Learn the answers to the top 10 questions about IVF…in 30 minutes or less

Answers to the most commonly asked questions about getting pregnant using ART/IVF

ivf post imageThese days the internet plays a big part in getting many women pregnant!

Let’s face it – the first port of call for finding out about fertility challenges – and pretty much anything about anything these days – is the internet.

But the bitter-sweet reality is, while the internet is simply outstanding for providing instant access to information, the quality of the information accessed isn’t always outstanding.

And when it comes to female infertility and trying to become pregnant using IVF, quality of information is vitally important.

In this post I’ll present some of the most frequently asked questions on the internet about ART/IVF and provide information from the most respected professional and scientific sources I can find (and in the simplest ‘lay person’ language possible) so you can make solidly informed decisions about medically assisted approaches to becoming pregnant.

Just a reminder; ART stands for Assisted Reproductive Technologies and covers a range of medical techniques including Intra Uterine Insemination (or IUI) while IVF stands for In Vitro Fertilisation (‘in –vitro’ literally means ‘in glass’) and refers to the collection of female eggs and male sperm to form an embryo in the laboratory.

I’ve used large green headings for each question, so you can easily peruse the questions and quickly get to the ones of most interest to you.

Here we go…

What is the IVF process, and what does IVF treatment involve?

unspecifiedIVF is short for In Vitro Fertilisation.

It involves collecting eggs from the female ovary at the correct time, and fertilising them in the laboratory with sperm from the male partner. This fertilisation could occur via the placing of the sperm in the same receptacle as the egg/s, or by the medicos injecting a single healthy sperm into a single healthy egg via a process known as ICSI (Intra Cytoplasmic Sperm Injection).

IVF process can sound quite simple when explained like this, and treatment is a little more complex in its entirety and essentially involves:

  • Stimulating the female ovulation process via injections of Follicle Stimulating Hormone (FSH). The woman usually self administers any injections involved in this process
  • The IVF doctor collecting eggs from the follicles using a needle under light anaesthetic via a process known as ‘aspiration’
  • Collecting and preparing the male sperm and conducting certain laboratory procedures to ensure the sperm sample has maximum potential to fertilise the female egg/s
  • Insemination and fertilisation– basically mixing the selected eggs and sperm together in a dish or conducting the ICSI process, and awaiting fertilisation
  • Embryo culture – which essentially means getting the fertilised egg to the three day mark in the case of a low number of eggs being collected, or to the 5-6 day mark where possible. The later time allows for tests to determine the best quality ‘blastocysts’ (recently fertilised eggs which have continued development towards embryo stage)
  • Embryo transfer – the process of transferring the fertilised egg or blastocyst into the female uterus
  • You can learn more about the details of the process at the:
    http://monashivf.com/the-ivf-process/?gclid=CNmqj4qzuswCFQJwvAod9NEJ7Q#step-2-8211-sperm-preparation

    How much does IVF cost?

    gold-hand-1This simple sounding question regarding IVF cost is actually far more complicated than you might think. Why is that?

    Apart from the fact that IVF cost differs between various countries and even between different practitioners within particular countries, there are other factors to be considered when this questions arises. These factors include, but most certainly aren’t limited to, issues such as:

  • Extent, if any, of government sponsored financial assistance
  • Actual cost of a full cycle in various locations and using various service providers
  • Whether the cycle is a full cycle or one using frozen embryos from a previous full cycle
  • The most expensive IVF cycle for one of my own clients (my field is stress management and counselling/psychotherapy support for women undergoing IVF, and I also conduct formal academic research into stress effects on IVF outcomes) was at a cost of the equivalent of 8,400 British pounds, $16,128 Australian or US $12,264, and this did not include some post transfer services that some other clinics might include as part of their ‘package’. That fee was for a service provided in a country in the Middle East (no, not the UAE).

