A Means to Motherhood: Breaking Down IVF

This year, while we honor the already mothers, we want to also remember the hopeful mothers-to-be who may be considering assisted reproductive technology, especially in vitro fertilization.

IVF

Mother’s Day can evoke the sweetest happiness. We see the joy splashed across social media, television, advertisements and billboards – it is impossible to miss. While it is a much-deserved celebration of mothers, women struggling with fertility are managing grief and sadness on that same Sunday in May. They are silently waiting for the celebrations to pass so their world can ease back to normal while simultaneously yearning for their own Mother’s Day.

We want to take a moment and highlight a potential option that may bring hope to those women who desire to be a parent but are having difficulty conceiving. We talked with Dr. Karen Wheeler, a reproductive endocrinologist who specializes in optimizing in vitro fertilization outcomes at Reproductive Medicine Associates of Michigan. She guides us through important information about the science of IVF. According to the Centers for Disease Control and Prevention, infertility is defined as not being able to conceive after one year (six months if older than 35) of having unprotected sex. 

The History

British scientist Robert Edwards made history in 1978 when the first “test tube baby,” Louise Brown, was born in England. It was a revolutionary procedure that Edwards had tried and tested for more than 10 years before baby Louise’s groundbreaking arrival. Before the United States would share in this innovation, England and Australia would welcome 14 babies using the technique. But, in 1981, Elizabeth Carr was born using the IVF process putting the U.S on the map, led by doctors Howard and Georgeanna Jones who opened an IVF clinic in Eastern Virginia Medical School in 1980. More than 40 years later, the procedure that was once deemed controversial is now the most widely used assisted reproductive technology technique. In 2017, almost 2% of all infants born in the U.S. were conceived with the use of ART.

The Science

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IVF is an assisted reproductive technology that fertilizes a woman’s egg with sperm in a lab as an alternative to the process that typically happens naturally inside the body after sex. This science-based intervention has been helping women overcome medical causes that may prevent this process. Wheeler and her team recommend a precise diagnosis to determine what types of issues may be at work, and it generally starts with a few questions:

• Are you ovulating normally?

• Are your fallopian tubes functioning?

• Are your partner’s sperm normal and functioning?

Ovulation is needed to release an egg. Functioning fallopian tubes are needed for an egg to be fertilized. And sperm is needed for fertilization. When a woman’s fallopian tubes are blocked or absent, or if a man has a low sperm count, IVF gives that couple a chance to conceive. Without fertility drugs, the science doesn’t work. According to the Reproductive Medicine Associates website, some of the medications required for the IVF process include those that:

• Help produce a greater number of high-quality eggs during a treatment cycle

• Help stop eggs from being released too early – giving them time to grow properly

• Help to prepare eggs for retrieval

The process of IVF can be consuming so being organized and fully present in the process is important. “(We) talk them through all of the next steps because it is a pretty intensive process that involves a lot of things that the patients and couples do at home,” Wheeler says. For instance, they may be asked to “administer medications for themselves and mix all the medications correctly.”

The Process

INITIAL COMPREHENSIVE SCREENING AND PREPARATION 

Wheeler says that diagnostic testing can take anywhere from a couple weeks to a month in order to assess a woman’s eggs supply, make sure that the inside of her uterus is ready to receive an embryo, and to do an analysis on her partner. In the case of same-sex couples or single women, this may include obtaining sperm from a donor. You may also be prescribed birth control pills or estrogen.

OVARIAN STIMULATION

“We use medications to grow multiple follicles in the ovaries,” Wheeler says. The medications are used for about eight to 12 days to stimulate the ovaries. “Once all of the follicles look like they are a big enough size, then we do a final injection of medication that starts the process of ovulation. But right before ovulation we do an egg retrieval,” she explains. “So instead of the eggs being released into the body, we go into the ovary and place a needle into each of the follicles to remove the eggs.” A woman’s natural menstrual cycle produces one mature egg. This process generates as many mature eggs as possible depending on the individual and the doses of medications used.

EGG RETRIEVAL 

Once enough follicles reach the mature stage, the prospective mother self-administers a human chorionic gonadotropin (HGC) hormone shot and, in about 36 hours, her eggs are retrieved. There is some discomfort and there could be bloating, but, Wheeler says, the average person is able to return to work or other typical activities the day after their egg retrieval process. The culture – or growing of the embryos – takes five or six days, Wheeler says.

EMBRYO TRANSFER 

“This step depends on if a couple is planning to do what we call ‘a fresh embryo transfer’ – meaning that the embryo is being transferred back in the same month or cycle that the egg retrieval happened, or if all the embryos are going to be frozen and then transferred back at a later time,” Wheeler says. Other factors considered include whether couples want to have the embryos undergo preimplantation genetic diagnosis.

