In Vitro Fertilisation (IVF) gives a lot of hope to couples who want to have their own children but cannot conceive. However, the treatment can be stressful and it can take a physical and emotional toll on women.
The injectable hormones which are a part of IVF treatment can have side effects like dehydration, mood swings, exhaustion, headaches, hot flushes, and ovarian hyperstimulation syndrome (OHSS). OHSS occurs when excess hormones makes the ovaries swell and become painful.
Femoai spoke to infertility specialist, gynaecologist, and obstetrician Dr. Arockia Virgin Fernando (consultant with Practo) about the success rate of IVF treatments, the risks associated with it, and its mental and physical repercussions on women. Edited excerpts:
- How many times is it safe to undergo IVF?
- What is the success rate of IVF treatment?
- How long should one wait between two IVF cycles?
- Will you also talk to us about the chances of miscarriage from IVF and from other fertility treatments.
- Women are left emotionally and physically exhausted after IVF. It can be very demanding. Will you talk to us about that?
- Women also feel a lot of mental stress while they are waiting to do their pregnancy test after the embryo transfer. Talk to us about that.
How many times is it safe to undergo IVF?
It is safe to undergo IVF three times. Let’s first understand what IVF is. What we essentially do is that we stimulate the ovaries using hormone injections, which are administered everyday. The first step in the process is taking medication to suppress your natural cycle, which is done to make the treatment more effective. This is usually done through everyday injections for about two weeks. Post that, the patient is given a fertility hormone called follicle stimulating hormone (FSH) for about 10-12 days. This increases the number of eggs the ovaries produce. We then retrieve the eggs, which are joined with the sperm in a petri dish. The fertilised eggs or embryos are then transferred to the uterus in a few days.
It is an invasive procedure; we administer anaesthesia while the eggs are being retrieved. The maximum number of times we stimulate the hormones and retrieve the eggs is three. In one IVF cycle, we can get about five-six embryos, and at a time we put in two embryos inside the uterus, this is called an embryo transfer. If one embryo transfer fails, it doesn’t mean IVF failure. You have still embryos left. So if, for instance, you have six embryos, you have at least three chances in one IVF cycle.
What is the success rate of IVF treatment?
The success rate is between 50 to 60% for each IVF cycle for the reproductive age group of 25-33, which is the prime age. In the younger demographic, one embryo transfer can have a success rate of up to 80%. For women above 35, the rate drops down to 20-30%.
How long should one wait between two IVF cycles?
If the first embryo transfer is not successful and you are going for the second one, and the embryos are already stored, you don’t need a break. However, you can take about a month’s break to be prepared for it psychologically.
If your eggs have to be extracted again, then you need hormone injections, and it is then recommended that you take a month’s gap at least so that the body gets time to recover. If you are 35-38 years old and don’t have many eggs left and the embryos didn’t fertilise after the first try, you should take a month’s gap at least before you try again.
Will you also talk to us about the chances of miscarriage from IVF and from other fertility treatments.
The miscarriage rate doesn’t really differ between women who conceive naturally and those who use IVF or IUI (Intrauterine Insemination). Miscarriage in the first three months happens because of chromosomal problems. And it is the same in all the three modes of treatment–IVF, IUI, ICSI (Intracytoplasmic Sperm Injection). There are some studies that show that that there is a marginal 5-10% increase in the miscarriage rate when women opt for assisted reproduction. In IVF, the rate appears higher because the women coming to us are those who are older or who already have problems conceiving. In IVF or IUI, the genetic composition does not change.
The miscarriage rate in the first three months is around 15%, but it is about 25 to 30% for women over 35.
Women are left emotionally and physically exhausted after IVF. It can be very demanding. Will you talk to us about that?
It is cumbersome. There has to be a lot of thought involved when you are opting for IVF. Women undergoing IVF have to follow a strict schedule of appointments, the hormone injections are time bound. For the 10-12 days of IVF stimulation, women have to program their life accordingly. Some women take leave or even quit their job while undergoing treatment. I will not advise them to quit, it’s better to take a time off.
It is cumbersome. There has to be a lot of thought involved when you are opting for IVF. Women undergoing IVF have to follow a strict schedule of appointments, the hormone injections are time bound.
You will feel stressed out. I’ve seen women going to work and then coming in for their injection. But if their work is very draining and exhausting then it’ll have an impact. These injections cause exhaustion, dehydration and headaches. We advise our patients to have a high protein diet as well as include a lot of fluids. If you are working late, and your sleep schedule is messed up, it will have an effect on the hormones. The process can be cumbersome, they have to program their lives accordingly. This is also an invasive procedure, you have to get admitted for half a day for the egg retrieval, and for half a day for embryo transfer. There is also a lot of medication involved. Women have to be prepared.
Women also feel a lot of mental stress while they are waiting to do their pregnancy test after the embryo transfer. Talk to us about that.
After the embryos are transferred into the uterus, there is a 14-day interval before one can do the pregnancy test. That is when women feel exhausted and drained. It can be hard for them to have a normal life during this time. They need to rest and take their medicines on time. These 14 days are the most difficult and mentally exhausting phase for women as they are waiting for their beta HCG (pregnancy test). During this time, they may experience breast pain, some women have spotting, it can be a sign of pregnancy but it need not be a sign of pregnancy. They feel worked up as they may feel that they didn’t get a positive pregnancy result despite the symptoms. We tell all the couples who come to us to have an open mind; they may not conceive the first time, but they have three chances.
For couples who can’t conceive in the first cycle, it can take time to recover from the psychological stress. For women who are in their late thirties, and have only a few follicles in each ovary, the time frame is crucial, it is important to counsel them.
The fertility treatments are a lot more advanced now. But, women may feel isolated, vulnerable, and stressed during the period of the treatment; they need support from their partner and family. Having support groups is also important. It is also important for doctors to understand that each patient comes with unique needs, and they have to be dealt with accordingly.
The fertility treatments are a lot more advanced now. But, women may feel isolated, vulnerable, and stressed during the period of the treatment; they need support from their partner and family. Having support groups is also important.