    Typical first cycle full costs in my country (Australia) are between nine and ten thousand dollars, with patients typically facing out-of-pocket expenses (after government contribution) of in the order of $3,000-$4,500 for the first full cycle, and $2,500-$3,800 for subsequent full cycles. A frozen embryo transfer would typically fall in the range of $2,250-$2,550 full cost with approximately $1,300-$1,800 out-of-pocket expenses. All these prices are in Australian dollars. Please be aware these are indicative costs and there are several practitioners quoting prices either lower or higher than the range provided. Following are some sites from which you can gather further information regarding IVF costs for Australia:
    https://www.qfg.com.au/ivf-fees/ivf-costs?gclid=CIfxoprEuswCFVgkvQodjoIOaw
    http://monashivf.com/treatment/vic-ivf-costs/#how-much-does-ivf-cost

    You can find details of a lower cost clinic here:
    https://www.thefertilitycentre.com.au/queensland/IVF-costs

    In the United Kingdom, the National Institute for Health and Care Excellence (NICE) recommends that IVF should be made available to women under the age of 43 who have had regular unprotected sex for two years (and I understand three in some countries of the UK) or who have unsuccessfully undertaken 12 cycles using IUI. There is a separate body that makes the final decision regarding government contribution to IVF. Costs for privately funded IVF cycles are reported to be up to 5,000 pounds and possibly more. You can find more information about the UK situation at:
    http://www.nhs.uk/Conditions/IVF/Pages/Introduction.aspx

    Interestingly, the government funding of IVF in the UK appears to differ quite significantly between England, Wales, Scotland and Northern Ireland (as alluded to in the previous paragraph) as you will find in the details available at:
    http://www.hfea.gov.uk/fertility-treatment-cost-nhs.html

    In the USA, the average cost of a first cycle IVF treatment is reported to be in the range of US $12,000, plus the cost of any medications (some sources report the cost of these to be between US$3,000 and $5,000). Following are some web sites that provide more detailed information about pricing in the US:
    http://www.advancedfertility.com/ivfprice.htm

    So uncommon is low cost IVF in the USA, it actually attracted a complete Newsweek article in 2010. You can read that article here:
    http://www.newsweek.com/why-ivf-so-expensive-united-states-74385

    Forbes magazine also printed an interesting article on IVF costs in the USA in 2014, and you can read that at:
    http://www.forbes.com/sites/learnvest/2014/02/06/the-cost-of-ivf-4-things-i-learned-while-battling-infertility/#411448d02a79

    One New Zealand clinic provides a comprehensive schedule of costs at:
    http://www.repromed.co.nz/site/repromed/Repromed%20Treatment%20Fee%20Schedule.pdf

    As in many other countries, the cost of IVF in New Zealand is so prominent in the minds of so many, it has attracted press attention:
    http://www.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10382817

    This post thus far has addressed costs of IVF to individuals opting to undergo the process. It is also worthwhile looking at the cost to governments of subsidizing IVF treatments.

    New Zealand is a small country and its government has very strict guidelines regarding who can avail themselves of government financial assistance for IVF treatment. Basically, it offers two IVF treatments to women who are diagnosed as infertile (according to the World Health Organisation definition presented in my last post, and not the more recent IVF clinic driven definition of just six months trying unsuccessfully) provided they are under 40 years of age, are not obese and do not smoke. When one considers that a 2011 study in Australia showed a cost per live birth of in excess of $180,000 for women over 40 compared with around $30,000 for women in their mid -30s, the New Zealand stance makes more financial sense (from a government perspective) albeit no doubt a cause for strong disappointment for many childless couples.

    The New Zealand restrictions would appear tough to Australian readers, but impressively higher success rates for women in the closer-to-40 age group stand in support of the government’s decision from a financial perspective. Having said that, the New Zealand Herald article quoted above did contain one statement that today’s success rate for IVF is around 65%, and later in that same article, presented national statistics of 2,000 IVF cycles per year for 650 live births – a success rate of 32.5%, which sounds far more credible when looking at published government endorsed statistics from a number of countries.