INTRACYTOPLASMIC SPERM INJECTION

“In about 30% of couples, there is a male factor to the infertility,” Wheeler says. “ICSI is a big advancement in male fertility. In cases where sperm counts are low or where fertilization has failed to occur with a prior IVF attempt, special egg insemination techniques may be used to help the sperm fertilize the egg.”

The Health Prerequisites 

Get your body ready. “You want to make sure that a woman is in good health prior to pregnancy, primarily making sure that she is not going to be (at) increased risk during pregnancy,” Wheeler says, adding that any preexisting conditions, like diabetes, should be well controlled beforehand. “If there are any medications that she’s on that need to be changed so that they are compatible with pregnancy, those are all things that need to occur before pregnancy.” Maintaining a healthy weight is also important. Being overweight to start can make it difficult to monitor changes and increase complications during egg retrievals. The Mayo Clinic offers a list of health conditions that could impact a woman’s fertility – including uterine fibroids, endometriosis or blocked fallopian tubes – and, for men, the problem could be an infection, hormone imbalances or ejaculation issues.

The Mental Support  

“I think women have a lot of emotions tied into their ability to be mothers and can have a lot of guilt or place a lot of blame on themselves for things that are definitely not their fault,” Wheeler says. IVF is a very intense process, and issue of fertility is super emotional. In Wheeler’s practice, they recommend that patients work with a counselor experienced in dealing with families faced with infertility. She says there are a number of resources to help potential mothers through the IVF process.

• Find a support group or a similar safe space offering education, awareness and support. Wheeler suggests Fertility for Colored Girls for women of color; they provide support and encouragement to African American women and couples. Another great resource, she says, is RESOLVE: The National Infertility Association, a patient advocacy organization that offers support groups in more than 200 communities.

• Try acupuncture, a technique of traditional Chinese medicine that has been around for thousands of years and is well documented for its efficacy in treating pain and reducing stress. “Acupuncture is a big adjunct to more traditional fertility treatments that’s really shown to be helpful for women,” Wheeler says.

“There is a lot of self-worth and self-value that women place on themselves if they are having difficulty getting pregnant, and so the IVF process, not only is it stressful putting a lot of pressure on their bodies to be able to perform, but also it can be expensive in a lot of cases, which adds to the stress of the procedure.” The reality is that infertility is a common problem.

The Department of Health and Human Services says about 6.1 million women in the U.S. ages 15 to 44 have difficulty getting pregnant or staying pregnant. 

• RESOLVE: The National Infertility Association says that about one-third of infertility is attributed to the female partner, one-third is attributed to the male partner and one-third is caused by a combination of problems in both partners, or is unexplained.    

The Money

The cost for IVF varies based on the procedure and the required and optional testing. Wheeler says, generally, the cost can range between $10,000 and $15,000 for one cycle. In some cases, one cycle of IVF can result in pregnancy, but it is possible to have to undergo multiple IVF cycles before a successful pregnancy. Costs can also vary by state and the procedure may or may not be covered by employer-provided health insurance. “In Michigan, there is usually very limited coverage for fertility,” Wheeler says. “There are more and more employers that are offering it as a benefit, but, in general, it’s not a requirement for employers in Michigan.” Investigate opportunities that could help offset your financial costs. Certain foundations may provide grants and scholarships that help pay for IVF costs, like the Baby Quest Foundation. Do your homework to determine if they are a good fit for you and your family.

The Persistence 

Most women require more than one cycle of IVF to be successful, but experts say not to get discouraged because many couples achieve success on subsequent IVF cycles. Be sure to ask your doctor the key questions.

What went wrong? You want to have as much information as possible to empower yourself to make decisions about next steps. 

Should the fertility drugs be changed? Your specialist may suggest changing the drugs that were used such as the stimulation medications.

What are my true chances of success? Ask for an honest analysis and for your doctor to be frank with you about your chances of success if you decide to move forward with another cycle. 

Should we consider other options? Discuss other infertility treatment alternatives – including surrogacy or adoption – with your doctor. 

“There is a lot of self-worth and self-value that women place on themselves if they are having difficulty getting pregnant, and so the IVF process, not only is it stressful putting a lot of pressure on their bodies to be able to perform, but also it can be expensive in a lot of cases, which adds to the stress of the procedure.” 

By Any Means

While IVF is the most commonly used assisted reproductive therapy, it’s not the only option. A few popular alternatives or co-therapies include:

Intrauterine insemination (IUI) involves placing sperm directly inside a woman’s uterus to increase the number that reach the fallopian tubes, thus increasing the chance of fertilization. 

Mature oocyte cryopreservation (egg freezing) is a method used to save a woman’s ability to get pregnant in the future. Eggs are harvested from the ovaries and frozen unfertilized for future use.

Gestational carriers (surrogates) bear genetically unrelated children for other women or couples. This process typically starts with IVF, but the egg fertilized is not that of the woman who will – it’s hoped – get pregnant.

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