Couples experiencing fertility issues are faced with many decisions when it comes to the type of treatment that is most suitable for their situation. For some couples the choices are limited, depending on the reason for the infertility, their age, or the likelihood of a particular procedure working for them. Other couples may be presented with a variety of choices.
The typical couple assuming the female has open tubes, is producing eggs and her partner has a suitable semen sample, will often start their fertility journey by trying artificial intrauterine insemination (also known as intra uterine insemination-IUI). If this procedure does not produce a pregnancy for them after 3-4 attempts, then the usual course is for the couple to consider more detailed types of treatments such as IVF. Typically, most couples end up deciding whether or not in vitro fertilization (IVF) is a viable option for them based on their personal and financial situation. This procedure of IVF has many pros and cons, which the couple should explore in detail and have a good understanding of, before making a decision.
The Pros of IVF
There are many benefits of having an IVF procedure. The biggest, of course, is having a baby! Couples who are unable to conceive naturally are now given a chance to start their family, thanks to IVF treatment. IVF is an exacted process which is tailored to a couple’s specific situation, giving them a higher chance of becoming pregnant.
Depending on the type of fertility issue you are dealing with, IVF can increase your chance of a pregnancy, but not in all cases. Here are three situations where IVF offers big advantages:
Blocked fallopian tubes. Many couples are not aware that this is a problem until they are faced with infertility. After testing to find out where the problem lies, the female’s tubes are found to be blocked. Blocked fallopian tubes can result from a previous pelvic infection, such as appendicitis or chlamydia.
Once it is determined that the tubes are blocked, IVF is the only possible treatment when attempting for a pregnancy. IUI (artificial insemination) is not an option because this procedure requires that the female’s tubes are open and working – meaning they will allow the sperm and the egg to fertilize and the subsequent fertilized egg to then travel from the tube into the womb (uterus) where it may implant.
IVF does not need the tubes to be functioning or even present, as the procedure works around the tubes by taking the eggs from the ovaries in a small procedure and then implanting the embryo (fertilized egg) directly into the uterus, where it then needs to “implant” in order for a successful pregnancy to occur.
Difficulty with the sperm’s ability to fertilize the egg. Male infertility is the cause of approximately 40% of couples needing assistance to have a baby. If there are significant issues with the quality of the man’s sperm (i.e. compromise in sperm count, motility or shape), then in most cases, IUI is not a suitable option. IVF, on the other hand, because it places the sperm and the egg within close proximately of each other, can facilitate the successful fertilization of the egg that may otherwise be unlikely to happen.
Lowered chance of baby abnormality. In some situations, couples are at high risk of conceiving a baby with an abnormality. For example, both partners may carry the gene for Cystic Fibrosis meaning that there would be a 1 in 4 chance of a baby being born with the condition. In this instance, with the use of IVF, the embryos can be tested for the condition before they are implanted into the uterus, therefore reducing the risk of having a baby with this condition. These procedures are called Pre-Implantation Genetic Diagnosis (PGD) or Comparative Genomic Hybridization (CGH) and are treatment options for couples that are at high risk.
The Cons of IVF
As with any medical procedure, IVF has its downsides. The biggest downside is the fact that you cannot guarantee a pregnancy, no matter how good things may appear. This lack of certainty can cause severe emotional issues for couples because of the stress that can result from this journey.
No one wants to imagine that their IVF cycle is going to be anything other than perfect. Please don’t skip this section in the hope that it won’t happen to you. We sure hope that you don’t experience any of the risks of IVF on this list, but we do want you to be prepared just in case.
The risks of IVF to be considered are:
Cycle cancellation. Sometimes you just don’t react to the treatment prescribed for you the way we would expect. This might be due to an under-response or an over-response to the medication.
No/fewer eggs collected than expected. It is important to understand that not every follicle seen on an ultrasound scan will have an egg collected from it during the egg collection procedure. It is expected that approximately 80-90% of follicles will yield an egg. Occasionally, there are fewer eggs collected at the egg collection procedure than expected. Sometimes, there are no eggs collected during the egg collection procedure.
We started with more Follicles than we ended up with Eggs and Embryos – What Happened? Once the eggs have been collected, not every egg will fertilise, although it is expected that approximately 70-80% will fertilise. Even once an egg has been fertilised, it does not necessarily mean it will be suitable for transfer or freezing. These results are very individual.
Fertilisation failure. Sometimes we will get eggs from you at egg pick up, but none of them will fertilise, meaning no embryos will form. Fortunately, this doesn’t happen very often and can sometimes be due to poor egg quality, or poor sperm quality.