    Canada also limits access to government funding for IVF, and you can read more about its 2010 attitudes to government funding of IVF procedures at:
    https://www.cadth.ca/media/pdf/Public_Funding_IVF_es-14_e.pdf

    and compare those with more recent reports at:
    http://www.theglobeandmail.com/news/national/ontarios-liberal-government-to-fund-a-cycle-of-ivf-for-women/article26616360/

    I’ve received wide-ranging reports on costs of IVF in the UAE. A newspaper article quoting a well-respected doctor who was responsible for establishing his Emirate’s first government fertility unit might be of interest to UAE resident’s considering IVF, and this can be found at:
    http://www.thenational.ae/uae/dubai-doctors-warn-against-cheaper-ivf-treatments-at-the-cost-of-extra-risks

    An article which indicates and all up cost of 37,000 Dirhams (just over US $10,000 is quoted by a UAE doctor being interviewed in the popular local magazine, Time Out Dubai. You can access the full article here:
    http://www.timeoutdubai.com/bodyandmind/features/42970-ivf-fertility-treatment-in-dubai

    And now, let’s move on to the next key questions.

    Apart from age, what causes infertility? Why does IVF fail? And what is ‘unexplained infertility’?

    orchidFemale infertility (that’s not explained by a woman being beyond her fertile years) can be explained by physical factors such as endometriosis, tubal blockages, polycystic ovaries and a number of other medical problems that are described on any number of IVF clinic sites. Once beyond the mid thirties, age becomes another significant factor in female infertility.

    Male contributions to infertility include low sperm count, poor sperm motility or movement ability, and/or poor morphology (formation/structure defects).

    Age is less an issue for male fertility, but research does show potential impacts on pregnancy and children once the male passes around 45 years of age.

    You can get more information on both female and male problems that can lead to infertility at sites from the various countries we have previously discussed herein … like:
    http://www.mayoclinic.org/diseases-conditions/infertility/basics/causes/con-20034770
    http://www.ivf.com.au/about-fertility/infertility-treatment
    https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/infertility-in-women

    http://monashivf.com/preparing-for-pregnancy/infertility-explained/
    http://www.nhs.uk/Conditions/Infertility/Pages/Causes.aspx

    When infertility can’t be pinpointed to a physiological issue with either male or female partner, or to contributions by both of them to the condition, the condition is usually diagnosed as ‘idiopathic infertility’ or ‘unexplained infertility’.

    There are several reasons that IVF can fail, and some of these are addressed in the links above, and in the information provided elsewhere on this post. It is important to know that we must also accept that the world does not always operate by statistics and probabilities (with apologies to the mathematicians of the world). We simply cannot say that if there is no physiological problem with either partner, and they are both in their twenties or early thirties, that conception is guaranteed, even if ART/IVF is used.

    There is more information about IVF success statistics elsewhere in this post.

    And on to the next (and often related) question..

    What is meant by the term ‘IVF poor responders’ and how can I avoid being in that category?

    This is a difficult question and one that requires a complex response to be properly and adequately answered. The best response would best be sought from your general practitioner or IVF specialist. I won’t provide many references here for the simple fact they can be either overly simplistic and don’t really respond adequately to a complex question, or overly complex and often upsetting for some women whose hopes can be dashed by their content if that content is considered in the absence of data from medical testing.

    One simple answer is that a ‘poor responder’ is a person who requires large doses of the hormones that stimulate the ovaries and who nonetheless produce an unacceptably small number of eggs. A more recent diagnostic test is that a woman needs to meet two of three factors to be seen to be a ‘poor responder’. Those factors are:

  • An abnormal ovarian reserve (number of eggs) test
  • Previous POR (Poor Ovarian Response) or
  • Factors that might indicate probability of same – such as advanced maternal age (in fertility terms)
  • Modern medical opinion can differ but there appears to be a strong view that it is better to determine likelihood of one being a poor responder or not prior to commencing IVF. This is for a number of reasons, not the least being that certain reasons for being a poor responder can indicate a low probability of IVF success.

    I have read several academic papers on poor responders and some make for complicated reading, despite my having read literally hundreds of formal academic papers on IVF success related topics as part of my own formal research. For this and the reason that I firmly believe this is one topic that very much should be discussed with your medical specialists, I will not provide further information or follow up reference suggestions in this blog.

    However, one of the diagnostic indicators of a woman being a ‘poor responder’ mentioned above is advanced maternal age…which just happens to be the focus of the next question I will address.

    What are the real rates of IVF success?

    Now this is where we could really be sailing into troubled waters.

