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What Are the Potential Risks of Fertility Drugs?


Updated April 17, 2014

Tripets, three boys sitting on the floor

Fertility drugs increase your odds of conceiving triplets, and multiple pregnancies come with higher risks for the mother and baby.

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Fertility drugs, like any drugs you take, come with potential risks and side effects. On the bright side, fertility drugs can create miracles, making parenthood a reality. They are also generally effective. Still, it's important to know what can go wrong, and how to possibly lower your chances of complications.

A short disclaimer -- reading about potential risks can increase your anxiety during treatment. While you should be educated about the risks, the goal isn't to scare you out of going through with treatments. Ideally, you should take what you learn here and use the information to make smarter decisions about your treatment. There are ways to reduce your risks.

Twins, Triplets, and High-Order Pregnancies

If you're plugged into the media in any way, you already know about the risk of multiples when using fertility drugs. The media reports primarily on the extreme cases, which are rare. However, twins are common during fertility drug treatment.

Some people mistakenly think that multiples are only a risk with IVF treatment. This isn't true, and actually, with IVF you can choose to have only one embryo transferred into the uterus (which in some women may be a good choice.) The use of fertility drugs during IUI cycles or cycles with timed sex both may lead to a multiple pregnancy.

Your risk of multiples is dependent on a number of factors, including which medication you're taking, what dosage, and how sensitive your body is to the drugs. Generally, with Clomid, your chance of having twins is 10%, and your chance of having triplets or more is less than 1%.

If you're taking gonadotropins (in other words, medications that mimic the hormones FSH and LH), even with monitoring, your risk of getting pregnant with multiples is higher. As many as 30% of pregnancies from gonadotropin fertility drugs are multiples, with two-thirds of those pregnancies twins and a third being triplets or higher-order pregnancies.

Sometimes, a couple will hope that they do get pregnant with twins or triplets, or even ask their doctors to help. This isn't the best choice, though.

Ovarian Hyperstimulation Syndrome

Another risk that comes with fertility drug use is ovarian hyperstimulation syndrome (OHSS). OHSS occurs when the ovaries become unusually enlarged, filling with fluid. When ovulation occurs, the fluid is released into the body, causing complications.

Some enlargement of the ovaries during fertility treatment is normal, but in the case of OHSS, they become dangerously so. In rare cases, less than 1% in women going through IVF treatment, OHSS can lead to blood clots and kidney failure.

OHSS is usually mild and can be treated at home. Your doctor should monitor your cycle carefully, and you should be aware of the early symptoms. The earlier it's caught, the less chance of a severe case developing.

Lowering Your Risk

You can lower your risk of multiples and OHSS by using the lowest dose of fertility drugs necessary, and with careful monitoring of your cycle.

Beware of fertility clinics that are overly aggressive in their treatment of infertility. On the one hand, it may feel good to have a doctor promising you success and starting with the “best” or strongest treatments first. On the other hand, jumping up the ladder too quickly might lead to a premature fall.

Also, during a treatment cycle, your doctor should order blood work to monitor your estrogen levels, along with regular ultrasounds to monitor the size of your ovaries and the number of developing follies (potential eggs). If there is risk of OHSS or higher-order multiples, your doctor can then either cancel the treatment cycle or give you medications to prevent further complications.

Of course, even with careful monitoring and a responsible doctor, you still may develop OHSS or get pregnant with twins or more. In that case, the best thing to do is to follow your doctor's treatment advice and take care of yourself.

Good prenatal care can lower the risks that come with multiple pregnancies, and with early detection and treatment, OHSS is rarely severe and usually can be dealt with at home.

Learn more about fertility drug risks and side effects:

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Complications and Problems Associated With Multiple Births: Fact Sheet. American Society of Reproductive Medicine. Accessed August 20, 2008. http://asrm.org/uploadedFiles/ASRM_Content/Resources/Patient_Resources/Fact_Sheets_and_Info_Booklets/complications_multiplebirths.pdf

Ovarian hyperstimulation syndrome. Medical Encyclopedia, MedlinePlus. Accessed August 20, 2008. http://www.nlm.nih.gov/medlineplus/ency/article/007294.htm

Medications for Inducing Ovulation: A Guide for Patients. American Society of Reproductive Medicine. Accessed August 20, 2008. http://asrm.org/uploadedFiles/ASRM_Content/Resources/Patient_Resources/Fact_Sheets_and_Info_Booklets/ovulation_drugs.pdf

Risks of In Vitro Fertilization: Fact Sheet. American Society of Reproductive Medicine. Accessed August 20, 2008. http://asrm.org/uploadedFiles/ASRM_Content/Resources/Patient_Resources/Fact_Sheets_and_Info_Booklets/risksofivf.pdf

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