IVF- Coping With the Emotional Roller Coaster

Procreation – and with it the ability to achieve immortality by living on through one’s children – is one of the most insatiable human needs. This strong natural urge exerts tremendous pressure on couples unable to have a baby. And the pressure to reproduce becomes increasingly acute as couples grow older and become more aware of their own mortality. The introduction of In Vitro Fertilization (IVF) more than 30 years ago has made parenthood possible for millions who otherwise would never have been able to conceive.

The biggest decision an infertile couple will ever make in regard to IVF is whether or not they really want to become parents. An IVF procedure requires an enormous emotional commitment at each level of the program, whether or not IVF is successful. This has a permanent impact on the couple. Because the toll can be so great, both partners must be committed to supporting each other from the very beginning.

The IVF process is stressful and since in general per egg retrieval, there is at least as great a chance of not being successful, it is essential for IVF patients and their partners to be realistic about the prospects – to be guardedly optimistic but to prepare themselves emotionally so that they are not overwhelmed by failure in case IVF does not succeed. Both partners should be prepared to respond to a variety of emotionally stressful demands as they undergo IVF, including:

  • Dealing with general stress “baggage” (shame, guilt, anxiety, depression, anger) they bring into the program because of their long‑standing battle with infertility
  • Following new procedures; interacting with a strange and sometimes impersonal clinical staff, and perhaps with a constantly changing cast of characters
  • Living in an unfamiliar environment: many couples will travel from another state or country to undergo IVF in a good program. This encompasses a different daily schedule, time‑zone changes, and separation from their normal support network
  • Coping with the unpredictable emotions that the fertility drugs trigger in the woman
  • Reacting to family and marital stress, which may be heightened by the constant need for mutual support
  • Managing the financial aspects of the procedure

Couples react to the demands of IVF in strikingly different ways.

One expectant mother found that the stimulation phase of her second IVF treatment cycle (her first cycle had ended in an ectopic pregnancy) was the most stressful:

“One of the most difficult things I went through was the roller‑coaster ride waiting for the estradiol level. Would it be high enough? Would I have enough eggs? Would I have to be on another day of fertility injections? It was really the most exhausting part of the entire process.”

The mother of a one‑month‑old IVF son also found the waiting to be most trying:

“The expectation between each step was difficult for me. But waiting for the pregnancy test‑that was the hardest part!”

Fortunately, she produced numerous eggs, had two embryos transferred and several left for freezing/banking and she went on to conceive and give birth to a beautiful and healthy baby girl.

In contrast, the mother of IVF triplets said:

“I was at the point of giving up, and then found new hope through IVF. I was so excited and exhilarated through the whole process that the time just flew by.”

IVF‑related stress cannot be entirely avoided, but it can be mitigated by a staff that helps normalize or demystify the experience as much as possible. The creation of an environment where all the couples are “like me” can be encouraging to the anxious IVF couple. In addition, the opportunity to talk with other couples undergoing the procedure or with representatives of a support group may be helpful. Finally, the services of an in‑house counselor can be particularly beneficial.

IVF patients need to be prepared for the fact that about 15-20% of pregnancies miscarry, and the risk of miscarriage after in vitro fertilization is probably the same as for natural conception. The reason the IVF miscarriage rate sometimes appears to be higher is that an IVF pregnancy is diagnosed long before it normally would be in the case of a natural pregnancy. Most women who conceive on their own do not test themselves for pregnancy until they have missed their period, whereas with IVF the diagnosis of pregnancy is made before the woman misses a period. One should remember, however, that a pregnancy is not confirmed until the presence of a gestational sac has been diagnosed by ultrasound. If this criterion is used to verify pregnancy, then the miscarriage rate with IVF is no greater than that of the population at large.

But miscarriage can have a positive side, however. Painful as it is to the couple, the very fact that they conceived at all indicates they are likely to be able to do so again. It is reasonable to expect that although a successful pregnancy was not achieved on the first try, the fact that they could initiate a pregnancy means that their overall chances of having a baby will increase on subsequent IVF attempts.

Couples must realize that no matter how hard they try to become pregnant and no matter how hard the doctor tries through IVF (and other methods), no one can guarantee a successful outcome. Having a baby should represent the “icing on the cake;” the couple’s relationship should represent the “cake” itself. IVF often imposes significant stress on a relationship. It is thus very important that couples undergoing IVF be made aware of this fact and counseled that they should not lose sight of the other aspects of their relationship.

One nurse‑coordinator reminds her patients to…

” ‘Lighten up’ a bit by writing prescriptions for candlelight and wine.”

