Realising How IVF Can Affect Your Mental Health 143

Understanding How IVF Knocks You About Realising you may be sad, but you're not Feeling good for Coping when life's not as fun as it used to Hanging In There Talking about your feelings often helps her, hinders him 147 Dodging the blame Losing a Waiting and Putting your life on Getting Deciding to stop Seeing Further Down the Chapter 12 Moving On When IVF Doesn't Work 153 Taking Reviewing your Getting off the Letting Dealing With Dashed Managing your Handling your partner's Recognising your...

Getting Ready for IVF

Perhaps you've been trying for a baby for many months and nothing has happened. If you think you've waited long enough and want to start doing something to help you conceive, I suggest that you start reading here. In this part, I talk about the steps you can take to find out why you can't conceive and the possible treatment options. I devote a whole chapter to discussing how you may feel when you discover that you're infertile and how to handle the emotional aspects of infertility. I also talk...

Finding Out Why You Dont Get Pregnant

As soon as you suspect that you have a fertility problem, you need to confirm your suspicions and find out what sort of problem you have, because this determines your treatment. Some detective work is needed here and you may have to see several doctors before you discover the cause of your infertility. A fertility problem is a challenge that you and your partner should tackle together. Whenever possible, make sure that you can both attend the required medical appointments. Don't waste precious...

Finding an infertility specialist

There are several types of specialist that you may see for an infertility problem 1 Andrologists are specialists in matters relating to the male reproductive organs. 1 Gynaecologists specialise in matters relating to the female reproductive organs. 1 Infertility specialists are gynaecologists who specialise in the treatment of infertility. If such a specialist practises in the area where you live, ask your family doctor for a referral straight to the top If you live in an urban area, you may...

Moving On to IVF The Hightech Way to Get Pregnant

Whether you've already tried other forms of infertility treatment or are told that IVF is the only way for you to have a baby, making the decision to start IVF treatment is a big one. Nonetheless, many couples at this stage also feel a sense of relief that they're finally going to be actively doing something that gives them a chance of having a family. To help make your decision, you need to find out as much as you can about IVF before you start treatment. This includes what the law says about...

Who can have IVF in Australia

There are laws and regulations governing IVF in many Australian states relating to who can access IVF treatment, what kinds of records clinics need to keep, what clinics need to do to make sure that couples can make an informed decision, how long eggs sperm embryos can be frozen, the rules for donation of eggs sperm embryos and other matters. These laws and regulations change from time to time and vary between the states. For example, in the past only legally married heterosexual couples were...

Reacting to Your Infertility Diagnosis

Even if you've long suspected that you have an infertility problem, the actual diagnosis of infertility can come as a shock. Like many people, your initial reaction to the news may be disbelief 'There must be a mistake here Maybe the test results are wrong, or they've been mixed up ' After it all sinks in you may feel angry 'Why us What have we done to deserve this This is so unfair ' You may also feel guilty, blaming your infertility on something you did in the past 'It's probably because I...

Improving Your Chances of IVF Success

The success rate for IVF treatment has greatly improved since the late 1970s when the technique was first introduced. Although your chance of having a baby with IVF depends largely on factors beyond your control such as how many eggs you produce in response to your drug protocol and whether your eggs and sperm turn into healthy embryos recent research shows that getting into shape before starting IVF treatment can influence the odds in your favour. This mostly involves things you should be...

Choosing an IVF Clinic

About 75 clinics around Australia provide IVF services. Your family doctor or the doctor looking after your infertility investigation may routinely refer his or her patients to a particular clinic, but you may prefer to choose the clinic yourself. If you live in a city you may have several IVF clinics within a ten-kilometre radius of your home or workplace. So how do you know which clinic's right for you Researching the clinics helps you make an informed decision. Start by gathering as much...

Legally Speaking Understanding How IVF Services Are Regulated

In Australia, assisted reproductive technologies such as IVF are heavily regulated by federal and state government legislation as well as professional bodies. Overall, such regulation is beneficial for couples seeking IVF treatment because you can be sure that clinics have high standards of care. All IVF programs have to abide by the following rules and regulations l Research Involving Human Embryos Act 2002 (Cwlth) and Prohibition of Human Cloning for Reproduction Act 2002 (Cwlth), both of...

