Babies Tale

Of all the new fertility treatments that have been developed, IVF has had the greatest impact. Since the dramatic news of the birth of baby Louise Brown in England on July 25, I978, IVF has given new hope to women who previously had no hope of a baby due to blocked or scarred Fallopian tubes. At the same time, it is important to remember that IVF is demanding in terms of time and emotional stress. It is expensive, is not readily available, and the failure rate is still high.

The success rate of IVF varies, but the most accurate figures show that just over I0% of all treatments actually result in a live baby. In specialist centers where larger numbers of IVF treatments are performed, the success rate is higher than in small centers, and the success rates also depend on the age of the women treated. If the treatment is at least a partial success-for example, the embryo may be fertilized and divide normally but fail to implant, or the woman might have an early miscarriage-most centers will probably give the woman another chance, but few recommend more than three or four attempts. The success rate of IVF also decreases with the woman’s age, especially once a woman reaches the age of 39. Official figures show that live birth rates per cycle went from I6% of women aged 25 to 34, to II % of women aged 35 to 39, to 5% of women aged 40 to 44. When donated eggs were used, the figures were higher.

IVF is a lengthy process. First, the woman’s menstrual cycle has to be controlled with drugs such as clomiphene or HMG (Pergonal or Humegon) to ensure she will ovulate at the right time for treatment. Drugs are usually used to stimulate her ovaries to produce more than one egg at a time. To do this, the woman’s hormone levels have to be carefully monitored by blood tests and often by ultrasound scanning. This is done so that several eggs can be fertilized at once, increasing the chance of success. Also, more than one embryo may be transferred, to increase the chance of at least one implanting and developing further.

The woman then goes into the hospital for an egg-retrieval operation, which involves a local and sedation anesthesia. A gas is pumped into her abdomen and an instrument called a laparoscope is introduced through a small incision in her abdomen. With the laparoscope, the doctor views the ovaries and can remove any ripe eggs from the follicles. Today, vaginal egg collection is sometimes done. The retrieved eggs are kept in a special culture fluid to allow them to mature. Then they are fertilized with the husband’s sperm, which he is expected to produce by masturbation. Fresh semen is used if possible, because this increases the chance of success slightly, but under the stress of the procedure some men are unable to produce any. For this reason, sometimes semen is collected earlier and frozen in readiness for use at the appropriate time.

The sperm and eggs are mixed in the special culture solution to aid fertilization. If fertilization does take place, the embryos are allowed to develop for two or three days, so doctors can make sure development is normal. The embryos then are introduced into the woman’s uterus in a process usually called embryo transfer. When the eggs are ready to be transferred, the woman will have to lie on her back with legs raised while the doctor passes a sterile catheter containing the culture fluid and embryos through the cervix (neck of the uterus). This procedure is usually done with the help of ultrasound monitoring. A mild sedative may be given to help the woman relax during this procedure, because passing anything through the cervix can be uncomfortable. Following the transfer, most women are asked to rest in bed for I0 to 30 minutes before leaving the clinic.

If there is a choice of embryos available, only the best will be introduced. If not, some embryos that appear less suitable may be used, because they do sometimes develop normally and produce a healthy baby. Most abnormal embryos are lost early. There is no evidence that babies born through IVF are any more likely to have serious health problems than those conceived naturally.

Over a period of months or years, attempts to conceive with the help of IVF can take over a couple’s life. For the woman, it can be difficult to keep a job or do anything else while IVF is being attempted. The frequent disappointments can seem overwhelming. Many mothers also find the existence of IVF, and the opportunity it represents, makes it harder to “let go” and accept childlessness, or, if they already have one child, that their child will never have a brother or sister.

In GIFT, eggs and sperm are collected in the same way as in IVE But then the eggs and sperm are reintroduced together into the Fallopian tube, through the uterus, in a process similar to embryo transfer. It is hoped fertilization will take place naturally. This procedure does not require sophisticated equipment for embryo culture. The embryo is formed not in a culture medium but in the woman’s own tubal fluid. This may mean there is a greater chance of the embryo developing normally and implanting.

GIFT can only be used when the woman still has one functioning Fallopian tube, so it is not an alternative to IVE It is normally used when no reason can be found for infertility (unexplained infertility) or when there is evidence the woman’s cervix is hostile to the man’s sperm, or the sperm are failing to make it to the egg. Success rates of 25% to 30% have been claimed, but in reality the success rate is likely to be similar to that of IVE In cases of male infertility, IVF is probably preferable to GIFT.

Some experts feel GIFT is used too often for couples with unexplained infertility, who have no signs of abnormalities and might conceive normally. One example is Jenny, who had her first son at 33. Two years later, she and her husband decided to try for another baby but seven months later, when nothing had happened, they went for fertility tests. Her husband Tom was told his sperm count was on the low side, but after he had given up alcohol, tried acupuncture and generally improved his level of fitness, they were told there wasn’t a problem. “All the time there was hope; after all, we had had Jake. Time was marching on; Jake was four, I was nearly 38, and still no baby. I felt some pressure. We tried GIFT, but this was very invasive, stressful and didn’t work. My whole life was consumed with treatment and worrying about having a second baby. I worried that Jake was missing out. Once I reached 40 I decided just to give up. Soon after, I discovered I was pregnant with Bradley, who was born safely when I was 4I. Who knows whether I could have become pregnant sooner if we hadn’t been messing around with GIFT?”

