Couples with fertility issues face many decisions when it comes to the type of treatment that is best suited to their situation. Choices are limited for some couples. This may depend on the reason for the infertility, your age, or the likelihood that a particular procedure will work for you. Other couples may be faced with a variety of choices. In this article, we will look at some of the pros and cons of IVF.
Assuming the female has patent oviducts, is producing eggs, and her partner has a suitable sample of semen, the typical couple often begins their fertility journey by attempting artificial intrauterine insemination (also known as intrauterine insemination - IUI). If this procedure does not result in pregnancy after 3-4 attempts, it is common for the couple to consider more detailed types of treatments such as IVF. As a rule, most couples decide whether or not in vitro fertilization (IVF) is an option for them based on their personal and financial situation. This procedure of IVF has many pros and cons that the couple should study in detail and understand well before making a decision.
The benefits of IVF
There are many advantages of an IVF procedure. The greatest thing, of course, is having a baby! Couples who are unable to conceive naturally are now given the chance to start their families, thanksIVF treatment. IVF is a sophisticated process tailored to a couple's specific situation. This gives them a higher chance of getting pregnant.
Depending on the type of fertility problem you are dealing with, IVF can increase your chances of conceiving, but not in all cases. Here are three situations where IVF offers great benefits:
blocked fallopian tubes.Many couples are not aware of this problem until they are confronted with infertility. After testing to find out where the problem lies, it is determined that the woman's fallopian tubes are blocked. Blocked fallopian tubes can result from a previous pelvic infection, such as appendicitis or chlamydia.
Once it is determined that the fallopian tubes are blocked, IVF is the only possible treatment when trying to conceive. IUI (artificial insemination) is not an option as this procedure requires the woman's fallopian tubes to be open and functional. This means that they allow the sperm and egg to be fertilized. The subsequently fertilized egg would then travel out of the tube into the womb (uterus) where it could implant.
In IVF, the fallopian tubes do not need to be functioning or even present, as the procedure works around the tubes by removing the eggs from the ovaries in a small procedure. The embryo (fertilized egg) is then implanted directly into the uterus, where it must then "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 about 40% of couples who need help to have a baby. If there are significant problems with the quality of the man's sperm (eg, impaired sperm count, motility, or shape), IUI is not a viable option in most cases. IVF, on the other hand, can facilitate successful fertilization of the egg, which would otherwise be unlikely due to the sperm and egg being placed close together.
Decreased chance of baby abnormality.In some situations, couples are at high risk of having a baby with an anomaly. For example, both partners can carry the gene for cystic fibrosis, meaning there is a 1 in 4 chance of a baby being born with the condition. In this case, the embryos can be tested for the condition using IVF before they are implanted in the uterus. Therefore, it would reduce the risk of having a baby with this condition. These procedures are called preimplantation genetic diagnosis (PGD) or comparative genomic hybridization (CGH) and are treatment options for high-risk couples.
The disadvantages of IVF
As with any medical procedure, IVF has its downsides. The biggest downside is the fact that no matter how good things may look, you cannot guarantee pregnancy. This lack of certainty can lead to severe emotional problems for couples due to the stress that can result from this journey.
Nobody wants to imagine that their IVF cycle will be anything but perfect. Please do not skip this section hoping this doesn't happen to you. We sincerely hope that you do not have any of the IVF risks on this list. But we want you to be prepared just in case.
The risks of IVF to consider are:
cycle abort.Sometimes you just don't respond to the treatment that has been prescribed for you in the way we would expect. This can be due to an under- or over-reaction to the drug.
Collected no/fewer eggs than expected.It is important to understand that not every follicle seen on an ultrasound scan will be used to retrieve an egg during egg retrieval. About 80-90% of the follicles are expected to yield an egg. Occasionally fewer eggs than expected are collected during egg retrieval. Sometimes eggs are not collected during the egg retrieval procedure.