Coming to Grips with All the IVF Acronyms and What They Mean

Several forms of treatment have evolved from the original IVF technique developed in the late 1970s. These treatments all go by their short names, or acronyms, with which you soon become familiar. Here's an explanation of what these acronyms mean and the treatments involved 1 IVF, in-vitro fertilisation In-vitro fertilisation literally means 'fertilisation in glass' and the term was coined because in the early days the eggs and sperm were placed in glass test tubes where fertilisation and early...

Finding out exactly what happens in an IVF cycle

At most clinics, the nurses make sure that you know what to do throughout the course of your IVF cycle. So, before you start your cycle, you have a scheduled appointment with a nurse to find out what to expect and what you need to do at each step. This meeting is likely to cover 1 The drugs used to stimulate egg production and when and how you take them i The potential side effects of these drugs i How your response to the drugs is monitored 1 Why these drugs sometimes don't work so well i What...

Type of fertility problem

Your chance of having a baby varies slightly depending on the type of infertility you have. Male factor infertility Couples with male factor infertility have the best odds of having a baby with IVF technology and in 2006 had a live birth rate of almost 22 per cent per started stimulated cycle and almost 17 per cent per frozen embryo transfer. Female factor infertility Couples with female factor infertility have slightly lower odds of having a baby with IVF technology and in 2006 had a live...

Riding the Emotional Roller Coaster of the IVF Cycle

Preparing for the roller-coaster by knowing what to expect Dealing with good news and bad news Sending out an SOS when things get on top of you A n IVF cycle is often described as an emotional roller-coaster ride during which you sometimes feel hopeful and optimistic and at other times sad and low-spirited. In this chapter, I describe the events that can make your emotions swing during an IVF cycle and give you some strategies for dealing with your feelings and staying in control while you're...

Understanding the Risks of IVF

'The twins are doing fine, but the doctor thought you may need this for the next few years.' rn n the hands of experts, IVF procedures are safe and medical complications are rare. But your emotional health can take a beating when you have IVF and sometimes, no matter how hard you try, the treatment doesn't work. In this part, I explain the potential risks involved with IVF to your physical and mental health and discuss how you can move on and get your life back on track if IVF doesn't work for...

Understanding the Risks of IVF to Your Physical Health

Weighing up the risks involved for the female partner Checking out the risks involved for the male partner Considering the health of IVF children A s with all medical procedures, IVF involves some potential risks that you should be aware of before you decide to embark on treatment. You need to consider firstly the risks that relate directly to the IVF procedure and secondly health problems that may develop down the track because you've undergone IVF. But the most burning question for couples...

Realising How IVF Can Affect Your Mental Health

Realising how IVF plays havoc with your emotions Being there for your partner Coping with pregnancy loss Avoiding letting treatment run your life Healing over time A lthough IVF doesn't pose a great risk to your physical health (see Chapter 10), the possible risks to your mental health and general wellbeing from IVF are probably greater than from most other medical procedures. As well as your immediate reactions to the ups and downs of each step in the treatment process (which I describe in...

Understanding How IVF Knocks You About Emotionally

Of course, people are different and the way you feel about being infertile and having IVF treatment depends on several factors, such as 1 How much support you have You can cope more easily with difficult patches in your life if you have a good support network and don't feel that you're alone. If you want to broaden your support network, refer to Chapter 2, where I talk more about finding various sources of support. 1 How you usually deal with difficult situations There are many different ways...

Moving On When IVF Doesnt Work

Closing the IVF door Managing your disappointment Getting back into life A lthough the chances of having a baby with IVF have increased dramatically over recent years, the sad fact is that treatment still doesn't work for everyone. IVF clinics provide plenty of information about their 'success' rates, but you need to remember on the flip side that they also have a 'no success' rate. Some couples fluke it first time around, but many couples need to try a few times before they strike it lucky...