Implantation failure. An embryo that had reached the stage of development that was expected was transferred back into your uterus. You took all the medications exactly as we asked. But now you are having a period. This is called Implantation failure. Cycle cancellation and fertilisation failure are fortunately rare, but implantation failure is common.
You’d think that the worst of it was over once you saw that positive pregnancy test! Miscarriage is the loss of the pregnancy before 20 weeks, and can happen at any stage, but is most common before 12 weeks of pregnancy. About one in five pregnancies will be lost through miscarriage. The chances of miscarriage are increased for older women, with as many as 50% of women over age 40 miscarrying.
Ectopic Pregnancy. An ectopic pregnancy is when the embryo implants outside the uterus and continues to develop. This may sound unusual given that the embryo is placed in the uterus at the time of transfer, but it can and does happen. The most common place by far is the fallopian tube. The chances of this happening are slightly higher in an IVF pregnancy, especially if the fallopian tubes are known to be damaged. It happens in about 1 in 100 pregnancies.
Multiple Pregnancy. “Hang on,” you say, “getting pregnant and having twins isn’t my idea of a problem – so why is it on the ‘cons’ list?” The aim of fertility treatment is to get you one baby at a time, so in some respects a multiple pregnancy (and especially if it is more than twins) can be considered not a good outcome of IVF. There are some really good medical reasons why it isn’t good for you or your babies if there is more than one in your uterus at once. This is why we prefer to only transfer one embryo at a time. Even when we do transfer only one there is still a risk (although small) of an identical twin pregnancy as the embryo can split to form two babies.
Baby Abnormalities. Approximately 2-3% of non-IVF conceived babies are born with some kind of abnormality. This might be minor (a large birth mark), or life threatening (a heart defect), or cause long term problems for the child as it grows up (spina bifida). One of the concerns about the widespread use of IVF has been the question as to whether there is an increased risk of abnormalities in babies born after IVF.
The research that has been done to date to answer this question has produced some conflicting results, with some studies indicating no increase in risk, while others have shown as high as a doubling of the risk. Even if the risk is doubled the chance of a perfectly normal baby with IVF is about 96%.
Risks of Egg Pick Up. The egg pick up procedure is a surgical procedure and like all surgical procedures, it carries some risk. However, the procedure is considered low risk, and the majority of women suffer no ill effects. During the egg collection procedure, it is possible for the needle that it used to drain the fluid from the follicles in the ovary to puncture other structures nearby. We always perform our egg pick up procedures with an ultrasound monitor so that the tip of the needle can be seen at all times to minimize this. Structures that can be injured include major blood vessels, the bladder and the bowel.
Risks of Embryo Transfer. The embryo transfer procedure is very low in risk, similar to having a Pap smear test. Rarely, an infection can occur in the uterus (called endometritis) which produces pain, discharge and bleeding. If left untreated, the infection could spread elsewhere and be potentially serious. It is treated with antibiotics, and sometimes admission to the hospital might be needed if the infection is particularly severe.
Ovarian Hyperstimulation Syndrome. Ovarian Hyper Stimulation Syndrome (OHSS) is a potentially serious complication of fertility treatments where the ovary is artificially stimulated. It occurs in about 5% of all IVF treatment cycles, and is severe in about 1% of all cycles. It generally begins to cause problems about 4 or 5 days after the egg pick up procedure.
To develop OHSS, you need to have had some form of stimulating drug. Generally this is FSH injections, but it has been known to occur when clomiphene tablets are used. To trigger the onset of the problem, ovulation (or a trigger injection) must occur. OHSS lasts for about 10 days, but if you become pregnant, it can last for several months and tends to be worse.
The positive side to your first cycle is that regardless of the outcome, we have learned valuable information about how you react to treatment, and can change what we do the next time so that you have a better chance of success.
As you can see, IVF has many pros and cons, both of which need to be considered in order to determine the right decision for you and your partner. Even if IVF is your only option of achieving a pregnancy, it does not mean you have to take this journey. It is OK to remain childfree. Talk to your doctor about the risks to help you make a decision. Every couple will differ in what works for them and IVF is not always the only answer. Managing expectations is the key to maximizing the chance that the entire goes as smoothly as possible and hopefully then the desired outcome becomes a reality.
Author Bio – Denise Donati
Denise Donati is a registered nurse/midwife and co-owner of Fertility Solutions, a full service fertility clinic with offices on the Sunshine Coast and Bundaberg, Queensland. In 2012, she launched Affordable IVF, which offers streamlined IVF and ICSI treatments at a lower cost to couples who wish to begin their family. Together, the clinics have helped bring hundreds of babies into the world through the miracle of assisted reproductive technology. At our clinics, your baby is our success.