Things I have learnt from and about IVF

Encouraged by Belle & Tedra’s recent posts, and just loving Jim Henley’s recent comment:

“I’d just like to say that all the ladyblogging about ladyparts and ladyissues only of interest to ladies around here lately has been awesome. I’m learning a lot from it”;

I’m going to share some observations as I near the end of my third round of IVF.



Embryos are not babies

You might think someone so eager to have children as to undergo months of difficult and expensive treatment would have a hard-core view on embryos and babies. You’d be right.

Twice now, I’ve had two embryos placed in my uterus. I have pictures of the precise moment they were ‘put back’. None of them stuck. The fact is, most don’t.

Despite what we went through to create these embryos, I am left with the cold conviction that they were opening gambits, and no more. Certainly, I would have loved them if they’d turned into babies and mourned them if I’d lost them farther along, and I was very, very sad to not get pregnant. But I felt as if the embryos were simply sets of ultimately flawed operating instructions that de-compiled within hours or days. Most embryos are only that. They may succeed, or they may not. They may be carried to term, or they may not. Human agency may intervene in any of these moments, or it may not. This makes me a bad Catholic, but I find it strangely comforting nonetheless.

I believe more firmly now that an embryo is a step along the way to becoming a human, but it’s not a human. It’s a possibility. And a real, live human woman in all her flaws and situational complexity is infinitely more important and deserving of consideration than the mere possibility of one.

Trans-vaginal ultrasounds are really quite invasive

This is a live issue in the US, where legislators are trying to force women who want abortions to undergo ‘just an ultrasound’ to see their babies. The idea is that once women see the fetus, they won’t want to kill it. Religious conservatives can’t seem to conceive that a woman can understand her pregnancy is real and still choose to end it.

During IVF, women have frequent trans-vaginal ultrasounds to see how their ovarian follicles are developing and to measure the lining of the uterus. I have them two or three times a week. It was a big deal for me when I started as it’s basically a dildo with a camera in it, wrapped in a condom, smeared with very cold lubricant, pushing quite hard against the cervix. Towards the end of the cycle it’s quite painful. At any point along, it’s awkward. Even though I can now chat happily about the weather or point out a missed follicle on the screen, the nurse and doctor are still incredibly solicitous of my comfort. They do this scan every day but they appreciate it’s not a normal or comfortable situation for the person being scanned, and they act accordingly.

I want to have these scans. They are getting me somewhere I want to be, and they are administered by professionals I know and trust and who are on part of that journey with me. I believe this invasive scan being forced on pregnant women seeking an abortion would be a violation of their bodies. As someone who gets this scan all the time, I truly cannot imagine the interaction in the room or the doctor/radiographer – patient relationship that would be involved in a woman unwillingly undergoing it from a professional intent on forcing her into something she doesn’t want. I also wonder how there can possibly be consent, when the women are forced to submit in order to be allowed medical care.

Most people are statistically illiterate – probably by choice

The odds in my case are 70 – 80% for failure. That’s unfortunate but normal for my age. Most people I talk to are irrationally optimistic about their chances. The likelihood is expressed as; ‘We have a 20 – 30% chance of success? That’s great!’ And it is great, of course, compared to people a decade or two ago whose chance of having a baby was precisely zero. But if a doctor said you had a 70-80% of dying in the next six months, wouldn’t you start writing your will and marking off that bucket list? The numbers are not kind, but I find it helps to be honest with myself about the glass being less than a quarter full.

Then there’s the Monte Carlo fallacy, which you hear often in IVF circles; ‘I have a one in three chance of getting pregnant each cycle, so if I do three cycles, I’m bound to get lucky’. Again, wishful thinking. Each cycle re-sets the likelihood back to a third. I don’t like to imagine how many cycles I would have to do before my numbers revert to the mean!