Offering Lowcost IVF in Developing Countries

IVF and other assisted reproductive technologies are very high-tech and expensive forms of treatment that are available almost exclusively in developed countries. However, the personal tragedy of childlessness is no different for men and women in developing countries. In fact, in some cultures women who can't have children may risk public humiliation, divorce, abandonment or withdrawal of food and financial support even if their infertility is due to a sperm problem. As a result, the Low Cost...

Cutting the Ties With Your IVF Team

When you undergo IVF treatment you're in constant contact with the members of your IVF team. But after your six-week scan confirms your pregnancy, you have to say goodbye to your team and move onto the obstetric team for antenatal care. However, the obstetric team members usually don't want to see you until several weeks after your first scan and during this wait some couples describe feeling a bit abandoned, unsure who to turn to with questions they have. If you're worried about something...

Ten Tips for Surviving IVF

Keeping yourself informed Being there for your partner Enrolling supporters m VF is a very high-tech way of getting pregnant and you have to get your head around all sorts of medical jargon and complicated instructions, not to mention putting up with the inconvenience of numerous clinic visits and all that poking, probing and prodding of your body along the way. But that's the easy part The trickiest aspect of IVF for any couple is hanging on to each other and your sanity during the ups and...

Ten Tips for New IVF Parents

Waiting for baby Getting to know your baby Growing confident and getting baby care down pat m ongratulations You've cleared all the IVF hurdles and you're pregnant As you close the door on your IVF treatment and enter the world of antenatal care, you can start to count the days until you finally meet your baby. The transition to parenthood is an amazing and joyous period that starts in pregnancy. But becoming a parent for the first time can be pretty daunting and unsettling, even if you've...

Fplus

More complex forms of treatment have evolved from the 'original' IVF treatment, some of which you may need in your quest to start a family i Third-party reproduction Today, some 10 per cent of IVF treatment cycles involve using donor gametes (eggs and sperm) or embryos to have a baby. The big question that arises in such cases is whether a child born as a result of the donation should be able to find out who the donor is. I discuss the arguments for and against in Chapter 13. 1 Use of a...

Beyond IVF

An IVF pregnancy is a happy ending to a very trying time. But it's also the beginning of a new journey into the unknown. After you put the worries about getting pregnant behind you, you find that you start to worry about the pregnancy, the birth and the welfare of your baby. Of course, couples who conceive without IVF also have such worries, but new research shows that some aspects of pregnancy, childbirth and parenting are a bit different and perhaps more complex after assisted conception. In...

Age and IVF success

A common misconception (no pun intended ) is that IVF can help you have a baby if you put off starting a family until later in life. After all, movie stars seem to have no problems having babies in their forties. Well, in many cases these women use eggs donated by younger women to conceive, although such a fact isn't usually publicised. (I cover donor conception in Chapter 13.) Age is one of the most important factors in determining your chance of having a baby with IVF. In Chapter 8 I show you...

Starting IVF again

If you know that you have to undergo IVF to conceive again, you need to bite the bullet and get on with it. Ask your family doctor for a new referral to your infertility clinic and then make an appointment to see the IVF doctor. Your IVF doctor will arrange for you to have any tests that need updating, then you can see the IVF nurse and get your instructions to start another IVF cycle (refer to Chapter 5 for a refresher on what the cycle entails). Having been there and done that already, you...

Authors Acknowledgements

Over the many years that I've been involved in the areas of infertility and IVF I've had the good fortune of working with, and being mentored by, many extraordinary people. The knowledge and experience I gained from these people has allowed me to write this book and I'm deeply indebted to them. In chronological order they are Professor Lars Hamberger, who pioneered IVF in Scandinavia Drs Matts Wikland and Lennart Enk, who established one of the first private IVF clinics in Sweden the late Ian...

Why Us Going Through the Emotions

Of Being Reacting to Your Infertility Diagnosis 26 But everyone else can have a baby 27 Talking about infertility How, and to whom 29 Treating yourself and each other 32 Having sex on demand where did the fun go 32 Chapter 3 Setting the Perfect Scene 35 Beating the Clock Age Counts, So Get 42 Part 11 All You Need to Know About 1VF 51 Chapter 4 The Law and the Legally Speaking Understanding How IVF Services Chapter 5 Taking IVF One Step at a Time 65 Coming to Grips with All the IVF Acronyms and...