    I say this simply because there is a tendency for some IVF clinics to proudly publish their results loudly and clearly, pushing the fact they are so far ahead of the average results across all centres for their country – or whatever other standard against which they might be able to show they excel in comparison.
    Of course this, in turn, can lead to the urge to defend the published results at all costs…after all, if they are proven incorrect, business might be lost.

    Frankly, I don’t think patients are that easy to convince. Most will probably research a little deeper – for example by reading blogs like this – or take recommendations from others who have experienced success etc.

    Notwithstanding any of the figures published by individual clinics, in this post, I’ll give you figures published by government authorities and other recognised agencies. That is not to say some clinics won’t get better results – the fact is many will. However, government published figures are a great starting point, and where figures from individual clinics are higher than these, you can investigate why.

    I’d suggest any such investigation begin with a single question. “do you use the World Health Organisation (WHO) 12 month definition of infertility or the more recently emerging 6 month definition, in recommending commencement of treatment?”

    You should be sure to ask this question if you are 35 years old or more. Why is that?

    I addressed that question in my last post. Particularly relevant to this question are the following words:

    The National Centre for Biotechnical Information of the USA seems to indicate that the six months diagnosis point might be regarded to be more IVF clinic driven than formal organisation (such as WHO) driven when it states that:

    Infertility is customarily defined as the inability to conceive after 1 year of regular unprotected intercourse. The infertility evaluation is typically initiated after 1 year of trying to conceive, but in couples with advanced female age (> 35 years), most practitioners initiate diagnostic evaluation after an inability to conceive for 6 months.

    You can read my previous post in full at:
    http://ivf-assist.com/fertility-blog/female-infertility-for-women-having-difficulty-getting-pregnant-with-ivf

    The point is that government figures about IVF success generally use the WHO definition of infertility which bases a diagnosis of ‘infertile’ on a person in the reproductive age range not having become pregnant after twelve months of unprotected sex at the correct time of the cycle.

    Clearly to begin fertility treatment after six months has a higher chance of success when one would not in the past have been declared as having the problem that required the treatment being administered for another six months.

    If anyone tells you that definition is ‘old hat’ or ‘out of date’ and devised by an organisation that is ‘out of touch’ with today’s reality – all responses I have personally heard, by the way – don’t listen to them. The fact is the 12 months period remains the gold standard for defining female infertility in particular, and it remains front and centre on many reputable private hospital and infertility centre blogs, including that for the Mayo Clinic in the USA, and is the definition used by most government authorities that subsidise infertility treatment. In fact some governments won’t subsidise until couples have failed to become pregnant over a considerably longer period than 12 months.

    And now – here’s where it gets kind of messy….

    While I feel duty bound to explain why some clinics might profess such high success rates, I don’t necessarily disagree with IVF doctors, in some circumstances, recommending that women begin ART procedures (including IVF, if necessary) after six months of trying.

    You only need to take a quick look at the success statistics to notice a rapid decline in success rates of IVF after a certain age. When responding to what my own university supervised research revealed was one of the strongest human drives – the maternal drive – a woman does not want to take what she might see as any unnecessary chances. In other words, I fully comprehend why a clinic might suggest commencing IVF prior to a 12 month period for women of certain age, and I fully understand why some women just want to get on with it – especially if they have the financial resources to do so.

    All I am advising is that, if you do intend making your decision about a clinic based on advertised success rates, it would be a great idea to be sure you are comparing apples with apples – and that means getting the success statistics for each clinic you are considering based on the WHO and government recognised approach to defining infertility, and excluding figures for women who insisted on commencing treatment prior to a 12 month period of trying naturally, or who responded to clinic promotion of commencing after just six months of trying for women of 35 years of age or older.

    Let’s now review some published IVF success rates. In Australia and New Zealand, all clinics must provide success rates for the ANZARD – The Australia and New Zealand Assisted Reproduction Database. The main complaints about this database are that it tends to be more than a year behind in currency (for example, the 2012 report might be released in 2014, and more importantly, only IVF clinics get to see the data the report contains – it is not available to potential patients.

