What are the most common fears when it comes to IVF treatment? Here are the top search suggestions that Google autocomplete suggests when I typed in “Does IVF…”
- “…hurt”
- “…work”
- “…cause cancer”
- “…work better the second time”
- “…work the first time”
The results for a query on “Is IVF…” were similar with a few expected additions:
- “…safe”
- “…painful”
- “…covered by insurance”
- “…tax deductible”
So it’s pretty clear that people are still focused on a couple of basic questions when it comes to IVF. Let’s look at each of these in just a little bit more detail. Those concepts that need some extra explanation beyond the scope of this blog post, we will expound on in future posts.
1. How Successful is IVF?
There are a couple of important points to consider here. First, there is no single answer when it comes to IVF success rates. However, the response “It depends” is a frustrating one and not very helpful to someone looking for some answers, so I will try to provide some useful and helpful information.
First, it is important to note that IVF is still the most effective and efficient method of fertility treatment available for most couples that are struggling to conceive. In most cases, other forms of treatment will have significantly lower success rates than IVF. For a woman in her 30s, a skillful and experienced fertility specialist should be able to achieve a 60%-80% pregnancy rate per embryo transfer with IVF treatment on average, if embryos have previously proven to be genetically normal. There are a number of variables here, of course.
A patient aged 31 will typically have better success rates than a patient aged 42, due strictly to the biological clock and age-related fertility decline. This is also assuming a similar diagnosis across all patients, which is also not realistic. Your specific diagnosis will have a significant impact on success rates. The good news is that with the protocols and technology available for both diagnosis and treatment, a competent Reproductive Endocrinologist should be able to provide a reasonable estimate of success rates for a woman with similar diagnosis, history, and circumstances.
2. How Expensive is IVF Treatment?
Because In Vitro Fertilization is rarely covered by insurance, people have a tendency to focus on the out-of-pocket costs as a lump sum. It does make for sensationalist headlines to throw out a huge number that a particular couple has spent on IVF Treatment — $50,000 … $75,000 … $120,000. That’s because it probably wouldn’t make the 6:00 news if they profiled someone that had spent $15,000 on IVF Treatment.
The average cost of a single “cycle” of IVF at Caperton Fertility Institute is currently $14,900 plus the cost of medications (which are generally around $3,000 but can range a bit, dependent on the custom-designed stimulation protocol that is created for your care). In addition, there is a fee for biopsy and genetically testing the embryos that are created during the cycle.
We are a unique facility that does not believe in high-dose medications that overstimulate and hurt the quality of your oocytes. A typical egg retrieval may yield 8-15 eggs, which are then prepared and fertilized in our lab. This number can differ dramatically depending on ovarian reserve (the number of remaining eggs in the ovary) and the quality of the eggs. It is significant to note here that we believe that all patients should have an opportunity to use their own eggs when possible, even if they are not great candidates for stimulation or yield a small number of eggs during the process. Our focus is on the patient’s wishes (as long as they are medically sound) rather than inflating our success rates, so if a patient wants to attempt an IVF cycle with her own eggs despite long odds, we will usually encourage and accommodate her.
Of the eggs retrieved, approximately 80% of those will be mature and capable of fertilization. Approximately 90% of eggs that are micro-injected via ICSI will fertilize normally when assessed the next day. From that point, the embryos will need to grow in culture for 5-6 days, until reaching the blastocyst stage. When the blastocyst has appropriately developed, a microsurgical procedure will be performed in order to carefully biopsy the embryo with a laser, and extract a few cells to use for genetic testing or DNA sequencing. Assuming 30-50% of the embryos will be chromosomally normal, this will yield 1-3 viable embryos, on average, for transfer to the uterus. All embryos will then be frozen so that we can stimulate the uterus with a more natural style of preparation – one that mirrors what happens physiologically in conventional pregnancies. With the uterus prepared and the embryos painstakingly screened, we perform the embryo transfer. We have found that this sequence of protocols provides the optimum environment for a successful pregnancy at minimum risk due in part to the advancement of vitrification techniques over the last decade.
Since we advocate strongly for Elective Single Embryo Transfer (ESET), some of our patients will be able to undergo several embryo transfers for each egg retrieval. And, because the likelihood of a positive pregnancy test in our clinic with these protocols and a single embryo transferred averages 60-80%, the odds of a pregnancy over two embryo transfers is even higher.
Unfortunately, not all pregnancies will continue to progress, even after a positive beta hCG test, but in our experience, embryos that have been genetically tested appear to offer a much greater chance of an ongoing pregnancy than those that have not been tested, including natural pregnancies.
At Caperton Fertility Institute, we are on a continual quest for breakthroughs – large or small – that can provide an incremental (or monumental) boost in our patients’ chances of a successful outcome.