How This Book Is Organised

IVF & Beyond For Dummies is divided into seven parts. The first four parts detail the journey from discovering that you can't fall pregnant, to undergoing an infertility investigation to find out why, to having IVF treatment to try to have a family. Part V is the 'beyond' component of the book where I talk about what's special about pregnancy, birth and parenting after IVF. Part VI consists of two lists of useful tips for IVF and beyond and Part VII contains abbreviations and terms used in...

Icons Used in This Book

To help you get the most out of this book, I include some icons that tell you at a glance whether a section or paragraph has important information of a particular kind. This icon points you to useful websites. Over the years that I've been working with infertile couples, I've heard many personal stories that have given me an appreciation of how infertility affects people's lives. I think you'll find some of these stories very pertinent. This icon points you to important information that you...

Where to Go from Here

You can read this book from cover to cover or use it as a resource that you pull out when you're looking for an answer to a specific question. Depending on where you are on your infertility journey and what particular information you're seeking, you may not need to read everything I have to say although you're certainly welcome to Use the Table of Contents to pick and choose the chapters or sections you want to read and skip the parts that deal with matters you've already been through.

Taking First Things First

Discovering why you can't conceive Dealing with negative feelings Preparing for treatment Understanding the treatment options Having IVF ike the majority of couples, you may have found that deciding to start a family is a major relationship commitment that takes time. But having made the decision and stopped contraception, you probably felt excited and full of expectations about this next stage of your life. Most couples take fertility for granted and don't expect to have trouble getting...

Talking to your family doctor

Your family doctor is usually the first person you turn to with your concerns. Expect your doctor to i Confirm that you're aware of the optimum time of the month for conceiving i Order some basic tests to confirm that the female partner ovulates (releases an egg) regularly and the male partner produces sperm i Take a detailed medical history and an even more detailed reproductive and sexual history of you and your partner i Undertake a physical examination of you and your partner Assuming...

Dealing with Your Feelings

Even if you suspect that you have a fertility problem, receiving the actual diagnosis of infertility suddenly makes it all real and scary. This isn't how you planned it Books written about the emotional impact of a diagnosis of infertility compare it's magnitude with the devastation of other major life events such as the loss of a loved one or divorce. You have no way of knowing how long your infertility will last. You may fall pregnant next month or you may never conceive. This uncertainly is...

Getting Ready for Action

Knowing that you need some type of infertility treatment doesn't necessarily mean that you're ready for it. You may need some time to get over the shock of the diagnosis and gather some well-needed energy to embark on treatment. On the other hand, you may be eager to get going with treatment and feel better knowing that you're actively doing something to have the baby you long for. Here are some things you need to do before undergoing treatment, whether you decide to wait or start straight away...

Helping the sperm to meet the egg

You can try artificial insemination homologue (AIH) (insemination with your partner's sperm) if you have idiopathic infertility or a very minor male factor problem. To make sure that eggs and sperm are given the best possible opportunity to meet and greet (and hopefully get together), the sperm are inseminated into your uterus just before ovulation (which is timed using hCG, as explained in the section 'Timing ovulation'). Your partner needs to supply a sperm sample, of course, which the lab...

But everyone else can have a baby

When you've been trying unsuccessfully to get pregnant, you see babies everywhere. Suddenly, everyone in your orbit has a baby and none of them appears to have had any trouble getting pregnant. It all seems grossly unfair and can make you feel sad and left out. Some women who're able to have kids at the drop of a hat can appear unconcerned whether they have another child or not. How fair is that Of course, you know that these things have nothing to do with your infertility, but they can still...

Dealing with Other Peoples Reactions

As if dealing with your own feelings about being infertile isn't enough, you're also confronted with other people's feelings and opinions about your infertility. Being prepared and thinking about how to best handle other people's reactions can help limit the impact of their lack of understanding of infertility. Talking about infertility How, and to whom Like many others, you may feel that infertility is a very private matter and want to keep it to yourself and your partner. Unfortunately, not...