The father of triplets, meeting with a group of other IVF couples, commented:

“All of us have one thing in common‑we’ve been through the highs and lows of IVF. My wife and I represent the high! But it wasn’t always easy for us. I can’t emphasize enough how important it is for everyone to keep their chin up through the whole procedure.”

Another man, holding his one‑month‑old son in his arms, added:

“I would encourage everyone definitely to maintain a positive attitude. The hardest part of the whole procedure is dealing with failures. It’s inevitable that when the first IVF attempt fails you just stop wanting to try because you don’t want to fail again. If you could just keep it in perspective and know IVF is a trial‑and‑error scientific procedure and sometimes you just have to expect problems that will help a great deal.”

It is important for couples to realize that there is little the woman can do to influence outcome following IVF in either a positive or negative way. Women often tend to blame themselves when they get a negative result. This is almost always unfounded and counterproductive, but it is also unfortunately relatively inevitable. Appropriate counseling and a good emotional support system can go a long way toward minimizing this misperception.

The physical demands of IVF ranging from the annoyance of hormone shots and blood tests to the discomfort of egg retrieval for the woman and the need for the man to produce a semen specimen on demand, all add to the emotional stress associated with the process. So does the financial burden and for couples that journey from afar to access IVF programs in another state or country, there is also the stress of travel, including jet lag and/or the general disorientation caused by temporarily living in unfamiliar surroundings.

Proper emotional preparation and mutual support throughout the treatment cycle will help both partners cope more effectively with the physical demands on the woman. And they should keep in mind that once the pregnancy is confirmed, the remainder of the gestational period will probably vary little from pregnancies experienced by all other expectant women.

Finally, there is little doubt that the overall expense of undergoing IVF often add to anxiety, stress and emotional lability. As one newly expectant IVF patient said:

“So far we’ve spent about $50,000 trying to get pregnant, so the IVF portion was really a minor part of the total cost. I first went through reconstructive surgery and several laparoscopies. I shudder to think of the money we spent on airfare to consult with doctors in other cities, plus hotel rooms and meals, to say nothing of all the income we lost by taking so much time away from work. Had we been advised from the that my tubes were permanently blocked and that I should go directly to IVF , we could have saved a lot of money Out of that $60,000 our insurance company has paid about $15,000, so we have been pretty lucky financially.”

Although this woman considered herself lucky to have paid “only” $45,000 out of her pocket, a similar outlay would be prohibitive for most other couples. That is why couples contemplating IVF should first determine whether their budget can accommodate all the direct and indirect expenses that IVF entails. IVF candidates should not automatically assume that their insurance will cover… In fact, while reimbursement practices do vary from company to company and from state to state the fact remains that in the United States less than 20% of IVF is covered.

As one new mother said vehemently:

“We’re still waiting for our insurance to pay. It’s been over a year since we went through the IVF program, and they just keep making excuses. So far we’ve only received $900!”

The father of triplets expressed his concern about the unfairness of insurance companies that refuse to fund IVF but cover other surgical procedures without question:

“Through all of our infertility treatments, including artificial insemination and surgeries, the insurance companies argued and refused to pay. Then our triplets were born seven weeks premature, and the hospital bill for them and my wife was more than $200,000. The insurance company said that was no problem and that they were going to pay the whole thing.”

The financial risk in IVF is great, but the return can be priceless. That is why it is so important for each couple to be absolutely sure of their willingness and financial ability to make such an investment before they attempt IVF. Yet more and more couples are willing to make the financial commitment. Why? When asked if he and his wife had difficulty deciding whether to undergo IVF given its cost and uncertain outcome, one new IVF father responded:

Well, when you really want children you set your priorities. We think babies are more important than fancy vacations or a sailboat. We were able to budget for IVF. But we’re sorry that insurance doesn’t usually cover it because a lot of people just can’t spend $10,000 or so to go through these procedures.”

Because of the emotional, physical, and financial toll exacted by IVF, it is preferable that no one undertake a one‑shot attempt. If a couple can only afford one treatment cycle, IVF is probably not the right procedure for them. After all, there is only about one chance in three that IVF will be successful‑and a tremendous letdown if it fails.

I believe it is unreasonable to undergo IVF with the attitude that “if it doesn’t work the first time, we’re giving up.” In vitro fertilization is a gamble even in the best of circumstances. But statistically speaking, the couple who have selected a good IVF program are likely to have a better than 70% chance if they undergo IVF three times, as long as their gametes can fertilize, and the woman is under 40 with a normal uterine cavity and a proper hormonal environment.

