testing times: IVF and the quest to conceive

by Sarah Myers

IVF and the quest to conceive | help and info

Fertility treatments like IVF can be a last hope for the one in seven couples in the UK who have trouble conceiving. But the emotional and physical strain it can cause both partners is often underestimated.

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what is it?

In vitro fertilisation, or IVF, is a type of fertility treatment or 'assisted reproduction' where the woman's eggs and man's sperm are mixed in a laboratory dish, and any resulting embryos are placed in the womb to develop. The laboratory dish was often imagined by the public to be a test tube, which is where the term 'test tube baby' came from. The procedure was originally used for women with blocked or damaged fallopian tubes. Now women with unexplained infertility are also treated with IVF.

Louise Brown, born in July 1978, was the very first IVF baby. Now around 24,000 couples undergo IVF each year in the UK, with around 8,000 babies born as a result.

what does the treatment involve?

To start the IVF process a women takes fertility drugs to stimulate her ovaries so she develops more eggs than usual (women normally release one egg a month). Regular ultrasound scans and blood tests check how the eggs are developing. When they're ready to be released, the doctor will operate to remove them using a fine hollow needle; this usually happens under general anaesthetic. Then the eggs are mixed with sperm and left to fertilise in the laboratory. About two days later, any fertilised eggs will have formed a ball of cells: an embryo. Usually two or three embryos are placed into the womb. If any extra embryos have been created, these can be frozen and used in future cycles of IVF if this one doesn't work. One cycle of IVF takes around four to six weeks to complete.

how successful is it?

Success rates vary depending on the type of fertility problem involved, and a great deal on age: a younger woman tends to have healthier eggs, making the chances of conceiving higher. One in four women under 30 have babies after IVF; this drops to one in 10 after the age of 40. The average chance of having a baby with IVF is around 20 per cent for each round of treatment. (This is with fresh embryos; with frozen ones the chance drops to around 12 per cent.)

Although this seems like a high failure rate, overall the chances of getting pregnant are about the same as for natural conception. A higher proportion of IVF pregnancies miscarry, although this is mainly due to the earlier detection of IVF pregnancies. Even in natural pregnancies only about 50% of fertilised eggs survive all the way through pregnancy, and many early miscarriages go undetected.

IVF mix up The recent Channel 4 drama, Born with Two Mothers, was based on the real life story of two couples whose eggs were mixed up during IVF treatment. The result? A white woman with a white partner gave birth to black twins. While mix-ups are extremely rare, other cases have occurred in the US and the Netherlands. To try to prevent such mistakes from happening again, there is ongoing research into tightening up procedures and a series of measures were implemented by the HFEA following the UK incident. These include the double checking of patient identification at all stages of treatment; the setting up of an alert system to ensure timely investigation of all incidents; unannounced inspections of clinics and the introduction of a new Code of Practice for clinics which sets out required standards of practice. The HFEA has also recently considered labelling all embryos, eggs and sperm with electronic identification tags which would sound an alarm if, for example, someone tried to fertilise an egg with the wrong sperm.

where can you get IVF?

Since April 2005, the NHS has agreed to fund one free IVF cycle for couples experiencing fertility problems if the women is under 40. As many couples will need more than one cycle to succeed with IVF, it's still important to investigate exactly what your local health authority will cover after that treatment is over. Many people choose to go private because of long NHS waiting lists and the choice of clinics offered to couples who opt to pay for their treatment.

Prices vary depending on the needs of individual patients. Generally, you can expect to pay between £1,000 and £3,000 per cycle. It's always worth checking if your health insurance will cover any part of the process.

There are some clinics that won't offer treatment to single women or to unmarried couples, and most have upper age limits for the women they're prepared to treat. Expect to be asked a number of personal questions about your medical and family history, as well as some relating to your ability to care for a child. The clinic is required to assess your suitability as parents, a process known as a 'Welfare of the Child' assessment.

Whichever route you take, NHS or private, your starting point should be your GP. They'll need to give you a letter of referral for your chosen clinic.

If you're not happy with the treatment you've received from your clinic Every licensed clinic has to have its own complaints procedure, which should be your first port of call if you're unhappy with your treatment for whatever reason. If you feel that a clinic hasn'dealt with your complaint in a satisfactory way, you should contact the HFEA. Write to: Head of Clinical Governance and Patient Safety, Human Fertilisation and Embryology Authority, 21 Bloomsbury Street, London WC1 3HF.

side effects – physical

Like any medical treatment, there are potential physical side effects with IVF. Some women experience a mild reaction to the drugs, leading to hot flushes, headaches and mood swings. Ovarian Hyperstimulation Syndrome (OHSS) is a more severe reaction, when cysts develop on the ovaries and fluid collects in the stomach. Symptoms include stomach swelling, pain, nausea and vomiting. In some cases, an embryo may develop in a fallopian tube rather than the womb. This is known as an ectopic pregnancy. Signs include vaginal bleeding, one-sided and often severe stomach pains, sickness, fainting or light-headedness. If you show any signs of OHSS or an ectopic pregnancy, it's essential you tell your doctor straight away.

side effects – emotional

Many couples describe IVF as an emotional roller coaster. 'During my treatment, it was a regular struggle to control my emotions' says Tina* who became pregnant after going through three cycles of IVF. 'I couldn't believe how stressful and emotionally painful it was. Just seeing a mother with their child, or hearing someone announce they were pregnant could send me into a real downward spiral. My moods had a great impact on my partner too. It really tested our relationship. It was hard to remember not to blame each other when things weren't going well.'

Joan*, whose IVF wasn't successful, says her feelings ranged from excitement, apprehension, and joy to 'deep deep devastation, and shame when it didn't work'. 'I felt deep regret for my husband – I couldn't help feeling if he'd married someone else he'd be a dad by now.'

Angela McNab, chief executive of the Human Fertilisation and Embryology Authority (HFEA), believes counselling is one of the most important aspects of fertility treatment. 'The counsellor will be able to explore the issues surrounding infertility and will help prepare you for the prospects of success or failure that lie ahead. It's also common for problems and anxieties from other parts of your life to be triggered by the stressful process of treatment and this is where therapeutic counselling is vital for couples.'

what support is out there?

As well as counselling at the clinic, you may find further 'couple counselling' useful to work through issues brought up by the treatment. Organisations such as Relate or BICA may be able to help with this, and support groups such as Fertility Friends and the Infertility Network UK can provide information on IVF and support patients throughout treatment (see help and info for contact details). Some websites have forums and message boards so people can post questions and advice for others going through a similar experience. Ask your health professional if there are any support groups at the clinic too. Where possible, explain how you're feeling to family and friends. The more they understand about what you're going through, the more sensitive and supportive they can be.

real life stories

* names have been changed

(updated April 2005)

Read on for details of relevant organisations, websites and reading.