Trying for a second or third baby

If you already have a child or children and are trying for a second or (goodness me ) third or fourth child, people are often less sympathetic for some reason. They may say things like 'You should be grateful for what you have' (as if you weren't) or 'Don't be greedy' (if you weren't having trouble conceiving, no-one would suggest that wanting more than one child is greedy). Dealing with secondary infertility, when you already have a child or children and have trouble conceiving again, can be...

Being on the same page

One of the tricky things about dealing with the emotional side of infertility is that each partner may be in a different phase of working out what to do. For example, your partner may be keen to start treatment, whereas you still feel angry and haven't yet reached a more constructive phase. Your different personalities can also make you handle the difficulties in different ways. One of you may want to forget all about the problem and hope that it goes away, while the other faces up to the...

Treating yourself and each other kindly

When you're struggling with infertility, you can easily lose sight of the fun side of life. Suddenly, everything is overshadowed by your unfulfilled wish for a child. The infertility journey can be long, so you can't afford to let it consume you totally and rob you of all the pleasures in life. Try to keep doing the things that you enjoy doing, be it sport, reading, going to the movies or escaping somewhere for the weekend. More than ever you need the energy and sense of wellbeing that these...

Having sex on demand where did the fun go

Infertile couples commonly feel that the joy and pleasure they used to experience in their sexual relationship goes out the window when the focus is on baby making rather than on love making. Trying hard to time sex at the most fertile stage can be the biggest turn-off and can dampen your enjoyment. It may even give him 'performance anxiety' and cause erection difficulties. And her libido may take a beating from tension about infertility and doubt about ever falling pregnant. Even if your sex...

Discovering help online

Endless opportunities exist to connect online with people anywhere in the world with whom you share experiences, and infertility experiences are no exception. Hundreds of websites and chat rooms are dedicated to couples with fertility difficulties. You can access these virtual support groups from your desk at home. The groups can be very useful as a sounding board and for making you realise that you're not on your own. If you find talking about infertility or your feelings difficult,...

Joining a support group

Support groups are groups of people who get together because they share a problem, usually a medical condition. Members of infertility support groups give each other moral support and understanding. Joining such a group helps you realise that you're not the only couple in the world struggling to have a family. Most local support groups are associated with particular IVF clinics or are devoted to a particular type of infertility. You can find contact details for all IVF clinics in Australia and...

Calling in the professionals

If all else fails, or you feel that talking to an expert in the field of the psychological and social consequences of infertility would be beneficial, your best bet may be to see an infertility counsellor or psychologist. Counselling services are an integral part of all Australian IVF clinics and couples are encouraged to use these services whenever they need to before, during or after infertility treatment. Counsellors provide useful information, individual or couple support, relationship...

Checking out your local clinics

The best starting point for your research is the Fertility Society of Australia (FSA). This organisation represents doctors, scientists, counsellors, nurses and consumers in reproductive medicine. FSA's Reproductive Technology Accreditation Committee (RTAC) monitors clinics around the country to make sure that they provide services according to industry standards. IVF clinics can operate only if they pass the auditing process and are granted a licence by RTAC. The FSA's website (www.fsa.au.com)...

Narrowing down your choices

After you've tracked down your local clinics and assessed the services they offer, you may find that one clinic appeals more than the others. Or you may still be undecided. Either way, before you make your final decision ensure that you consider the following specific issues One-stop shops Most clinics are one-stop shops, so that you complete your whole treatment cycle under the one roof. This means that you go to the one place for all your blood tests, ultrasound examinations, egg collection,...

Covering the Costs of Treatment

Australia is one of the few countries in the world where the health-care system covers a substantial proportion of the financial costs of IVF treatment and where women aren't limited in the number of treatments they can have. As a result, an Australian couple may pay ten times less than an American couple for an IVF cycle. Each clinic sets its own fees and you can find out the exact total cost of your treatment from the clinic's accounts department. In addition to the clinic fees you may need...