There is really very little you can do

It’s good that some women find cutting out alcohol and coffee helps, or doing post-embryo transfer meditation, having acupuncture, giving up work, or any number of things that make them feel better from one minute to the next. (Giving up coffee may possibly help with implantation, but the improvement is vanishingly small.) But none of these things improves outcomes as much as not being fat, not being old, not being poor, living in the right local authority area, picking the right clinic, or, sometimes, just using a different drug or protocol.

Women receive an endless stream of unsolicited advice – largely from other women – that amounts to an implicit and unintentional blaming when assisted conception doesn’t work. It pains me to be ungracious about help so generously offered, but I’ve read too many discussion threads of women torturing themselves for not lying down for long enough afterwards, for drinking that cup of black tea or not making it to yoga, that one time. Or the worst; not relaxing!!

There is only one thing a woman on IVF can do to improve her chances of getting pregnant: be born with a lot of good quality eggs and don’t spit them out too soon. Massages and detox diets have zero effect on the ovarian reserve. Zero. It is hard to accept, but the level of agency involved once you’ve surrendered to IVF is almost nil. Take your shots at the right time, and get enough food and sleep. That’s it.

As a feminist, I believe that irrationally constraining my lifestyle in ways that don’t demonstrably help, just so I can say ‘I did everything I could’, is just another way of staying small and quiet so no one can blame me if, as the numbers so cruelly indicate, it doesn’t work out.

So yes, do all the scented candles, evening primrose oil, positive thinking and lovely long walks you like. They help with peace of mind and overall wellbeing, and can be essential to just getting through it. But they won’t demonstrably help to start a pregnancy, and not doing them doesn’t mean you didn’t want it enough.

IVF clinics (in the UK) are choke points for everyone’s pet public health priority

If I were amongst the lucky majority who fall pregnant by simply having sex, I wouldn’t have to submit to endless checklists imposed by well-meaning public health busy-bodies. But I am not allowed to proceed unless my smear is up to date, my vaccinations can be proven, and I undertake to swallow extra folic acid daily. There are lots more I can’t remember, and they all involve providing the clinic with paperwork in case there’s an inspection. Some of these requirements have to do with pregnancy, but many are simply unrelated trip-switches that shut off IVF to anyone who doesn’t comply.

It’s classic bureaucratic irrationality. Almost anyone can get pregnant without permission, but once you fall into the trap of needing help, you must prove again and again that you are worthy of it.

Practically, it doesn’t make sense. The IVF demographic is a small one, but, I’ll hazard, on the whole a lot healthier than the general child-bearing populace. Chances are you’ve tried a lot of lifestyle improvements before you start on the Gonal-F. So why should I have to satisfy expensive and time-consuming box-ticking exercises to get permission for motherhood?

But the current hot button issue in the UK is single embryo transfers. There’s no possibility of an Octomom scenario in Britain. Doctors here can only transfer one embryo at a time unless there’s a good reason to transfer two, such as the woman being older than thirty seven. Three embryos can be transferred to women in their forties, but this is rare. When two embryos are transferred, the likelihood of a twin pregnancy can be up to 25%. (That’s 25% of the successful 10 – 20% of transfers in the >37 age group.) But the UK fertility regulator, the HFEA, has just told fertility clinics they must bring multiple birth rates down even further, to 10%.This means more pressure on women or couples to transfer a single embryo, no matter what their situation is. If they don’t, they are selfishly risking multiple births and burdening the system.

Like most public discussion of IVF, there is a lot of cant that tries to disguise the unpalatable truth. Hardly anyone wants to carry twins, but we only have a couple of shots at getting pregnant, so the risk/reward calculus is different to that of most people. To support its directive, the HFEA insists that single embryo transfers result only in slightly lower pregnancy rates. But this is only part of the story. (And given what women are already told to do to only marginally increase their success rates, it is striking that the same differentials can be completely dismissed when it suits.)

If you don’t transfer the second embryo, you have to freeze it. When you freeze it, the odds of successfully thawing it drop to around 60%, depending on the facility. So by insisting on freezing the second embryo instead of giving it a chance in utero, the authorities are effectively destroying anywhere between a quarter and a half of them.

This issue tends to be misrepresented as ‘Well, it’s difficult for clinics to say no to pushy couples who are paying for a service / only get one or two cycles on the NHS’. The truth is that individuals opting for double embryo transfers have gone through a lot to create a small number of embryos, and are making sensible decisions based on the full range of relevant information, not just the statistics that serve the HFEA’s case.

What’s at issue is the relative risk calculus of the individual couple versus that of a national health provider, but with the added dimension of time. We are comparing the risk of failure today versus risk down the road with multiple births. Most people get about a two-year window to succeed or fail with IVF. Improving thawing rates of embryos or pre-implantation identification of successful ones are, for anyone undergoing IVF today, merely interesting hypotheticals. Our timeline is by necessity shorter than that of the regulator, and none the less compelling for that.

In short, these are complex and difficult questions that deserve an honest debate based on the full range of available information, and not the patronizing partial truths coming out of the HFEA.

Blaming IVF multiple births for hoovering up scarce public health resources may or not be fair, but it’s probably inaccurate. NICUs are not full of IVF multiples. The NICU population comes from a range of groups, including babies with genetic disorders and the premature children of very young mothers with chaotic lives who would never pass the bureaucratic scrutiny required to darken the door of an IVF clinic. I don’t believe the state has a right to prevent these women conceiving, so why should it be allowed to stop me?

Everyone has a story

Many, many people have had tricky or unhappy times, not just with infertility, but with miscarriage, and the moment you hint you might be one of them, stories just come tumbling out. Infertility is a great leveler, and another lens through which to see that the reality of life is unpredictable, painful but also richer than the happily ever after I would have chosen for myself.

But ‘everyone has a story’ works in another way, too. If many media commentators are to be believed, IVF is a quick fix for sharp-elbowed women who ‘want it all’ but ‘left it too late’ and, let’s be honest, were probably ‘asking for it’. This doesn’t happen to be my story, but I don’t generally volunteer that because a) it’s nobody’s business, and b) if it was my story, would I be somehow deserve this? And would my husband?

It’s horribly commercialized, but if it wasn’t we wouldn’t have it

There is a whole medical/commercial infrastructure that seems to determine that no matter what the cause of infertility, IVF is nearly always the answer. This makes sense for many patients, but the incentive structures for large-scale provision of just one type of treatment may crowd out others.

However, as pretty run of the mill, middle class people living in a provincial city, we would not be able to access IVF without the scaling made possible by the financial rewards of a somewhat industrialised process. So I’m fairly sanguine about becoming grist to the mill of the fertility industrial complex. And, as I hope I’ve indicated, my clinic and the people who work in it are lovely and very, very good at their jobs.

IVF is not all that bad

I won’t generalize my own, relatively easy, experience to those of all women undergoing IVF. But I will share that, even with the bone-tired exhaustion, endless appointments, and recovery from minor surgery every couple of months, I’ve found it all surprisingly ok. It’s human nature that we probably don’t hear as much about the many IVF experiences that are really quite tolerable. But for everyone, IVF is also an emotional rollercoaster, albeit one which defies the laws of gravity with a lot more downs than ups.

IVF is a lot of things. It’s highly political, as I’ve tried to illustrate. It’s unpleasant, tiring and time-consuming. It’s bloody expensive. In all these respects, it’s perhaps not bad practice for the down-sides of parenthood. It’s also a timely counter to the downward supply curve of adoption.

But if I had to sum up all I’ve learnt, particularly for those considering it, I’d say ‘It’s actually not all that bad, considering. And at least it gives us a chance.’

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A word to the wise, I’ve edited out my thoughts on adoption in the UK, but suffice to say it is difficult, if not impossible, for people in my situation to adopt, and I will zap any comments along the lines of ‘There are loads of needy children out there. Why don’t you just get one?’

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P.P.S. My belated thanks to the many commenters below for such a generous and informative discussion.