Because most infertility treatments do become less successful with age, some doctors and clinics may decline to treat women over 40. However, some doctors strongly disagree with this policy and will treat women regardless of age if they believe the woman has a strong argument in her favor, and there is no reason why she shouldn’t have a baby.

If a woman cannot use her own eggs because the chance of pregnancy is too low, she may succeed with donor eggs. This leads to a situation in which a woman may give birth to a child who is genetically not her own. When donor eggs are used, the embryos are likely to be of better quality and more likely to implant. The risks of a multiple pregnancy in an older-age woman are very real with this method.

The new treatment of using egg donation in women who have had premature menopause or indeed in menopausal women up to the age of 50 was first used in Britain in I986. The first mother gave birth to twins at 46; the second was 43. Research has shown that, provided a woman has no problems with her uterus and she responds well to hormone-replacement therapy, the success rate following egg donation can be high. The oldest woman to date to give birth, in Los Angeles in I997, was 63. She relied on a donated egg and her husband’s sperm.

The success rate when donor eggs are used seems to depend more on the age of the donor than on the woman who receives the egg. In particular, miscarriage rates are the same as those of younger women rather than the higher rates usually found in older mothers.

Following the success of egg donation in helping women in their 40s to conceive, other doctors-notably Professor Severino Antinori in Rome and Dr. Mark Sauer at the University of Southern California-have used the same treatment on women in their fifties with great success.

Many criticize the treatment because it overturns the “natural” order although we know that it can be natural for a woman to conceive as late as 57. But how many women will want to choose that option? Women who have suffered infertility problems for years and given up the hope of ever having a baby may now be able to step forward and receive help. This was the case with Giuseppina Maganuco, a 54year-old homemaker from Sicily, who had spent years unsuccessfully trying to conceive. She had had surgery for blocked Fallopian tubes before being told she was too old to have a baby. Dr. Antinori used donated eggs mixed with her husband’s sperm to achieve the birth of baby Anna Maria in December I99I.

Using donor eggs raises further ethical considerations, They have been used for various infertility treatments, where the woman has no ovaries but has a healthy uterus, where her eggs are unsuitable for transfer in IVF, or where she has some genetic abnormality she does not want passed on to her children, Donating eggs involves the donor going through the IVF procedure except for the embryo transfer. She takes fertility drugs to induce her to produce more than one egg for donation, and she has to undergo a minor operation-called a laparotomy-to collect the eggs. She must be highly motivated to agree to these procedures. Some women who have experienced fertility problems themselves donate eggs, as do sisters, friends or other relatives of the infertile woman. Some doctors are wary of using eggs from close relatives because they fear this may cause stress in the family and confusion in the child as to his or her “real” mother; however, unknown donors are hard to find.

Christine became an egg donor in I99I when her friend Jane was turned down for egg donation at a private fertility clinic. “They told her that, at 4I, she was too old and that they would only give the treatment to a younger woman for whom the chances of success were higher. This was the end of a long saga of fertility problems and miscarriages; she had also been turned down by adoption agencies because of her age.

“I asked her if they would do an egg donation if she found a donor and offered myself. They were reluctant; we had to bully them into it. I had to have counseling to make sure I understood what I was doing, and I had to sign a piece of paper waiving all my rights to the eggs. I had an AIDS test, and I had to have a course of ten injections and use a nasal spray every four hours or so. My cycle had to be synchronized with hers so they could use some of the eggs fresh to increase her chances.

“I did the injections myself, every morning in my rear, for ten days. I had to remember to use the nasal spray, which I didn’t like. I had some pain in my ovaries due to the large number of eggs that were developing. Then I went in, had another large injection and a scan-I could see they had nine eggs on one side and three on the other-and a light general anesthetic while they brought out the eggs.

“At the time I did think about it a lot. I told myself, it’s not a child, its just an egg, but if Jane had gotten pregnant … I think I would have wanted to see the child and know how he or she was doing, especially since I knew Jane. When she failed to get pregnant I was very disappointed, for her and for me, because I had been through something big myself. She wanted me to try again but I didn’t want to. It’s too much and it isn’t pleasant. I told her at the beginning I’d do it once and that was all. It also stirred up a lot of emotions in my family. My mother said she was relieved not to have a grandchild out there she’d never see. And to be honest, I’m a little relieved myself now.”

One Response to “In-vitro Fertilization IVF”

1. roya dolat Says:
   April 21st, 2008 at 3:29 am

   Hi, I am 44 years old, somke 7-10 sigarates per day, I & my husband want to have a baby, please noyify me what are the chancds oh having a healty baby and sercomstances and what should we do?
   best regards

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