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Ever since the American Society for Reproductive Therapy dropped the “experimental” label for IVF, the fertility treatment has been widely accepted as being not without risks, but pretty safe. Clinics aggressively market the procedure to young women, and celebrities like Michelle Obama speak openly about their experiences with IVF. But according to a report from the Washington Post, there’s a huge discrepancy in what providers are telling women about IVF, and what can actually happen to them once the procedure begins.

Ovarian Hyperstimulation Syndrome, or OHSS, has always been a risk for women taking fertility medication, and even potentially fatal. The American Society for Reproductive Medicine tells the Washington Post that OHSS is “an uncommon but serious complication,” which is estimated to occur in moderate or severe form in just 1 to 5 percent of cycles. But when the newspaper analyzed national emergency room data, they found that about 1,000 women a year were entered for OHSS at hospitals between 2006 and 2014. What’s scarier, death by OHSS is reportedly hard to track because overstimulated ovaries can produce excess fluid that can shut down other organs. For example when Temilola Akinbolagbe died in 2005 after beginning IVF drugs, her fluid build-up led to a heart attack, but the coroner listed her death as “misadventure,” glazing over the potential IVF link.

The problem isn’t just that OHSS risk might be more serious than previously thought, but that providers are also overdosing patients in the treatment process. Even though fertility treatments at large are advertised as not harming women’s health in the long term, higher doses pose a greater risk to women even if they might be administered to boost their success rate. “The reason hyper-stimulation happened is because these fertility clinics compete against each other by posting their success rates,” the founder of the Pacific Institute for Women’s Health told the New York Times in a 2012 article on IVF complications due to higher doses. And the Washington Post notes that there’s really nothing to stop doctors from administering higher doses even if they ultimately put patients in danger.