    This is not a formal academic journal piece, but the following explains the situation in easy-to-comprehend lay person’s terms:
    http://theconversation.com/the-art-of-deception-ivf-success-rates-are-not-what-you-think-42894

    It’s interesting that the ‘middle band’ of the nearly 40 clinics that report to ANZARD achieved a success rate of between just above 13% and just under 20% across all age ranges, BUT the success rates for the lower performing clinics was around 4% while the top reported success rate across all age groups was just under 31%. With such a huge difference in formally reported figures, is it any wonder women can be confused in selecting the IVF clinic to help them satisfy their maternal drive?

    And to make matters even more confusing the ANZARD report for 2013 contains results based on pregnancy rates and not live births (again, the gold standard of success). You can read a ‘Choice’ (Feb. 2016) consumer report on that here:
    https://www.choice.com.au/health-and-body/reproductive-health/conception/articles/ivf-clinics-and-success-rates

    This article also contains some excellent suggestions for questions you could ask clinics you are considering using.

    Here are some more interesting statistics:

  • In March 2016 The United Kingdom Human Fertilisation and Embryology Authority released its figures for 2014. In that year, 58,288 women underwent 67,708 IVF cycles, which resulted in a live birth rate between 25 and 27%
  • In the USA the numbers were 175,000 IVF cycles from which 63,000 live births resulted – a success rate of 36%
  • One study in Australia conducted by The Fertility Society of Australia and the University of New South Wales reported that of 71,516 ART cycles conducted in Australia and New Zealand during 2013, only 12,997 live births resulted – a rate of just 18.2%, and that some 25% of cycles did not even progress to embryo stage.
  • Now those numbers do raise several questions, not the least being what are the rates within specific age groups – which I’ll address in just a minute – but the point for here is that the statistics clearly show far more failure than success across all IVF cycles….and that means if you’re trying to get pregnant using IVF, you need to have as much going for you as humanly possible.

    In that regard you can get free access to an infographic overview and a video case study from my own pilot study and university qualitative research findings into the effects of managing stress at five points across an IVF cycle by clicking on the purple banner in the right hand column at www.ivf-assist.com.

    You can also chat with your General Practitioner about success rates. In Australia, you will need a referral from a GP to a specialist IVF clinic, but I do notice that some clinics are now offering a ‘one-stop shop’ whereby you can go to the clinic and see a GP who will conduct your initial consultation and if necessary, refer you to the specialist side of the clinic. This makes things simple and quick in a time-stretched world. Personally, I’d want to chat with my own GP and get independent advice concerning my options.

    Let’s now move to our next questions, the answer to which is really a continuation of this answer…

    Just how important is maternal age to IVF success chances?

    image-3This is a natural follow on question from the last one. And the short answer is, after a particular age, it’s very important – even crucially so. I’ll go a little deeper with some statistics from respected sources in a minute….

    In the meantime, while this blog is mainly concerned with female fertility challenges, we will be addressing male issues from time to time, and I will provide some information about age effect on male fertility in responding to this question. The simple reason I address female issues is my practice and research is mainly around female fertility challenges, AND, many male issues can often be far more easily dealt with than many female issues – for example, by using the ICSI technique (Intra Cytoplasmic Sperm Injection) where, once a single healthy male sperm can be located, it can be injected into a single healthy egg.

    Back to those statistics about maternal age and IVF success rates…

    In one interview you can find at …
    http://www.kidspot.com.au/birth/conception/ivf/14-things-you-should-know-about-ivf-in-2016

    …an IVF clinic manager stated that, “Nowadays, it takes three or four IVF cycles for the majority of couples to find out whether they’ll fall pregnant or not”. Not good news for the bank account, but in my experience, probably more the rule than the exception, despite it being far different from the expectations of most women commencing IVF. Fortunately, we did find better results during our research wherein women (who had experienced problems becoming pregnant using IVF alone) used our IVF-Assist programme to manage stress in concert with undergoing IVF. You can learn more about that programme at http://ivf-assist.com/products/ivf-assist

    The question arises, ‘if women commence IVF with higher expectations of success than are statistically supported, how much can that contribute to increased stress upon failure, and does that stress has any impact on future cycles?’

