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IVF - Bearing the Pain

IVF treatment for most people is an emotional rollercoaster and is not something which should be embarked upon lightly. The process can put a strain on relationships, feel intrusive and have unpleasant side effects. This article focuses on some of the unpleasant realities of IVF so that users can make an informed decision about whether the procedure is right for them.


IVF Cost
IVF is expensive. A full cycle of treatment can cost anywhere in the region of £3,000 - £10,000 in the UK but may be significantly less in other countries. A woman may need three or more treatments before falling pregnant. In addition to the cost of the treatment itself accommodation and commuting costs may have to be factored in if the clinic chosen is in another country. The cost of the drugs alone can be as much as £900 per cycle.


IVF Availability
IVF may be available on the public health in some countries. For example, in the UK a woman aged 23-29 can receive at least one IVF cycle free under the NHS if referred by their local health authority but they must have been diagnosed with a fertility problem and have been infertile for at least 3 years. In Belgium women can receive up to six IVF cycles free of charge. However, the majority of women will find that they will have to approach private clinics for treatment.


IVF Success Rate
The chances of pregnancy depend on the age of the woman but can vary from between 20-30% in women under 40. Those who are 40 and over will experience more difficulty in conceiving (chances of success are well under 20%) and therefore face more expensive treatment in the long term.


IVF Drugs
IVF involves the use of strong hormonal drugs particularly ovarian stimulating drugs. These are given 8-10 days before treatment as they allow a larger number of eggs to be collected and removed for fertilisation outside the body. These drugs can lead to a condition known as Ovarian Hyperstimulation Syndrome (OHSS) which in turn can lead to the development of ovarian cysts. Other symptoms may include hot flushes, nausea, mood swings, headaches, restlessness, weight gain, heavy periods, vomiting and severe bloating.

Ovarian stimulation can also reduce the chances of pregnancy by producing too many eggs of reduced quality.

Further hormone drugs include those to stimulate the pituitary glands and progesterone given to prepare the womb for pregnancy.

There has been some progress in this drug giving lottery. Dr Geoffrey Trew of London's Hammersmith Hospital in the UK has developed a computer program that individually tailors fertility drugs given to a patient. This 'dose calculator' is known as "the Consort Calculator" and uses the woman's age, body mass index, blood hormone levels and the number of eggs in her ovaries to prescribe a bespoke treatment.

An alternative to taking hormonal drugs is to consider "natural cycle IVF". This is where the one egg which a woman produces during her normal monthly cycle is collected and fertilised in the laboratory. This avoids the need for ovarian stimulating drugs although progesterone may still be given to increase the chances of implantation occurring.


IVF Surgery
Two main stages of minor surgery occur in the IVF process. The first is when eggs are retrieved from the woman and this is done by using an ultra sound guided needle which pierces the vagina or by laparocopic recovery which involves making an incision in the abdomen. These methods are done under anaesthetic and one month recovery is usually required before the egg extraction procedure is repeated.

The second minor surgery involves the transfer of the fertilised eggs back into the uterus using a catheter which passes between the vagina and cervical canal.
 

Multiple Pregnancies
There is a risk of multiple pregnancies (conceiving twins, triplets or even quadruplets) as a result of IVF. Although multiple pregnancies can occur in natural pregnancies there is a slightly higher risk with IVF. As a result many countries have limited the number of embryos which can be implanted back in the woman. For example in the UK it is a maximum of 2 for women under 40 and a maximum of 3 for women 40 or over if they are using their own eggs. Whilst in countries such as Italy and Germany every embryo created must be implanted.


Ectopic Pregnancies
This occurs when the embryo develops in the fallopian tubes rather than the womb. Ectopic pregnancies can occur with natural pregnancies as well but the risk appears to be higher with IVF where there has been overstimulation of the ovaries by the use of hormonal drugs.


Strain on Relationships
IVF can take all the spontaneity out of a sexual relationship. You will find yourself preoccupied with monitoring hormone levels and ovulation. There may be episodes of hopes being raised and then dashed by miscarriages. It will test even the strongest of relationships. The experience can also bring you closer together rather than tearing you apart from your partner but it is important to be open and honest about your feelings and talk through the process together and agree at what stage you will give up if a successful pregnancy is not achieved.

Many people find it hard to admit or discuss fertility problems with friends and family and if you are hiding the fact you are undergoing IVF treatment this becomes an added burden. Frequent clinic appointments with long waiting times will also mean that you will require a sympathetic boss as you will need to take time off work to attend appointments.

No-one would claim that IVF is an easy choice by any means and often people who choose it have exhausted all other options. It is important to remember that there are alternative fertility treatments such as surgery to unblock fallopian tubes or vasectomy reversal. Clinics will usually offer other procedures such as IUI. This stands for Intrauterine Insemination. This is where specially washed and prepared sperm is inserted into the uterus. It is used to treat infertility due to a low sperm count where the female partner is young and has regular periods and ovulation. It is also used when a woman does not have any known fertility problems but may not have a male partner and is trying for a baby using donated sperm. The sperm will have been sorted before treatment to ensure that only the healthiest sperm are used. This can circumvent some of the problems associated with a full cycle of IVF treatment.


Conclusion
If you are embarking on IVF treatment be prepared to go through a number of changing emotions. At times you will feel you have lost control as you will have to accept others (medical staff) telling you what to do and when and this may feel as if you have no say in the treatments offered to you. The best way to deal with the whole process is to ensure that you get as much information as possible about the process involved in your particular treatment as fore-warned is forearmed.