Private health insurance

Private health insurance helps you with the costs associated with in-hospital treatment for IVF, such as for egg collection, as well as pregnancy and childbirth-related costs you incur as an in-patient. Insurance companies vary in the length of time they want you to be a member before you can claim reimbursement for IVF-related expenses. They also vary in what they reimburse and how much, so if you don't already have private health cover, make sure that you check these conditions carefully...

Making Treatment Work with Work

You're likely to experience frustrating time clashes between your IVF treatment and work commitments. During your course of IVF treatment you attend the clinic for appointments with doctors and nurses and for blood tests, ultrasound examinations, egg collection and embryo transfer. Some of these visits are scheduled well in advance, allowing you to plan ahead and reduce the disruption to your work. But sometimes you have to visit the clinic at short notice or at an inconvenient time work-wise,...

Introducing the team members

Your IVF team members are highly skilled professionals and in this section I explain the different roles they play. Each person has a particular job to do and each and every one of the IVF team is crucial to your journey through the IVF process. Don't forget to include yourself as part of the IVF team You're an expert on yourself You're as important as any other team member. So ensure you actively involve yourself in the treatment process Ask plenty of questions if you're not sure about...

Getting the most out of your team

Despite the number of people on your IVF team, ideally you should i Be able to get hold of a team member easily when you need to i Feel that all team members care about you and respond to your needs I Feel well-informed and well-supported throughout your treatment I Have confidence in the team members being knowledgeable and competent In smaller clinics you soon get to know who's who and the team members get to know you quickly too, so communication usually flows easily. In larger clinics it...

Fixing a communication breakdown

Good communication between members of the IVF team (including you) is crucial to ensure a smooth journey through the IVF process, whether the treatment ultimately is successful or not. The IVF team can't always help a couple to have a baby, but team members can and should make sure that the couple are always treated in a compassionate, respectful and sensitive way. However, the relationship between patients and doctors other healthcare professionals can be pretty uneven, because patients are at...

Completing some basic medical tests

You need to have several more medical tests before treatment can finally begin. These basic tests help your IVF doctor to manage your treatment effectively. Screening blood tests Couples are routinely tested for several things, including German measles (Rubella) and chickenpox ( Varicella) immunity only the female partner needs these tests if you're not immune to these infectious diseases, you need to be immunised before starting treatment 1 Other blood tests Depending on the cause of your...

Undergoing counselling

Most clinics offer couples the opportunity to meet with an infertility counsellor before starting treatment although in Victoria, this is actually required by law. Whether mandatory or not, many couples benefit from talking things over with a counsellor as part of preparing for treatment. Infertility counsellors are experts on the emotional aspects of infertility and infertility treatment and can offer you many useful tips on how to manage the stress of treatment. According to a guide to...

Consenting to treatment

As with other medical procedures, you have to give your permission for IVF treatment by signing consent forms. The exact content of the forms varies between clinics, but each form incorporates information about the procedures you agree to have and the risks of treatment, including the fact that the treatment may be unsuccessful. You may also be asked to decide on the following 1 The number of embryos that can be transferred at any one time 1 What you want to happen to any embryos that you don't...

Suffering information overload

The sheer volume of information that you have to take in before you undergo IVF treatment is huge. Naturally, you may worry about not remembering it all or getting something wrong. Make sure that you and your partner attend as many of the appointments as possible during your treatment, because between the two of you, you'll retain more information than either of you would on your own And you can be sure that all the important stuff you need to know is included in the written information that...

Recovering from the egg collection procedure

An hour or two after your egg collection, you get a bite to eat and then you're ready to go home. Before you leave, you're given details about when to contact the IVF clinic to find out if and how many of your eggs have fertilised and when you're needed back for embryo transfer. In most clinics you call the nurses for this information. Take it easy for a day or two after your egg collection. You're bound to experience cramping and feel a bit sore afterwards, and some vaginal bleeding from the...

