Jennifer Edwards, sexual and relationship therapist, has been working with couples and individuals for more than 20 yrs. Jennifer gives us the inside story on IVF. Every year thousands of couples in the UK seek IVF treatment through the NHS and in the private sector. The majority of them are over 35 years old. For perhaps 75% of these couples, IVF will fail to deliver the much longed for child.
It is now more than 30 years since Mr Patrick Steptoe, consultant gynaecologist, and Mr Robert Edwards, a Cambridge research physiologist, pioneered the technique which produced the world's first test-tube baby, Louise Brown. The church can always be relied on at times of major scientific breakthroughs to utter a word of caution, and at the time of Louise's birth it was Cardinal Gordon Gray the Archbishop of St Andrews and Edinburgh who said “I have grave misgivings about the possible implications and consequences for the future”. I wonder if Cardinal Gray or anyone else at the time could have possibly envisaged the fertility industry that was to follow.
Infertility has become a worldwide industry and it has marketed itself well. It sells hope, that most powerful of commodities. The hope that you can have a much longed for child and be spared a childless life. Hope, you can't see it or touch it but you can feel it. Not dissimilar to religion really, and equally successful and divisive.
NHS trusts across England and Wales are seeking to provide the same level of IVF provision but at present eligibility for IVF treatment is decided at a local level. The national guidelines require that the woman is no more than 39 years old, the reason for her infertility has been identified and that the couple have tried to conceive naturally for at least three years. Most primary care trusts will offer a couple a maximum of three cycles and priority will be given to those who have no children of their own. Anyone who doesn't meet the criteria can then look to the private sector and choose from clinics across the world; from China to Czechoslovakia, from Rangoon to Romania. This worldwide industry knows no bounds and, as with other major industries, many associated businesses have also blossomed. Hotels have sprung up near to the clinics, airport transfer companies ferry the hopefuls between clinics and hotels and laboratories do good business to provide the various medical tests which the clinics deem necessary.
It's a shopper's paradise but also a minefield. In many countries the fertility industry is poorly regulated but very well marketed. As with all advertising the devil is in the detail and the small print. Some clinics operate a two-tiered system, whereby women who are likely to conceive are processed through one clinic and those whose chances are slim are diverted to a sister clinic. This enables them to exploit the success rate in one clinic for advertising purposes whilst not including the failure rate of the sister clinic.
The advertised ‘success rates’ of private clinics is also worthy of scrutiny by potential customers. Success may mean an embryo which has successfully been transferred to the uterus. It does not mean a full-term pregnancy and the birth of a child. It may also be categorised as a live birth. Again, this may relate to the exceedingly premature birth of a child unable to survive. The Human Fertilisation and Embryology website has copious amounts of information with regard to success rates and what they actually mean.
It’s a reflection of today’s ‘have it all’ society for young couples to believe that having babies can wait until they've done their travelling, made their mark in their career and got their lifestyle right. If by this time they're well into their 30s or even touching 40 then they'll have their babies and if the babies don't come along after a few months well, not to worry, there's always IVF. With the advent of the Internet, medical terms slip off the tongues of young women with amazing ease. They speak authoritatively about the quality of their eggs, their FSH levels and sperm mobility.
Yet infertility is still a subject which lots of couples do not share with their friends and family. Many couples only disclose that a child was conceived through IVF when they're well into their pregnancy and confident that nothing is likely to go wrong. I still hear women and men express a sense of shame and embarrassment that they are not able to conceive a child.
What becomes of these couples, these people for whom IVF has failed? What is the true cost to their lives of this most expensive and intrusive procedure? Infertility and failed IVF treatment proves to be too stressful for many couples and their relationship is often irreparably damaged and may end in separation or divorce. Others seek professional help with a specialist sexual and relationship therapist like me in order to see if it is possible to pick up the pieces both emotionally and sexually and attempt to reconstruct their relationship.