    That really is the million-dollar question, and it’s the one I’ll address in the last point of this post.
    Statistics show that people are having their families later in life. Just a decade ago peak birth rates were from mothers between 25 and 29 years of age, whereas today it’s the 30-34 year old group. Over the last couple of decades the median age of fathers for babies in the peak group has risen from just over 31 to around 34.

    For women in particular, that age group begins to approach the point at which fertility decreases significantly. I’ve even had women mention they’re not concerned about waiting, they’ll just go direct to an ART approach after a month or two of trying. With a bit of cash in the bank and career satisfaction in mind, that seems a perfectly reasonable logic. But it overlooks one very important factor, if the logic prevails too late in life, and too late might be a lot earlier than many women think.

    The fact is, ART procedures can be effective, but it simply doesn’t make sense to presume they can always make up for the decline in natural fertility that is as much a fact for intending mums from their late thirties onwards (even earlier in some cases) as are grey hair and wrinkles for most of us in our sixties.

    It seems to me that, as one writer so eloquently put it, ‘the underestimating of the impact of increasing age, and the overestimating of the capability of ART’ can almost inevitably lead to a very high level of stress, anxiety – even depression – upon the experience of ART failure. And it will take a lot to convince me that stress has no effect on IVF outcome after the research I’ve conducted, and based on recent research in the medical area as well. I reiterate, that will be the last question I address in this post.

    So what is the ‘cut off’ age for ART/IVF success for women. The following is one of the most concise articles I have ever read on the topic:
    http://www.fertilitysociety.com.au/wp-content/uploads/FSA-Age-fertility-and-reproductive-technology-2016.pdf

    For those wanting just the key points, they are:

  • At around age 25 female egg quality begins to decline
  • By the mid 30s, the degree of oocyte (egg) quality decline becomes clinically relevant
  • 1% of women are infertile at 25, and 55% at 45
  • 75% of women trying to conceive naturally at age 30 will become pregnant within 12 months
  • That figure decreases to 44% for women at age 40
  • 20% of women who conceive at age 35 will have a spontaneous abortion (miscarriage)
  • At ages 30, 35 and 40, monthly fecundity (likelihood of conceiving) is 17%, 12% and 5% respectively
  • Maternal age is the single most important factor in infertility
  • In 2012 across Australia and New Zealand, the average age of women undergoing ART procedures using their own eggs was 35.8 years
  • The live birth rate per fresh ART cycle for women under 30 was 26%
  • That figure for women 44 and older was less than 1%
  • Their figures showed no pregnancy for any women over 46 using her own eggs
  • The report also addressed male aspects of infertility and stated that:

  • There was no really conclusive evidence regarding male age and infertility
  • Male age at and over 45 did increase time to pregnancy
  • Higher male age (45+) increases risk of spontaneous abortion (miscarriage)
  • Higher male age (45+) increases risk of certain disorders in children, including schizophrenia and autism spectrum disorder
  • Perhaps the most impactful comment in the report was that

    The chance of ART success for women aged 44 or over using her own eggs is negligible.

    Perhaps strangely, the results of my own pilot study and university supervised research programme showed results for women in their late 30s and early 40s that contradicted some of the somewhat glum outlook that the general statistics give rise to. However, that study involved a quite small number of women and should not be taken to contradict the published statistics. I’ll address that research in my next blog post where we’ll look at key aspects of stress and how to manage them to enhance chances of becoming pregnant.

    Is there a higher risk of miscarriage when using IVF?

    IVF miscarriage is a common topic in professional circles these days. There’s little doubt you’re going to hear a lot of that talk if you are dealing with people undergoing IVF, especially if they are in their mid to late thirties or older. And therein lies the quandary.

    It’s probably true to say there’s a higher risk of miscarriage when using IVF than when getting pregnant naturally (measured across the full population).

    This raises the question, ‘is it IVF that’s causing the miscarriages, or is it the factors that lead the women to undergo IVF to get pregnant that’s the cause?’. I’m guessing the bulk of professional opinion would favour the second explanation, and with little hesitation.

    A longitudinal study undertaken in the UK over 18 years and covering over 124,000 IVF pregnancies revealed a 20% rate of miscarriage among women who produced fewer than four eggs after ovarian stimulation. The study reported that miscarriage rates were not much different from the 15% across the full population when between four and nine eggs were collected, and the figures was slightly better that for the full population if the number of eggs collected was between ten and 15.

