breathe — that was trigged by OHSS and led to cardiac arrest
OHSS is a potentially fatal reaction to fertility drugs, which are taken ahead of egg collection to stimulate the ovaries and make eggs grow.
For a third of IVF patients, the drugs cause the ovaries to develop too many follicles — the sac which contains the egg.
In the vast majority of women, this causes short-lasting mild abdominal swelling, discomfort and nausea.
But one in 100 IVF patients develop moderate or severe OHSS, which triggers painful swelling in the abdomen, as well as difficulties passing urine and breathing.
In the most severe cases, women may also develop a blood clot in their legs or lungs.
When this happens, fluid from the blood vessels may leak into the abdomen and the space around the heart and lungs.
Around one woman a week in the UK is thought to suffer severe or critical OHSS.
Ms Norcross said: ‘In egg donors, the risk of death from OHSS is vanishingly rare.
‘It is important to share the news that this has happened and to flag the investigation into the egg donor’s death so that everyone working in the fertility sector can learn from it.
‘It may also make fertility specialists reflect on how they counsel egg donors about the risks involved.’
The number of couples undergoing IVF has tripled in the last three decades. Around 390,000 babies in the UK have been born via IVF since 1991, while there have been more than a million in the US.
More than eight in 10 couples conceive naturally within a year of trying.
But couples who have unsuccessfully been trying to conceive can access treatments on the NHS, such as IVF, or intrauterine insemination (IUI) — when sperm is inserted into a woman’s womb.
WHAT IS OVARIAN HYPERSTIMULATION SYNDROME?
Ovarian hyperstimulation syndrome (OHSS) can affect women undergoing IVF or other fertility procedures.
It is triggered by injectable hormones taken to stimulate the development of eggs in the ovaries.
For a third of IVF patients, the drugs cause the ovaries to develop too many follicles — the sac which contains the egg.
This causes the ovaries to expand to more than 12cm — about five times their usual size.
In rare cases, OHSS occurs after taking oral fertility treatments or even just spontaneously.
In the vast majority of women, this causes short-lasting mild abdominal swelling, discomfort and nausea.
But one in 100 IVF patients develop moderate or severe OHSS, which triggers painful swelling in the abdomen, as well as difficulties passing urine and breathing.
In the most severe cases, women may also develop a blood clot in their legs or lungs.
When this happens, fluid from the blood vessels may leak into the abdomen and the space around the heart and lungs.
Around one woman a week in the UK is thought to suffer severe or critical OHSS.
Symptoms typically begin within ten days of taking injectable medications. In mild cases they can include:
- Moderate abdominal pain
- Bloating or an increased waist size
- Nausea and vomiting
- Diarrhoea
- Sudden weight gain of more than 6.6lbs (3kg)
These symptoms often ease within a week without treatment.
In severe cases, symptoms include:
- Rapid weight gain of 33-44lbs (15-20kg) within five-ten days
- Severe abdominal pain, nausea and vomiting
- Blood clots in the legs
- Reduced urination
- Shortness of breath
- Tight or enlarged abdomen
In around 1-2 per cent of cases, OHSS can be life-threatening and lead to:
- Fluid in the abdomen or chest
- Blood clots
- Kidney failure
- Ovary twisting
- Rupture of an ovarian cyst, leading to bleeding
- Breathing problems
- Miscarriage
- Death
Severe sufferers may require IV fluids in hospital and drugs to suppress their ovarian activity.
Surgery may be necessary if an ovarian cyst bursts, as well as anticoagulants if clots have occurred.
OHSS’ exact cause is unknown but is thought to be due a hormone called HCG, which triggers the release of an egg.
Ovarian blood vessels react abnormally to HCG and begin to leak fluid, which causes swelling that can move into the abdomen.
Source: Mayo Clinic
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