Lucy and David had been together for eight years and married for four of those years when they first came to see me. They were in their late 30s, both with good jobs when they decided that the time was right to start a family. Lucy conceived relatively quickly but eight weeks into the pregnancy she had a miscarriage. By this time she had celebrated her 39th birthday, and felt dangerously close to that watershed in the world of fertility, being 40. And so the urgency began. Suddenly assumptions about conception, pregnancy and birth were snatched away. Mother Nature stepped in and said “Hang on, it's not that easy and I'm in charge”. Six months later and no sign of a further conception, concern then set in. They both agreed that a visit to the doctor was needed. The doctor referred them to the local infertility clinic. Sperms were counted and mobility noted. Ovulation was recorded, FSH levels were monitored and fallopian tubes were checked in order to establish they provided a viable route of the egg to reach the uterus where it would meet the sperm and so yet again another human being could be created.
However, for Lucy and David one year on from the original miscarriage there was a still not a baby in sight. Their tests had shown that nothing was obviously wrong and it was sensitively pointed out to them that their local health authority had a policy of not offering IVF treatment to women over 40. It was at this point, as completely naive punters, they entered through the portals of the fertility industry. One year on and £20,000 poorer David began to question what they were doing. Lucy however was feeling more and more desperate for the child she felt as a woman was hers by right. It was at this point that their relationship began to suffer. David said “At this time every fibre in my being was screaming ‘Stop. What the hell are you doing? Get off this roundabout as soon as you can.” When he tried to confront Lucy with this she accused him of not loving her, saying if he did he would support her in her need to continue their quest for a child and explore further treatment. They then sought help in Eastern Europe where treatment is usually cheaper than in the UK.
At their initial consultation held in London they were persuaded that a donor egg may be of better quality than Lucy’s own egg. (Of course it would be more expensive too!) Four weeks later they arrived in a grey ex-soviet city at the beginning of winter. They checked into the hotel close to the clinic. It was a huge concrete building left over from the soviet era. Treatment was due to begin the next day. That evening in their shabby room they had nothing to say to each other. After a sleepless night Lucy woke the next morning feeling ill and nauseous with anxiety. David was very distressed. After a tense and tearful conversation they both agreed to fly home without the treatment. Lucy and David both felt they had a chance to save their relationship at that point, regardless of whether or not they had a family. Three months later they made contact with me to seek help to explore what had happened to them and what was left of their relationship. They had not had sex for over a year, they spoke in monosyllables to each other and socialised with friends and family less and less.
Sally came to see me after four rounds of IVF following a miscarriage at the age of 37. She and her husband Joe went straight to the private sector believing that private is best and there’s no waiting list. After each round the embryo was transferred, and after a number of days the clinic confirmed a positive pregnancy test. However, with each cycle she began to bleed within seven days of the pregnancy test. According to the way in which many clinics define their success rates, sat before me was a ‘success’. So why was she quietly sobbing and unable to speak?
Sally felt unable to cope with the relentless cycle of hope followed by disappointment. She said she felt it had broken her into tiny pieces and she didn’t know how to put herself back together. Her friends, family and husband seemed confused by the person she had become and veered between being sympathetic and then angry towards her. This was the first time in Sally’s life that she had not been able to attain something she set out to achieve. At our first meeting, between her tears, she reiterated what a confident, positive and hard-working person she was. Sally wanted to know what had happened to her on her IVF journey.
Perhaps the dark side of IVF is best summed up in the words of Karen, another woman for whom IVF was a nightmare. “I too had been brainwashed into thinking that if we kept on trying IVF in the end we would succeed. Nobody ever talks about the roller-coaster ride, how it feels to be childless, broke from the huge medical expenses, your relationship and sex life strained to breaking point, your self-esteem as a woman questioned and at rock bottom. IVF is pitched as the saviour to all fertility issues. It’s mentioned in magazines; miracle babies after the tenth attempt etc. Nowhere do we see the other side of this industry. Nobody warns women and couples about the devastation it causes. What happened to sisterhood?”
Copyright Jenny Edwards 22.11.10 Private Therapy Ltd