    There are so many factors that can contribute to miscarriage whether or not ART/IVF is involved. Obesity, level of alcohol consumption, smoking, male partner over 45 yrs of age, and any number of lifestyle factors can contribute to increased risk of miscarriage whether or not ART or IVF is involved. If you’d like a more comprehensive coverage of these lifestyle factors, you can find my programme, Tips to Enhance Your Chances of Pregnancy at:
    http://ivf-assist.com/tips-to-enhance-your-chances-of-pregnancy

    Are IVF forums of benefit for getting information about female infertility and fertility challenges generally?

    Difficult question, and I guess it gets down to personality and attitude in the long run.

    My strong recommendation is, if you’re thinking about joining forums (or fora as my Latin master at school might have insisted) join one moderated by a medical professional, if possible. Sure, many of these have the objective of getting business for the particular clinics of the moderators, but that’s likely to be a concern for pretty much only those readers in the vicinity of the clinics involved. With the internet, people worldwide can benefit from these forums without needing to be concerned at any underlying sales motivation of the moderators.

    In any case, getting advice from a medical professional – and in the case of some of the better forums, from several available professionals – who might have a underlying selling motive – is of far greater value, in my opinion, than getting involved only in forums for which contributions come from people facing the same problems as you might be. These people often write with a sense of authority despite having no depth of knowledge beyond their own personal experience.

    I’m not saying don’t engage in popular forums, just remain aware of the extent of their inherent value – to share stories with like minded people facing similar challenges. However, before you act on any advice from this type of forum, it’s always advisable to ask your medical professional for his or her opinion.

    And the following and penultimate question or this post is most definitely one on which your primary source of information should your medical specialist.

    What’s the point at which you should cease IVF treatment after failure or multiple failures, and what are the impacts of ceasing treatment?

    Another million-dollar question! There really are no rules, but there are some common sense indications that come to bear on this very tough decision – unfortunately one that hundreds of couples have to make every day.
    To my mind, there are four factors that become significant above all others. They are presented here in the order they come to mind and not in any research-proven order of importance.

    The first is physiology. If your medical specialist tells you there are physiological problems that cannot be rectified, there’s little point proceeding against impossible odds.

    Having said that, I’ve had clients who used donated eggs, and others who used donated sperm, and have successfully given birth. Of course, even a decision to take either of those approaches should be discussed with your medical specialist, and for some, seeing a psychotherapist who is experienced in this field is to be advised before proceeding.

    In my time as a psychotherapist, counsellor, and clinical hypnotherapist specialising in stress effects on fertility, and on IVF outcomes in particular, I’ve met only one woman (thankfully) who was unable to carry to term, even using donated eggs, and the impact of that final decision, one which in her case was pretty much imposed upon her and her husband, was quite devastating for them.

    Professional psychotherapists are thoroughly trained in the art of getting a sense of another human being’s pain – even feeling it to a degree – but not becoming completely immersed in that pain. In fact one of the six key principles of counselling and psychotherapy taught early in any decent training course is the concept of ‘congruence and incongruence’ – which in effect means the therapist should not be working with people who present with a problem with which the therapist is also suffering.

    Notwithstanding the thousands of hours of training I have undergone and the thousands of hours I’ve experienced in clinical practice, I found it extremely difficult to not feel that couple’s pain at a much deeper level than ‘the books’ might recommend.

    The second is finance.
    This requires no explanation. IVF can be expensive, and most couple will need to make cost an important factor in deciding whether or not to continue after failure.

    The third is age.
    Make no mistake about it, the single most important factor in a woman’s ability to conceive is her age. I have covered the statistics on this in a previous post, so won’t repeat them in detail here. Sufficient to say that beyond the age of 35, the ability to conceive and carry to term for a healthy live birth gets less at an exponential rate.

    The fourth is personal well-being.
    IVF can take a toll on couples, and women in particular, and that toll can express itself in many different ways. Relationship problems have been known to emerge, physical reaction to the process is not uncommon. Stress reaction to IVF process (and other life factors) has been shown by research to at least have a correlation with IVF failure, and possibly even to impact pregnancy chances. Month after month having the IVF process as the main focus of life itself can be very draining indeed.

