CHAPTER 13 ( Maternal ) death related to in vitro fertilization

Objective: The most severe complication of IVF, death, is reported rarely. IVF-pregnancies are known to have more obstetric complications, which may result in a higher incidence of maternal deaths. In order to demand attention to this severe complication and to prevent recurrence, we collected deaths that may have been related to IVF. Materials and Methods: All deaths from 1984-2008 were collected by sending a letter to all gynaecologists in the Netherlands, and by retrieving data from a large cohort study examining the late effects of ovarian stimulation (OMEGA), and from the Dutch Maternal Mortality Committee. The total number of women that had had IVF was estimated to be 100,000. Only deaths that occurred within 1 year after IVF were studied. Results: Six deaths were directly related to IVF (6/100,000). Three women had Ovarian Hyperstimulation Syndrome, two died from sepsis and one was due to a dose error of a local anaesthetic during ovum pickup. Seventeen deaths were directly related to the IVF-pregnancy (42.5/100,000): pre-eclampsia (n=4), sepsis (n=2), vascular dissection (n=2), pulmonary embolism (n=2), liver failure (n=2), portal hypertension, small vessel disease, meningitis tuberculosa, suicide and amniotic fluid embolism. Eight deaths were not related to the IVF-procedure nor the IVF-pregnancy. Conclusions: The overall mortality in patients undergoing IVF-procedure was much lower than in the general population, whereas the overall mortality in IVF-pregnancies was much higher compared to the general population. The first observation is probably due to a 'healthy female effect' in women undergoing IVF. The high mortality in IVF-pregnancies is probably due to the fact that (donor egg) IVF is succesfully used in women who are older. The fact that only a few mortalities are reported in the literature whereas we calculated six in the Netherlands indicates that there should have been many more cases worldwide. We underline the importance to report all lethal cases and we call on everybody to report lethal cases to the ESHRE Committee 'Safety and Quality after IVF'.