Infertility treatments can be draining, physically and mentally, so get ready for a wild ride.
The term IVF is commonly used to talk about any form of assisted conception, but it actually refers to a specific procedure, in-vitro fertilisation. No matter what you call it or which exact procedure you're having, there's one thing you can be sure of: it's not going to be easy.
"A huge rollercoaster ride" is how parent-infant counsellor Nichola Bedos describes the experience of going through IVF procedures. "It's an incredibly stressful period," she says. "And as soon as [couples] get pregnant it's 'oh my god, something may go wrong'."
It's a stress that more and more Australian couples are going through as the number of babies conceived via IVF continues to rise each year. Yet despite an increase in the number of successful pregnancies, there are also a lot of couples out there who don't end up with a baby.
Some experts estimate that roughly one in four women will have a successful pregnancy via IVF. Even though couples are advised of this success rate when they start treatment, it can come as a huge shock if it doesn't work, says Nichola, whose work with couples undergoing IVF treatment and with families raising IVF children led her to write the book IVF & Ever After (Rockpool Publishing, $32.95).
Dealing with your feelings
A diagnosis of infertility is traumatic and can give rise to feelings of failure, anger, grief, blame, self-pity and jealousy, putting a strain on even the most loving relationship. It's important to acknowledge these emotions and talk about your feelings with your partner. Don't get caught up in the medical aspects of your infertility and neglect your emotional health.
"Arriving at the door of an infertility clinic without having reflected on the feelings evoked by a diagnosis of infertility can be disastrous," writes Nichola.
Give yourselves space and time to mourn the fact that you won't be able to take part in the normal process of conception. Face your fears that pregnancy, birth and parenthood may not be possible for you. You need to keep the lines of communication open with your partner to help you get through the stressful times ahead.
Getting started
Despite the grief you may feel, there are reasons to be positive about the journey you're about to embark upon. Once you've chosen to start IVF, you can do things to maximise your chances of a successful pregnancy — for example, Nichola counsels couples on diet and exercise and how to cope with stress.
Choosing the right time to start an IVF program is crucial. Nichola advises couples not to begin the treatment when they're moving or renovating their house, caring for a sick relative or starting a new job — all times when stress levels naturally rise.
When the treatment begins, so does an incredibly stressful period. The hormone treatment that women undergo on IVF can make you feel very different and treatment can be very tiring and bring with it a whole new set of anxieties.
Stages of IVF
IVF involves a series of procedures that take place over several weeks. In the first step, your ovaries will be stimulated with a hormone to produce a number of eggs; normally a woman produces just one egg a month. Blood tests and ultrasounds will monitor the eggs and ensure they're collected at the right time. You'll be given a light anaesthetic or sedation for the collection procedure. An ultrasound will find the follicles holding the eggs and a needle will be inserted via your vagina to collect them.
Your partner must then provide a semen sample. This will be combined in a dish with the eggs or the eggs may be directly injected with the sperm. The fertilised egg is known as a zygote and will be incubated for one to four days before being transferred to your uterus via a soft fine catheter (a procedure called embryo transfer).
Now you face a wait of two weeks before you have a blood test to find out if you're pregnant. It may feel like the longest two weeks of your life!
The pregnancy
You may have to go through all this several times, as only the lucky ones get pregnant on their first IVF attempt.
"It will often take three or four attempts before it works," says Nichola. "But [overall], by the third attempt, 66 percent of women will be pregnant."
A positive result is obviously a great relief, but your worries aren't over just yet. "Spotting is more common in IVF pregnancies, though we don't know why," says Nichola.
Bleeding in any pregnancy is worrying but in an IVF pregnancy, which has been so longed for and has caused much suffering, it can be especially devastating. Spotting or staining can occur 10 to 12 days after fertilisation, often with no further consequences or ill effects on the baby, but Nichola explains that "it feels like the end of the world for IVF couples".
Some pregnant women have an ultrasound at six or seven weeks, then almost all women have one at 12 or 13 weeks. But that's often not enough for IVF parents, says Nichola. "They end up having more questions than couples who conceive without assistance."
Many couples worry about miscarrying in the first trimester but for IVF couples this is an even greater concern. "They can feel that the manipulation of the egg and sperm will cause something to go wrong," she adds.
Once the pregnancy is well established, there will be tests and regular visits to antenatal clinics and obstetricians. Some women undergoing IVF will suffer from depression during pregnancy. In this case, it's important to seek help from a counsellor who can answer your questions, treat the depression and help you and your partner prepare for parenthood.
The birth
There's no reason an IVF birth should be any different from the birth of a baby who was conceived naturally. Going to antenatal classes will answer many questions and worries you have, most of which you'll find are common to all couples expecting their first child.
IVF parents who have conceived twins or triplets are likely to go into labour prematurely and more likely to have a caesarean. Twins have three to six times higher rates of neonatal and perinatal mortality and the risk of cerebral palsy is six times higher. Rates for triplets are even greater.
About 50 percent of IVF babies are delivered by caesarean section. Some IVF mothers will opt for a caesarean because they think it's safer. The main medical reasons for a caesarean for a single birth are the same as for multiple births. If there are no medical issues, babies who are delivered naturally are generally at less risk than those delivered surgically and have fewer breathing problems.
Parenting stress
Women who conceived with IVF are more likely to doubt their mothering abilities and experience difficulties parenting, according to a study by the University of Melbourne's Dr Karin Hammarberg. According to Dr Hammarberg, IVF parents have very high expectations and feel "they need to earn the right to parent their child".
IVF parents often turn to a counsellor such as Nichola for help because they are having problems parenting. Parenting twins can be stressful and Nichola finds she needs to work especially with these parents on developing coping strategies.
"IVF parents, even more than other parents, need regular reality checks," she writes. "They need to be helped to focus on what is normal, healthy and acceptable."
For more information on assisted fertility processes and infertility, visit the website of Australia's National Infertility Network at www.access.org.au. The group is a consumer-based, not-for-profit, independent organisation and the site is a valuable resource that provides news, links to other informative sites, a directory of IVF clinics and much more.
All material is © Mother & Baby: Making Babies
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