Unfortunately, some people will ultimately be unsuccessful. Repeated IVF failures and disappointments can exact such a financial and emotional toll as to become counterproductive and destructive on relationships. There is a time to stop trying. Couples trying to have a baby should always examine the option of adoption which can be very rewarding because it addresses both fertility as well as a social need. In my opinion, it is rarely advisable to undergo IVF repeatedly without there being a well defined and potentially remediable cause for failure.

One woman (who eventually adopted a newborn boy) described her disappointment over three failed IVF procedures:

“It’s very difficult to deal with. You go into any of these procedures with the expectation they will work. Somehow we are raised in our society to think that it’s not whether you are going to have children, but how many do you want? We plan for our car, and we plan for our house‑ and assume that the children are going to come. And when they don’t, it’s devastating. You are basically out of control of your own body. There is nothing that you can do to make the egg and sperm unite.”

Couples who choose to undergo IVF should realize from the outset that the inability to become pregnant should never be considered a reflection on them as individuals. They should view the entire procedure with guarded optimism but nevertheless must be emotionally prepared to deal with the ever‑present possibility of failure.

Debunking 11 Common Male Infertility Myths- Chicago Tribune

In honor of Men’s Health Month this June, Fertility Centers of Illinois is debunking 11 common male infertility myths for men nationwide.

Approximately 2,000,000 men per year are diagnosed with infertility in the United States, but through simple lifestyle changes, many men can improve their fertility significantly.

For male infertility issues that require fertility treatment to achieve pregnancy, men should rest assured that these issues are highly treatable with great success.

“Many men don’t think about their fertility, and avoid learning more due to a fear of the unknown,” explains Dr. Christopher Sipe of Fertility Centers of Illinois. “Learning about basic male infertility helps take the fear and confusion out of conception.”

To help men understand fertility, Dr. Sipe has dispelled 11 male infertility myths:

Myth: Age does not affect male fertility.

A recent study published in the journal Nature has shown that paternal fertility decreases with age. The study found a direct link between paternal age and an increased risk of autism and schizophrenia. The study also shows that fathers pass on as many as four times more genetic mutations when compared to mothers. It is important that men are aware of their age and fertility potential during conception. If you plan to delay fatherhood, preserving fertility by freezing sperm is a relatively inexpensive way to “freeze” your fertility in time. If you are older and looking to conceive, a semen analysis evaluating shape and motility will provide valuable insight to fertility potential.

Myth: Only women need to take supplements to improve fertility.

It has long been known that women should take folic acid while trying to conceive, as well as during pregnancy to prevent certain birth defects, but folic acid is now known to be an important supplement in male fertility. Researchers at the University of California found that men had a higher rate of chromosomal abnormalities in their sperm when their diet was low in folic acid. Coenzyme Q10 has also been found to increase sperm count and sperm motility, while Vitamin E also improves low sperm count.

Myth: Smoking doesn’t affect male fertility.

Statistics don’t lie. Smoking increases chances of male infertility by 30 percent. Cutting out cigarettes is an obvious health advantage, but many don’t realize how harmful cigarettes can be to fertility. A report by the British Medical Association showed that smokers may have up to a 10-40 percent lower monthly fecundity (a.k.a. fertility) rate. The American Society for Reproductive Medicine has estimated that up to 13 percent of infertility may be caused by tobacco use. The effect is dose dependent on the number of cigarettes smoked per day. Smoking as few as 5 cigarettes per day has been associated with lower fertility rates in males (and females).

Myth: Cell phones, laptops, hot tubs and bicycles don’t have an effect on semen quality.

Heat in extreme amounts can damage the testes and decline semen quality. A recent study by Fertility and Sterility found that the heat created from laptops can affect sperm motility and cause DNA damage. Cell phone emissions can also cause sperm damage, so keep phones in the back pocket and put a fan under your laptop. Men should be careful of putting too much time on the bike or lounging too long in a hot tub. Not to worry – semen quality typically declines only in extreme use or regular exposure. Enjoy your life and simply be aware and moderate in your habits.

Myth: Only hard drugs can affect male fertility.

Hard drugs affect fertility – and most importantly, pose a threat to your life. But it isn’t just hard drugs that can affect fertility health. Prescription drugs, antibiotics, blood pressure medication and even exposure to lead and mercury can affect the quality and quantity of sperm. Frequent marijuana use has also been known to cause similar problems.

Myth: In a healthy male, all sperm are healthy.

In an average male, only 14% of sperm by strict morphology have a normal shape, size, and ability to move properly. While this may seem low, remember that you only need one sperm to fertilize an egg and become pregnant.

Myth: Male infertility is genetic.

