Assisted reproductive technologies: How to minimize the risks and complications in developing countries?

Abstract

In 2% of assisted reproductive techniques (ART) cycles complications occur. Some are preventable, some are not. In this paper, we will discuss risks and complications of the standard 'Western' approach in ART today and point to some measures to be taken when implementing ART in developing countries, where resources and access to medical care may be limited. Ovarian hyperstimulation syndrome (OHSS, and its thrombo-embolic complications) is responsible for the majority of cycle-related complications, followed by bleeding and infection at oocyte retrieval. ART pregnancies are complicated by first-trimester bleeding more often than spontaneous pregnancies, they are more often ectopic, but the major complication is the very high incidence of multiple pregnancies, when more than one embryo is transferred. OHSS can be prevented by screening patients at risk and by using mild or no stimulation. Simple measures can minimize the risks of bleeding or infection. Obviously single embryo transfer is the only way to avoid multiple pregnancies, which have a highly increased risk for severe maternal and neonatal morbidity and mortality (mainly due to prematurity). Special attention should be given to pre-existing pathologies. Risk minimization of ART in developing countries is not only mandatory from an economical but also an ethical point of view. © The Author 2008. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved.