Once a couple decides to go ahead with IVF(In vitro fertilization), the next concern is the IVF success rate and to decide when to go for IVF treatment. As we all know IVF has its limitations and a variety of factors influence the outcome. Some of them are under our control and some of them are not.
What is the Sucess Rate of IVF?
The outcome of an IVF cycle depends on the quality of the embryo which in turn depends on the egg quality and the sperm quality. Egg quality is mainly dependent on the age of the woman. As age increases, particularly in the late thirties, the chances of having aneuploid/ abnormal eggs increases.
ICSI( intracytoplasmic sperm injection) can overcome most of the sperm-related problems but severely abnormal semen samples can give rise to poor quality embryos, thereby compromising the IVF success rates. Egg numbers are equally important. Studies show that IVF success increases as the number of eggs retrieved increases up to about 15 eggs. Thereafter there is no further increase in the success.
‘Smoking is injurious to health’. This applies to reproductive health as well. Passive smoking is equally harmful, but not many women are aware of this. One survey of female hospital employees found that less than 1 in 4 knew that smoking could hurt their fertility or increase the risk of miscarriage.
Men and women are affected by infertility in different ways.
Most couples experience the struggle in much the same way. This is related to the traditional ways men and women have been trained to think, feel and act. Women are typically seen, by others as well as themselves, as the emotional caretakers or providers of the relationship.
Women typically feel responsible not only for everyone’s bad feelings but also for anything bad that happens. When women try to repress feelings, their emotions can become more ominous until they finally feel out of control. Their emotions can become a monster about to swallow them whole.
Women in infertile couples often protect their husbands from their own pain and feelings of failure by taking much of the responsibility for the treatments upon themselves. When it is suggested that men accompany their wives for appointments, couples get concerned about issues like income loss, use of time, etc. While these concerns are usually relevant and important, they also serve the purpose of protecting husbands from their own responsibility in the conception process and from their own feelings, which could easily be intensified by so much contact with the medical process.
Men are traditionally seen as the financial providers of the relationship and are responsible for protecting the family from real or imagined dangers. Men usually feel more threatened expressing themselves since they have often been conditioned to repress their emotions. They are trained to be more instructional to take charge, to make decisions and to think without being sidetracked by emotions.
Males in infertile couples often feel overwhelmed by the intensity of their partner’s emotions as well as an inability to access their own. They tend to focus their energy back into their work, a place where they feel they can have more success.
Impact of Infertility in Women
As a result of taking responsibility for the emotional impact of infertility, the woman experiences intense feelings, such as pain, anger, fear, etc., which, combined with the messages that her way of dealing with things is in some way dysfunctional or “crazy”, causes her to feel an anxious depression. As feelings spill out, she feels out of control and doesn’t really know how to ask for what she needs, especially from the husband she is struggling so hard to protect. She may yearn for an emotional connection/interaction at one moment and in the next withdraw emotionally from her husband when she fears she has disappointed him.
Men find themselves in a position where, regardless of how well they’ve been trained to solve problems, they are helpless to make this situation better for the woman and, as a result, may give off messages that she is “too” emotional or sensitive, hoping that this will calm her down. The wife hears this as a criticism of her coping and caretaking skills rather than as an expression of her husband’s fears.
This is the time when couples cling together for dear life, feeling that they’ve failed in the most basic of all roles: reproduction. Couples are hesitant to admit problems in their marriage, feeling that having difficulty coping would mean that their marriage is also a failure.
Luckily, there are ways that men and women can help each other balance thinking and feeling as they struggle side by side on their journey toward parenthood.
The questions then arise:
- How do I get what I need from my partner?
- How can I support my partner during this difficult time?
Here are some suggestions to help both partners during the infertility process:
- Communicate openly with each other.
- Realize there’s no right or wrong way to feel. Getting in touch with your feelings will help you know what you need. Once needs are identified, clearly and specifically tell your partner how to help you.
- Ask your partner what she/he needs rather than assuming that you can/cannot give it.
- Recognize the psychological and emotional differences between men and women.
- See if you can teach each other some of the skills you’ve learned from your own life experiences as a man or woman.
- Share more in the process of treatment. Share both the burdens and joys of your different perceptions/experiences of infertility. It will help to balance the intensity and bring you closer with a deeper respect for each other.
The process of IVF(In-Vitro-Fertilization) involves the ovarian stimulation with hormones with the intention of retrieving more eggs. The whole idea is to have enough eggs to produce an optimum number of good embryos to transfer and to freeze a few in case the fresh transfer fails. The question here is how many do we actually need? What is the optimum number of eggs needed to achieve a live birth, which in turn is the ultimate aim of IVF?
Does the collection of eggs increase the chance of pregnancy?
The higher number of eggs retrieved is associated with a probability of more chromosomally normal (euploid) embryos which can implant and give rise to a living birth. Chromosomally abnormal embryos (“aneuploid”) are unlikely to develop as pregnancies, and, if they do, frequently result in miscarriage. The frequency of chromosomally abnormal embryos increases with age and thus the pregnancy rates decrease with age. To produce one and two euploid embryos respectively, five and 14 oocytes would be required at age 34, while 10 and 24 oocytes would be required at age 38. Thus it makes sense to retrieve more eggs.
But this comes at a cost .. To retrieve more eggs often we have to use a higher dose of hormones increasing the cost as well as the side effects. It also leads to a potentially serious complication of ovarian hyperstimulation where they collect fluid in the abdomen, lungs and also susceptible to hypotension, increased clotting tendency and at times renal shutdown. The excessive ovarian response can also cause the enlarged ovaries to twist on its pedicle, cutting off its blood supply – what we call as ovarian torsion. This is an acutely painful condition which requires immediate medical and surgical attention. Another reason for concern is the compromised egg quality for unknown reasons when there is an excessive ovarian response. The raised estradiol hormone in case of excessive ovarian response advances the implantation window, thereby causing an asynchrony between the embryo and the endometrium (uterine lining), ultimately decreasing the implantation rates.
Frozen Embryo Transfer
So our aim in IVF cycle is to retrieve anywhere between 8 to 15 oocytes, so as to consider a fresh embryo transfer and also to expect a reasonably good pregnancy rate. Studies have proven that pregnancy rates steadily increase till 15 oocytes and thereby it decreases. When there is hyperresponse we may have to defer embryo transfer and freeze all embryos to avoid potential complications of ovarian hyperstimulation. They can be transferred at a later date after preparing the endometrium – Frozen Embryo transfer.