While male infertility can be genetically passed down, there are several different factors that can cause male infertility. A cancer diagnosis or injury can result in male infertility, while repeated infection or immunity problems can decrease male fertility. A multitude of lifestyle choices such as diet, nutrition, smoking habits, drug use, exercise habits and body weight can decrease male fertility.

Myth: There is no common diagnosis with male infertility.

While the specific cause of male infertility can vary greatly, the most common diagnosis associated with male infertility is low sperm count.

Myth: Separate health problems do not affect male fertility.

Chronic conditions such as diabetes and liver cirrhosis can cause abnormal male ejaculation due to nerve damage and retrograde ejaculation. Muscles in the bladder normally close during ejaculation, preventing the entry of semen. During retrograde ejaculation, the semen is redirected into the bladder when these muscles fail to activate. If you are concerned that a chronic condition may be impacting your fertility, reach out to a physician to learn more.

Myth: Weight does not affect fertility.

Extra weight presents a multitude of health issues, and can wreak havoc on male fertility. Obesity causes elevated estrogen and low testosterone levels, which can cause sperm count to decrease. Overweight males also experience a decreased libido. The simple solution is to calculate your Body Mass Index, which provides a healthy numerical range based on height and weight, and work towards it. Exercise will increase energy, decrease weight, and equalize testosterone and libido levels.

Myth: Diet does not affect male fertility.

Quite simply, you are what you eat. Men who consume high-fat diets have been found to have a decreased sperm count. Conversely, a mostly plant-based diet has been found to improve fertility and overall health. Fill your refrigerator and pantry with whole grains, fruits, and vegetables while avoiding thick cuts of meat and refined carbohydrates such as white bread and cookies.

 

Major IVF Breakthrough Could Triple Number of Births- Medical News Today

A new IVF advance that significantly increases the chances of having a baby through artificial reproduction could bring hope to infertile couples across the country, according to an article published in Reproductive BioMedicine Online.

A technology which records a series of images at regular intervals, known as time-lapse imaging, is now available for monitoring the development of in vitro fertilization (IVF) embryos before they’re implanted in the womb.

The first test tube baby was born in July 1978, in England. Since, then approximately 5 million babies have been born as a result of assisted reproduction technologies – namely IVF and ICSF.

This breakthrough could help triple the chances of a couple having a baby through IVF.

According to the abstract of the study, “Time-lapse imaging of human preimplantation IVF embryos has enabled objective algorithms based on novel observations of development (morphokinetics) to be used for clinical selection of embryos.”

The first baby to be born using this revolutionary in vitro fertilization technique is expected to be born in Scotland within the next few months.

In vitro fertilization using sperm
Scientists claim that time-lapse imaging may help boost the success rate of IVF.

Only 24 percent of IVF embryos which are implanted in women are born alive and well, according to data from UK public health authorities – figures in the rest of the developed world are fairly similar. The research team believe that the birth rate could shoot up to around 74 percent with this new imaging technique once they perfect it.

With this new technique, the authors were able to develop a way to successfully identify which embryos have a high risk of abnormal chromosomes, called “aneuploidy”. When embryos have this chromosome abnormality there is a much lower chance of implantation resulting in a healthy live birth.

The study, carried out by scientists from CARE Fertility, involved using time-lapse imaging among embryos from a total of 69 couples who underwent IVF. They wanted to determine whether the technique would help detect which embryos were more likely to result in a successful pregnancy and birth.

By identifying which embryos were at risk of aneuploidy using the time-lapse cameras, the researchers were able to choose which ones were best suited for implantation.

The researchers observed that the time-lapse technique resulted in a 61 percent successful live birth rate among the couples compared to only 39 percent for all embryos (at any risk level).

Using Time-Lapse Imaging As An Early Embryo Viability Test – Video

However, the NHS noted that this study “assessed the outcomes for only 69 couples who received care at one fertility service. Larger numbers of embryos would ideally need to be assessed to confirm the results. Ideally, prospective studies comparing this new technique with standard techniques would also be carried out.”

Last year, Australian IVF researchers discovered “that the greater the glucose intake the healthier the embryo”.

Written by Joseph Nordqvist

New Study Enables Women to Calculate Their Chances of a Live Birth After Egg Freezing

New Study Enables Women To Calculate Their Chances Of A Live Birth After Egg Freezing

31 May 2013   

Researchers from New York Medical College and the University of California Davis have for the first time codified age-specific probabilities of live birth after in vitro fertilization (IVF) with frozen eggs. A team of researchers led by Kutluk Oktay, M.D., a New York Medical College physician/scientist who specializes in preserving the fertility of female cancer patients, conducted a meta-analysis of oocyte cryopreservation cycles using individualized patient data to report the probability of live-birth from IVF cycles.