Performing magic in the lab

After selecting the mature eggs and cleaning the sperm, the embryologists start their part in the magic by adding a droplet with thousands of sperm to each egg if you're having IVF, or by injecting a single sperm into each egg if you're having intracytoplasmic sperm injection. Each egg sperm combination is kept in a dish in a special culture medium that has all the nutrients and trace elements embryos need to develop. The dishes are placed in an incubator where the environment mimics the inside...

Transferring the Embryos

Assuming all goes well, the next hurdle is embryo transfer. When you arrive at the clinic for transfer your doctor gives you the latest update on the development of your embryos and advises whether any embryos are available for freezing. Your doctor explains i How many embryos have developed normally 1 The quality of your embryos as assessed by the embryologist (see Chapter 7 ) 1 How many embryos can be frozen (see Chapter 7 ) If possible, both you and your partner should attend the clinic...

Enduring the Longest Wait

Whether you've transferred fresh or frozen embryos, the next step is to go home, carry on with your normal activities and have a pregnancy test about two weeks later. As if that's possible What you really need to do is to brace yourself for the longest wait of your life, because during the two weeks there won't be a waking moment when your mind isn't busy thinking about your uterus. Every study about the IVF experience that I'm aware of has found that the hardest part is the wait after embryo...

Understanding what can go wrong after embryo transfer

This last hurdle is the most difficult one to get over because, of all the embryos that are transferred, only some have what it takes to grow and develop into a healthy baby. Of course, this is true not only for IVF treatment but also for many spontaneously conceived pregnancies. Many pregnancies are lost at a very early stage, often even before the woman knows that she's pregnant. It's not uncommon for women to have a 'late' period delayed by a pregnancy that didn't continue beyond the first...

Arriving at Dday Your Pregnancy Test

Hard as it may be to believe, the day for your long-awaited pregnancy test does eventually arrive. For this test, most clinics require you to have a blood test, either at the clinic or locally if you live far from the clinic. The blood test measures the level of pregnancy hormone, 3-hCG (beta human chorionic gonadotrophin), in your blood. Thankfully, the result is usually available later the same day and your IVF nurse gives you the news. A positive pregnancy test marks the happy ending of a...

Having the Bonus of Frozen Embryos

The techniques for freezing eggs haven't yet been perfected (see Chapter 15) but scientists have developed very successful methods for freezing and thawing embryos (see Chapter 7). After a stimulated cycle, extra embryos are sometimes available that the embryologist judges as good quality and these embryos can be frozen for later transfers. Depending on how many embryos you have, these extra frozen embryos give you bonus chances of getting pregnant without having to go through all the hormone...

Taking Drugs Drugs and More Drugs

Finding out the good and the bad about IVF drugs Understanding how your doctor works out what IVF drugs are best for you Measuring your response to stimulation 0rugs are an inevitable part of IVF treatment. The goal of treatment is to make your ovaries produce several eggs all at once rather than the one egg you normally release every month. When you undergo treatment you're likely to feel like a pincushion and have hormones coming out of your ears, but using drugs give you a much better...

Understanding What Drugs Are Used and

The main aim of IVF treatment is to make the most of every 'go'. So, while you normally release only one egg every month, which may or may not be 'perfect', with IVF the goal is to have about a dozen eggs reach maturity to improve the chance of at least one of them being 'just right'. To stimulate your ovaries to produce multiple eggs, your doctor gives you a carefully measured cocktail of drugs that can make you feel quite hormonal and a bit off the planet but not in the same way as you feel...

The contraceptive pill strange but true

Who'd have thought that you need to take the contraceptive pill when you're trying to have a baby Of course, there's a good reason for this. When you take the pill, your own hormones are put on hold and you don't ovulate (that's the whole point of taking the pill). So, a month or so before you start IVF treatment your doctor may prescribe the pill to suppress your own hormones in preparation for the drugs you need to take later to stimulate your ovaries. Suppressing your own hormones in this...