We started with more follicles when we ended up with eggs and embryos - what happened?Once the eggs have been collected, not every egg will be fertilized, although approximately 70-80% are expected to be fertilized. Even if an egg has been fertilized, it does not necessarily mean that it is suitable for transfer or freezing. These results are very individual.
fertilization failure.Sometimes during egg collection we receive eggs from you, but none of them are fertilized, which means that no embryos are formed. Fortunately, this doesn't happen very often. This can sometimes be due to poor egg quality or poor sperm quality.
implantation failure.An embryo that had reached the expected stage of development was placed back into your uterus. They took all the medication exactly as we requested. But now you have your period. This is called implantation failure. Cycle termination and fertilization failures are fortunately rare, but implantation failures are common.
miscarriage
You would think the worst is over as soon as you saw that positive pregnancy test! Miscarriage is the loss of pregnancy before the 20th week of pregnancy and can occur at any stage but is most common before the 12th week of pregnancy. About one in five pregnancies is lost through miscarriage. The likelihood of miscarriage is increased in older women, with up to 50% of women over the age of 40 having a miscarriage.
ectopic pregnancy.In an ectopic pregnancy, the embryo implants itself 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. By far the most common location is the fallopian tube. The likelihood of this happening is slightly higher with an IVF pregnancy, especially if the fallopian tubes are known to be damaged. It happens in about 1 in 100 pregnancies.
multiple pregnancy."Wait a minute," you say, "getting pregnant and having twins isn't my idea of a problem—so why is it on the 'cons' list?" The goal of fertility treatment is to give you one baby each therefore, in some respects, a multiple pregnancy (and especially if there are more than twins) cannot be considered a good outcome of IVF. There are some really good medical reasons why having more than one in your uterus at a time is not good for you or your babies. For this reason, we prefer to transfer only one embryo at a time. Even if we only transfer one, there is still a risk (albeit small) of an identical twin pregnancy as the embryo can divide to form two babies.
baby abnormalities.About 2-3% of babies conceived without IVF are born with some kind of abnormality. This can be minor (a large birthmark), life-threatening (a heart defect), or cause long-term problems as the child grows (spina bifida). One of the concerns about the widespread use of IVF has been whether there is an increased risk of abnormalities in babies born after IVF.
Research to date to answer this question has yielded conflicting results, with some studies showing no increase in risk while others even showing a doubling of risk. Even if the risk is doubled, the chance of a perfectly normal baby with IVF is about 96%.
Risks of Egg Collection.Oocyte retrieval is a surgical procedure and, like all surgical procedures, involves some risk. However, the procedure is considered low-risk, and the majority of women experience no ill effects. During egg retrieval, the needle used to drain the fluid from the follicles in the ovary may puncture other nearby structures. We always perform our egg retrieval procedures using an ultrasound monitor so the tip of the needle is visible at all times to minimize this. Structures that can be injured include large blood vessels, the bladder, and the intestines.
Risks of embryo transfer.Embryo transfer is very low risk, similar to a Pap smear. Rarely, an infection in the uterus (called endometritis) can occur, causing pain, discharge, and bleeding. If left untreated, the infection could spread elsewhere and be potentially serious. It is treated with antibiotics, and sometimes hospitalization may be needed if the infection is particularly severe.
Ovarian Hyperstimulation Syndrome.Ovarian Hyperstimulation Syndrome (OHSS) is a potentially serious complication of fertility treatments that use artificial stimulation of the ovaries. It occurs in about 5% of all IVF treatment cycles. It is severe in about 1% of all cycles. It generally starts to cause problems about 4 or 5 days after the egg retrieval.
To develop OHSS you must have been on some form of stimulant medication. Generally these are FSH injections but it has been known to occur when clomiphene tablets are used. In order to trigger the onset of the problem, ovulation (or a trigger injection) must occur. OHSS lasts about 10 days, but if you become pregnant it can last for several months and tends to get worse.
The positive side of your first cycle is that whatever the outcome, we have gained valuable information on how you are responding to the treatment. We can therefore change our approach next time to give you a better chance of success.
Summary
As you can see, IVF has many advantages and disadvantages. Both must be considered to make the right decision for you and your partner. Even though IVF is your only option to achieve pregnancy, it doesn't mean you have to go that route. It's okay to be childless. Talk to your doctor about the risks so you can make a decision. Every couple is different in what works for them, and IVF isn't always the only answer. Managing expectations is key to maximizing the chance that the entire treatment will go as smoothly as possible. Hopefully the desired result will then become a reality. Discuss the pros and cons of IVF with your specialist.
If you have any questions, please contact the clinic –Contact us.
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