The study, “Age-specific probability of live birth with oocyte cryopreservation: an individual patient data meta-analysis,” was published in the online May issue of the American Society for Reproductive Medicine’s journal Fertility and Sterility.

Egg freezing is a relatively recent technique which enables women to preserve their fertility for medical or elective reasons. Until now, women who were undergoing oocyte cryopreservation, or egg freezing, were unable to predict their chances of a live birth once the eggs were reimplanted. Oktay and his team collected raw data from 10 previously published studies on egg freezing, allowing them to amass what may be the world’s largest database on pregnancy outcomes after egg freezing. Using this database, which included data from 2,265 egg freezing cycles in 1,805 women in the U.S. and Europe, the researchers generated norms which can be used to determine egg freezing success rates based on a woman’s age, the number of eggs frozen, and the method of egg freezing.

“Because of this breakthrough, women and fertility doctors will now be able to use a live pregnancy rate estimator to calculate their individual chances and to make a well-informed decision about the procedure,” said Dr. Oktay.

The study also showed that while egg freezing success rates decline with age as expected, there is a sharper drop after age 36. Though pregnancies can result from frozen eggs implanted as late as age 44, the success rates are less promising after age 42.


References:
Dr. Oktay holds professorships in obstetrics and gynecology, medicine, cell biology and anatomy, and pathology at New York Medical College, where he also directs the Division of Reproductive Medicine and Infertility. He is medical director of the Innovation Institute for Fertility Preservation.
New York Medical College

 

Kveller.com- Three Years of Trying and Still No Baby, Sharon Mckellar

That I will be a mom someday has always been a given, and like all other things in my life, I have always known that if I plan and try, I will achieve my goals. This is what my own mom taught me. She is the quintessential mother, who gave up a career to raise us not because she was supposed to, but because it was what made her the happiest.

When my husband and I first talked about building a life together, we decided on an order for things. First, we would travel. Then, we would have babies.  At 32 we were married, at 33 we traveled the world for a year, and at 34 we returned to have babies. As a librarian, I am an information seeker, so we did it correctly, right from the start. With the fanciest ovulation monitor, and the will of two people who are used to getting their way, we wasted no time. At the six-month no-success meeting with my doctor she told us that this is the meeting where she just makes sure people are doing it right. You two, she told us, are doing it right.

Well, here we are, three years later, and a year into assisted reproductive technology (IUI and IVF) still doing it right, and still child-free. We havewatched friends and family get pregnant, have children, have first birthday parties and have second children, while still we wait, feeling like our life is passing us by.

The word “infertility” has a lot of baggage. Getting pregnant and having a child is meant to be a joyful and uncomplicated part of life. I remember in Torah School learning about the life cycle, and while I can now see a multitude of issues that might come with teaching life in such a simplified way, the one I fixate on is this one: starting a family. Starting a family. When it goes wrong, it can feel like you have failed at being a woman, a wife, a daughter, a sister.

Infertility is a disease affecting one in eight couples (2002 National Survey of Family Growth), and it is defined as the inability to conceive after one year of unprotected intercourse or the inability to carry a pregnancy to live birth. In our case, the infertility is unexplained. We have passed every test with flying colors, but have never once seen a positive on a pregnancy test. We have undergone four cycles of Intrauterine Insemination, one cycle of In-Vitro Fertilization and two additional Frozen Embryo Transfers.

A lot of people mistakenly believe that once you relax, pregnancy will happen. Infertility is a disease, and, this is just not true. A lot of people are under the impression that IVF is a guaranteed success, but 30-40% of people will not get pregnant through their course of treatments. Adoption sounds to some like an easy answer, but it is an expensive and potentially emotionally painful process that requires first mourning the loss of the pregnancy envisioned.

So, where does that leave me? It leaves me feeling constantly left out of a club that I am desperate to be a member of. It leaves me researched and ready to be the best mother I can be, childless and jealous of baby bumps and sleepless nights and spit-up. It leaves me stuck in an exhausting cycle of hope and despair, enduring physical discomfort and financial hardship.

It also leaves me strong and secure in my relationship with my husband, knowing that together we *are* a family. It leaves me grateful for the support of people who care about me. It leaves me proud to be fighting my own shame and embarrassment in order to bring a voice to this disease that is often misrepresented because those of us with the most information find it so scary to talk about.

I hope that by sharing some of my journey, I can help light the way for others who may be experiencing the pain of infertility. I also hope that you amazing beautiful mothers out there think about the one in eight who may be silently suffering and wishing for your life, even in its most frustrating challenging moments. This disease will resolve somehow, and I will find peace. The state I am in now, though, is far from peaceful.