Are we over using IVF?

Originally IVF was developed for women with tubal disease. It was then expanded for use in men with poor semen quality. Now IVF is being applied to other types of subfertility such as mild male subfertility, endometriosis and unexplained subfertility.
Are we over-treating couples who had a reasonable chance of conceiving naturally? Is it equally effective in these conditions? What are the consequences of using IVF? Do the risks outweigh the benefits?

What is meant by IVF?
IVF is commonly used term for Assisted Reproductive Technology (ART) which includes:

• Assisted insemination (AI) or Intrauterine insemination (IUI) – sperm introduced in uterus around ovulation for fertilisation
• In Vitro Fertilistation (IVF) – when egg and sperm are put together in test tube to fertilise prior to transplantation into the uterus
• Intracytoplasmic Sperm Injection (ICSI) – sperm is injected into egg for fertilisation prior to transplantation into the uterus
• Gamete & Zygote Intrafallopian Transfer (GIFT) – gamete (egg & sperm) are introduced into the fallopian tube; less often used

Rising Rates of IVF

• One million babies were born in first 25 years of IVF (1978 – 2003)
• An estimated 5 million babies will have been born to IVF by end 2013.
• 2-3% of all births occurs via IVF in developed countries

Unexplained Fertility and IVF

• More than 90% of fertile couples are expected to achieve conception within 12 months of contraception-free sexual intercourse
• Sub-fertile couples are considered to have a good prognosis for natural conception in 2-3 year timeframe of trying to conceive
• Unexplained fertility accounts for 25-30% couples presenting for IVF, and many of these conceive before treatment. A Dutch study of 500 sub-fertile couples showed 60% conceived naturally after their initial assessment at the fertility clinic.

 

Emerging Risks of IVF

• Multiple pregnancies are associated with maternal and perinatal complications; this is not such an issue in Australia where single embryo transfers are the norm
• Some studies show 50-70% additional risk of preterm birth and congenital anomalies
• Healthy children born through IVF may have higher blood pressure, glucose levels and vascular dysfunction than children conceived naturally. Epigenetic and developmental abnormalities after ART have been shown in animal studies.

Emotional Adjustment to IVF

• IVF is a multidimensional stressor; many couples seeking fertility help, especially IVF are not prepared for the challenges ahead
• The treatment (doctor visits, hormonal changes, daily injections) constitutes the primary stressor and is most likely to evoke anxiety
• The unpredictable outcome of the treatment is another major stressor and more likely to evoke feelings of depression
• Other considerations are the financial burden and the impact on the couple’s marriage

IVF or not IVF?

• IVF has allowed many infertile couples to have a family
• IVF procedures are improving and having increasing success. Although IVF success rates fall away with increasing maternal age
• Some couples will be clinically defined as infertile, that is, unable to achieve spontaneous conception within 12 months of contraception-free sexual intercourse
• However, many of these may indeed be sub-fertile, and just need more time to try for spontaneous conception

Next week: Nutritional Support for IVF
If you would like more information on IVF procedures and support, please call the clinic on 9976 5466.