    For many couples there comes a time when they realise the impact of the process of trying to conceive is having an unacceptably negative effect on their overall quality of life and relationship, and they simply have to say, ‘enough is enough’, and perhaps seek professional assistance to find meaning in life without the child they were hoping to give birth to.

    This is hardly ever an easy decision for couples to make. Sometimes, there’s the miraculous upside – after all that trying, they accept they might never have a child, relax about it all, and BINGO!…a few months later, they’re pregnant naturally. Sadly, and particularly for older women, the people who experience this fortunate outcome are in the minority.

    For those who find they have to make the decision to stop trying, my heart goes out to you, and I extend to you my best wishes for a fulfilling life without that child you were hoping so strongly for, and I am sure the best wishes of all who read this blog.

    Just what impact does stress have on IVF outcome?

    image-2The literature in formal academic research archives remains divided. Some say there is a correlation between stress and ability to conceive, others say stress can be proven to extend time to pregnancy and to reduce chances of becoming pregnant.

    Towards the end of my own pilot study and university supervised and ethically controlled qualitative research programme, a US study using objective testing techniques (much previous research had used subjective testing) concluded that stress definitely reduced chances of pregnancy and extended time to conception. That research was not focused on IVF outcomes but on attempts to become pregnant naturally. However, reasonable logic suggests that, given IVF itself is, for many women, a strong inducer of stress, it’s highly likely the findings of this study might apply to IVF outcomes as well.

    For my pilot study, I conducted and extensive review of current research literature. From that, and my own clinic observations from working with couples trying to become pregnant (some naturally and some using IVF) I concluded that stress was a factor at some important level. I then went on to identify five specific phases across and IVF cycle at which stress was likely to have maximum negative effect and devised intervention strategies to minimise the impacts of stress at those times.

    I then tested the resulting ‘formula’ of techniques on a group of women who’d had multiple failures in their attempts to conceive, and the result of the study was the number of women who become pregnant and delivered a healthy baby was far in excess of government published normal results.

    I followed this pilot study with a formal university supervised qualitative research study to learn form the experience of the women on the pilot, and that revealed some very important things about the types of stress women experience while undergoing IVF and the types of stress they believe impact their ability to conceive.

    These factors will be the topic of my next post.

    The ART of pregnancy

    The term for the collective procedures to assist women (having difficulty getting pregnant) to conceive is Assisted Reproductive Technologies, or ART for short.

    When Griffiths University Student and talented final year art student, Olivia Heath, approached me with a request for an internship, I was a little confused. At first, I could not see how I could place her. I remember thinking, ‘My clinic practice has nothing to do with art.’

    It didn’t take long for me to realise that, while my practice had nothing to do with art (apart from the fact I have a nice painting on the office wall) it does have a lot to do with ART (as defined above). I was also motivated to assist Olivia because, as a professor at a different university, I know how difficult it can be for students to get an internship, despite the fact that theses can make all the difference in a graduate getting a job later.

    The connection seemed too strong to overlook, so Olivia and I met at a tea lounge and brainstormed ideas that led to her serving her internship programme with my office.

    The concept development was relatively simple, and the enjoyment from its execution has been immense. I told Olivia about the IVF-Assist programme and how it worked, and suggested that she prepare pieces of art to illustrate 3-4 posts for the launch of my IVF-Assist blog.

    Olivia needed more guidance, so I asked that her work included abstract references to concepts such as natural flow, fertility, nature, femininity, stress, and the like. Also, we agreed the art should focus on aspects of the conscious or unconscious behaviour of a woman striving to conceive.

    Her responses included abstract pieces that fit the brief precisely. The images of her art you see with this post are of dark colours flowing in abstract patterns representing the dark and sometimes confusing flow of thoughts a woman having difficulty conceiving might experience on a daily basis. Into some of her art is the impression of a female breast – emphasizing the need of the woman to nurture this child she wants so much.

    You can see more of Olivia’s work at www.oliviaheathcolourcreative.com

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