The “The Success Rates of Assisted Conception - Part II” plus 3 more

The Success Rates of Assisted Conception - Part II
Pregnancy Stress - Logistics of Treatment & Loss of Privacy
Pregnancy Stress - Thinking About the Consequences & Physical Aspects of Treatment
Pregnancy - Changes in Fertility

The Success Rates of Assisted Conception - Part II

Posted: 12 Feb 2010 10:10 AM PST

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When considering your chances of success, you need to look carefully at what is meant by it, and what is used as the baseline for measurement. There are many different stages of IVF treatment, and each one has its own success rate. The success rate per treatment cycle will be much lower than per embryo transfer - because for so many couples the early stages of treatment do not work. Up to a quarter who start treatment may not even reach the stage where the woman has an embryo transferred back into her womb.

Frequently success rates are given in terms of pregnancies. But this can be seriously misleading, as many pregnancies will not continue through to the birth of a child. Pregnancies may be biochemical only: the woman may have a positive test, but there may be no sign of pregnancy on an ultrasound scan and she then bleeds. In addition, the high level of monitoring of women during IVF treatment will pick up a pregnancy at a very early stage. In nature, many are not viable and are lost at such an early stage that the woman might not ever realise that she was pregnant. For these reasons the more cautious clinics will only chalk up a success where the woman has not only had two positive tests, but where a foetal heartbeat has been detected by ultrasound, confirming a clinical pregnancy.

The second measure of success is the live-birth rate, often called the take-home baby rate. It's important to look at this because it shows the chances of the desired end result - going home from hospital with your own baby. The live-birth rate is lower than the pregnancy rate. Unfortunately, even once the diagnosis is assured, IVF has a high level of what is euphemistically called pregnancy wastage - what most women would call miscarriage. Whether this is higher than for naturally conceived pregnancies is a matter of debate. Sometimes it can be hard to get an accurate live-birth rate. Clinics may not know the ultimate outcome of a confirmed pregnancy, while others may be reluctant to take responsibility for mistakes made by others during antenatal care or childbirth.

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Pregnancy Stress - Logistics of Treatment & Loss of Privacy

Posted: 12 Feb 2010 09:51 AM PST

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Logistics of treatment

Other difficulties are travelling from home for treatment, juggling treatment and work, and the financial burden of repeated cycles at a cost of around £2500 a go. Some of the logistics can be resolved by careful choice of clinic, and details and organisation of treatment. For example, getting your partner to give you the injections will save a daily trip to the GP or clinic.

Loss of privacy

The intrusion into a couple's private life by in vitro fertilisation (IVF) treatment can be hard to handle. Hilary Everett, of the social work department at St Bartholomew's Hospital, says: 'IVF is a fairly straight¬forward idea. However, usually you would be having sex and conceiving. With IVF you are giving up that privacy. I emphasise that to people because they have to understand it. From the time they start the treatment they will be very exposed and vulnerable, and they need to think about the stress of that.'

Women are often used to enduring embarrassing intimate gynaecological procedures at the hands of male doctors, especially if they have had previous fertility treatment or pregnancy losses. Many are inured to the humiliating round of scrapes and probes. One saving grace with IVF is that much of the day-to-day treatment is carried out in an all-woman environment, by specially trained infertility nurses and radiographers. But for men it can be a shock to realise the extent of the interference with their partners' bodies. One woman, who otherwise found her treatments uneventful, was none the less left with this feeling.

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Pregnancy Stress - Thinking About the Consequences & Physical Aspects of Treatment

Posted: 12 Feb 2010 09:48 AM PST

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Thinking about the consequences

It's important to think about the consequences of successful treatment: at the end of the day a child of one's own, or, given the higher than average rate of twins and triplets, more than one. Yet some women entering IVF may not have thought beyond getting pregnant, because they want to experience pregnancy, to compensate for those lost or because they have been trying so long to get pregnant they find it hard to think beyond that goal. Indeed, pregnancy may have become a goal in itself.

It's important also to think about the consequences of failure. Most people who go in for this treatment may face repeated disappointment, and it may take several forms. Some may experience problems at the early stages, not responding to the drugs or the sperm not fertilising the eggs, or they may get right through to the end only to find that what at first testing is a pregnancy turns out not to be viable and is lost. At some stage in the future, the couple may have to decide to chart out another course for their life together. So whilst hoping for the best, you have to prepare for the worst.

Physical aspects of treatment

Some women find the actual treatment stressful and get worn down by the grind of injections, tests and scans. Others may suffer side-effects from the drugs. These are set out in Chapters Four and Five, although there is still relatively little documented evidence of serious side-effects. There is a risk of the ovaries being over-stimulated, from which one death has been reported in Britain. One study has linked the drugs to ovarian cancer, although the data is disputed. For those women who have general anaesthetics for the egg collection, or for related surgery, there is the usual risk, associated with general anaesthetic, as well as the stress of facing repeated surgery during what may be several years of treatment. The physical procedures can be painful, especially egg collection; or people may be frightened of having injections. Otherwise, the physical stresses of treatment lie in the fairly unpredictable short-term side-effects of the drugs. These can include headaches, nausea, an unpleasant bloated feeling and mood swings: unacceptable side-effects and risks to some. Others may find that they and their partners can make arrangements to minimise the problems.

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Pregnancy - Changes in Fertility

Posted: 12 Feb 2010 09:45 AM PST

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It's important to remember that fertility is not static. It changes over time for both sexes and they may react differently with different partners. It can be very distressing for a man or woman who has children with one partner to find that it is impossible with a new one. A couple with one child may be pole-axed to find that they cannot have a second - what's known as secondary infertility, which is very much misunderstood. The couple will hardly be consoled by friends and relatives telling them to be grateful for what they already have. Fertility problems can sometimes be overcome without medical intervention: couples come off the waiting list for treatment because they have a child without assistance.

Sadly, most fertility problems cannot be cured, although many couples can be helped to have a baby. Tubal surgery may be a solution or ovulation induction. But despite research to try to create an artificial fallopian tube, badly damaged or missing tubes cannot - yet - be replaced. Ovaries which have completely ceased to function cannot be renewed, although research into foetal ovarian tissue may make transplantation an option in years to come. There is no miracle drug that will suddenly enable a completely infertile man to produce healthy sperm. Some people argue that prevention is anyway better than cure, and the emphasis should be on reproductive health from an early age: less use of damaging contraceptive devices or drugs, less exposure to toxic chemicals and a more healthy life-style. This may hold true for future generations, but it does not help couples now. For many people it will never be possible to deal with the cause of their infertility, but it may be possible to resolve their childlessness through assisted conception.

This section has provided only brief details of some of the main causes of infertility. Many of these conditions can be extremely distressing, and people need information and support to come to terms with them. There are a number of books with more information and there are also several support groups.

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