It is also significant to note that the cost of a frozen embryo transfer without stimulation medications, monitoring and coordination is substantially less expensive than a full stimulation and egg retrieval cycle. Patients with remaining embryos stored in our advanced cryopreservation facility can return for a subsequent embryo transfer where the costs usually total less than $5,000.
3. How Safe is IVF?
There are a couple of issues that drive many of the concerns about the safety of IVF treatment. Most people associate IVF with high-profile stories like that of the infamous “Octomom” whose doctor transferred 12 embryos at her request. The result was a medical fiasco and a tabloid dream story – octuplets. A rational review of the circumstances should help allay fears that this is in any way typical. The mother was clearly not operating from a normal and rational mindset, nor was the doctor.
At Caperton Fertility Institute, we strongly encourage single embryo transfer to minimize the potential complications of multiples. As a result, we have never had a set of triplets born through IVF, and only a handful of twins, all of which to this point have been patients that have respectfully declined our recommendation for single embryo transfer. This policy, and our commitment to our patients, makes Caperton Fertility Institute one of the safest fertility clinics in the nation when considering outcomes.
4. Will IVF Cause Me to Run Out of Eggs Faster?
Because IVF uses fertility medications that cause a woman to produce multiple mature eggs, there is a misperception that this speeds up the depletion of a woman’s egg supply and pushes her towards menopause faster. It is true that a woman has a finite supply of eggs and that once this supply is depleted, she enters menopause. However, IVF doesn’t increase the number of eggs that are “used up” in any given month. In reality, a large number of eggs are recruited in a woman’s menstrual cycle every month. Without the aid of fertility drugs, just one or two of these eggs will become mature and ovulate. What IVF stimulation medications do is cause more of these eggs to become mature and available for fertilization. So IVF is not increasing the rate at which eggs are used, just increasing the number of eggs that mature in the ovaries in a given month. Our natural cycle selection creates one egg for fertilization, but the other eggs, which normally are destroyed by the dominant egg, can often be “rescued.” That is, using the above-mentioned methods and protocols, we can often times save the “good” eggs in the cycle, and create healthy embryos from more than one egg at a time.
5. Do Fertility Drugs Cause Ovarian Cancer?
The short answer: NO, it does not appear that fertility drugs have a causal link with cancer. In 2005, Oprah Winfrey dedicated a show to the review of a scientific study that showed an increased rate of ovarian cancer in women who had used the fertility drug Clomid. The immediate reaction from the media was to declare that fertility drugs were the cause of the cancer. HOWEVER, just because two things happen within a certain group of people doesn’t mean that one is causing the other. For example, if there are two people in a group with blue eyes and they happen to be involved in car accidents, we can’t assume that having blue eyes caused the accidents.
What was revealed after further analysis was that women who never experience pregnancy or who get pregnant after age 35 are at a higher risk for ovarian cancer. In addition, women who have been on the birth control pill are less likely to get ovarian cancer.1
Because infertile women generally align with the higher risk groups mentioned above, their incidence of cancer happens to generally be higher. Another potential factor that might contribute to both is obesity. Obesity is a risk factor in both infertility and cancer, so this could have been a more significant link to the cancer than fertility drugs. A number of studies done since this time have examined the link between fertility drugs and cancer, but have not found a significant correlation. This included a review of studies that involved more than 180,000 women, which concluded that there was not an increased risk of cancer in patients that used fertility drugs.2
6. Is IVF Painful?
One word…NEEDLES. One thing that most people know about IVF treatment is that there are needles involved. This is true. IVF involves a series of self-administered injections, blood tests, and a minor surgical procedure, all of which involve needles. And some of them are big needles. What we find is that even patients who start with a serious aversion to needles don’t seem to rank the injections as anything more than some discomfort in the grand scheme of their treatment. Many patients actually view overcoming their fear of injections as one of their emotional victories. In many cases, it is one of the things that gives people their first taste of success. It seems to be symbolic of overcoming the fear of other things related to IVF.
And the physical pain tends to be the least of people’s real worries when it comes down to it. The prospect of living a life without a child, the pain of wondering if they made the right choices and did everything they could do – these are the things that hold more pain for infertility patients.
Do you have fears that are keeping you from taking the step of pursuing treatment or learning about your options for starting or completing your family? We are happy to answer your questions and address any of your concerns. Contact Caperton Fertility Institute to set up a consultation today. We will help you set up a customized plan tailored to your situation and circumstances.
References
1. The American Cancer Society Medical and Editorial Content Team. (2016, February 4). What Are the Risk Factors for Ovarian Cancer. Retrieved October 31, 2017, from https://www.cancer.org/cancer/ovarian-cancer/causes-risks-prevention/risk-factors.html
2. Rizzuto, I., Behrens, R., & Smith, L. (2013). Risk of ovarian cancer in women treated with ovarian stimulating drugs for infertility [Abstract]. Cochrane Database Syst Rev. doi:10.1002/14651858.CD008215.pub2