IVF - where are we now?

"There is no stronger force than the desire for a family and IVF has provided a solution for many couples," said MBF's Chief Medical Officer, Dr Christine Bennett. "IVF research is ongoing and the possibility of successful pregnancies is improving. This fact file has up to date on current expert thinking in relation to IVF and trends in usage of fertility programs."

What is IVF?

Infertility is defined as not being able to get pregnant after trying for one year 1. In vitro fertilisation (IVF) is the process used to conceive a child outside the body. A woman's eggs and a man's sperm are placed together in a plastic dish for fertilisation. Once fertilised, the resulting embryos are placed back in the woman's uterus in the hope that a successful pregnancy will follow ².

Depending on the cause the couple will undergo a series of tests to determine whether there are any obstacles that can be overcome or if not you might be offered a course of management that might end with hormone treatment and IVF.

Why is it important?

For some people who want to start a family but have trouble doing so, IVF can be their sole path. But it is expensive, time-consuming and can be very stressful.

"You know that the first sign of pregnancy is a missed period. Each month, you watch your body and examine your feelings, looking for signs of pregnancy. If your period is late, your spirits rise, only to be dashed. You go to the loo every five minutes, looking for blood. You go through these cycles of emotions month after month. You begin to ask yourself what's wrong with you. You feel you have no control over your body or your life. Conception can become an obsession, and you start to feel isolated."

"It dawns on you that you might have a problem. You might try to deny it. You pretend that this is not really happening to you, maybe you haven't been trying hard enough, or maybe you've been trying "too hard". Maybe you really don't want that baby. Around you, everyone else seems to be pregnant and you can't believe how easy it is for them. You begin to feel angry with your body for letting you down." ³

General statistics:

Approximately 15 per cent of Australian couples have difficulty with conception ³
Around 40 per cent of problems originate in the woman 2; around 40 per cent originate in the male; and for the remaining 20 per cent it is a joint problem or the cause is unknown ³
Average age of women who had assisted reproductive technology (ART) treatment in 2005 was 35.5 years, slightly older than average age (35.2 years) of women who had ART treatment in 2002. The proportion of women aged older than 40 years has increased from 14.3% in 2002 to 15.3% in 2005 ⁴
A report recently published suggests babies born to women who had a single-embryo transfer have more successful pregnancy outcomes compared to babies born to women who had a double-embryo transfer (DET) ⁴

What are the common causes of infertility?

Men: male fertility problems can be caused by abnormalities in sperm numbers, motility (ability of the sperm to move and get to the egg) or morphology (structure of the sperm cell). These may be brought about by factors such as:

Failed vasectomy reversal
Retrograde ejaculation
Blocked ducts
Absence of vas deferens
Mumps
Undescended testes in childhood
Exposure to toxic chemicals
Exposure to excessive heat
Hormonal disorders
Autoimmune (antibody) disorders
Sexually transmitted diseases (perhaps)
Other unknown cause

Women: causes of female fertility problems commonly include:

Tubal problems
Endometriosis
Disorders of ovulation
Premature menopause
Polycystic ovarian disease
Frequent miscarriage
Hormonal problems
Uterine fibroids and polyps
Autoimmune (antibody) disorders
Previous pelvic infection ³

What's happening with IVF in Australia?

A recent report released by the Australian Institute of Health and Welfare showed that the number of babies born to women who have a single embryo transfer (SET) is increasing and that those babies had better outcomes than double embryo transfer (DET) babies. ⁴

Since the Fertility Society of Australia recommended that women under 35 have only one embryo implanted, the number of twins born by IVF has fallen by almost 20 per cent. Babies born in multiple births are more likely to be born underweight and with a higher risk of birth defects. ⁴

The number of babies born after IVF treatments has reached an all time high, accounting for almost 3% of births in Australia. ⁴

The report also showed that the number of women in their 40s using IVF had increased despite only a 4 per cent chance of success of a live delivery. ⁴

What are the risks?

Hormones are usually given prior to treatment to stimulate the ovaries. These hormones, such as oestrogen, can cause breast tenderness, slight nausea, dizziness and slight abdominal swelling. Occasionally, too many follicles develop and a condition called ovarian hyperstimulation syndrome (OHSS) may occur. There is also a low risk of damaging organs, or causing infection or bleeding, with the collection needle. ²

Where can I go for more information?

Talk to your GP who can refer you to a specialist.

Other reliable sources include:

Australian Government: www.health.gov.au

Fertility Society of Australia: www.fsa.au.com

Access, Australia's national infertility network, support group and information source: www.access.org.au

Sources:

Centers for Disease Control and Prevention, USA
Better Health Channel, Victorian Government
Australia's national infertility network, Access
Australian Institute of Health and Welfare 2005

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