Gonadotrophinreteasing hormone analogues

Gonadotrophin-releasing hormone (GnRH) is produced naturally in an area of the brain called the hypothalamus. This hormone controls the production of the two hormones that regulate the menstrual cycle follicle-stimulating hormone and luteinising hormone (I explain how these hormones operate in Chapter 5). When you have IVF, the last thing you want to do is ovulate all the eggs that you've worked so hard to produce before your doctor has a chance to retrieve them. The magic bullet to avoid this...

Introducing the Common Stimulation Protocols

Not all women follow the same ovarian stimulation protocol Your protocol depends on your age, your IVF doctor's preference and the clinic's routine. Figure 6-1 shows a sample protocol demonstrating what drugs to take and when. IVF nurses and doctors use the term cycle day (cd for short) to tell you when to take the various drugs. The first day of your period is the first day of the cycle, cycle day 1 or cd 1, the second day is cd 2 and so on. The drugs in ovarian stimulation protocols start on...

Deciding on your dosage of FSH

The dose of GnRH analogues is the same for all women and stays the same right through the treatment, but the dose of FSH varies for each woman. Your doctor has no way of knowing exactly how you'll respond to FSH when you have your first IVF cycle, but the following criteria can guide the decision regarding the dose of FSH most likely to result in you producing about a dozen eggs 1 The number of follicles in your ovaries before stimulation starts A vaginal ultrasound of the ovaries shows the...

Measuring your response to FSH

After having FSH injections for a week or so you have a vaginal ultrasound scan to check on your response to the drug. The ultrasonographer counts the number of follicles and measures their sizes (I talk more about this examination in Chapter 5). You may also have blood tests to determine your estradiol levels, which is another gauge of your response to ovarian stimulation. Ideally, the stimulation results in the simultaneous growth of between ten and 15 follicles that reach a size of 18 mm or...

Taking a Peek Inside the

Preparing for you in the lab Confirming what's yours in the lab Maximising your chances of a successful egg sperm union Helping your embryos to thrive Boosting your chances with embryo freezing he most important part of the IVF process happens behind closed doors in the lab, where a bunch of extremely dedicated and highly skilled embryologists work to make your dream of having a baby come true. The IVF lab is a place with strict rules The embryologists follow detailed protocols and rigorous...

Getting Ready for

The embryologists are involved in the management of your treatment. They review your medical history close to egg collection and make sure that they're ready to take good care of the eggs and sperm when they're delivered to the lab. The following information helps the embryologists to 104 Part am You Need to Know About vf estimate how many eggs you'll have and what your sperm quality may be like, in order to adequately prepare for your treatment 1 Any special treatments requested by your doctor...

Labelling Dishes And Avoiding Mix Ups

The embryologists carefully label, check and recheck all the items of equipment that house your eggs, sperm and embryos to make sure that there's no possibility of mix-ups and you don't end up with the wrong embryos. Couples sometimes worry about mix-ups, but you can rest assured that the systems in place in Australian IVF labs to avoid mix-ups are extremely stringent. Australian IVF clinics have to follow the Reproductive Technology Accreditation Committee's Code of Practice in order to be...

Leaving the incubator

Clinics vary in how long they wait before transferring your embryos after egg collection. Some clinics do the transfer two or three days after egg collection, whereas others culture the embryos for five days until they reach the blastocyst stage, which is when the embryos have 60 to 100 cells. Most clinics do a bit of both, depending on the number and quality of embryos available. Your doctor can advise about your clinic's policy for timing of embryo transfer and explain the pros and cons of...

Getting Over All the Hurdles What Are Your Odds

IVF is a series of hurdles that you have to jump over to get what you really want a baby. At every stage of treatment there's a chance that things may not go according to plan, and each time you make it over one of these hurdles another hurdle looms ahead. In this section I explain what you need to keep in mind when you read clinic statistics about IVF 'success rates' and take you through the 2006 National Perinatal Statistics Unit (NPSU) report, which is the most recent edition of this annual...

Understanding clinic statistics

To help you assess your chances of success, what you really want to know is, of all the couples who start an IVF treatment cycle, how many have a baby at the end of it IVF clinics provide various facts and figures about their success rates with couples in general. When you read this information keep in mind that data can be presented in many ways and this presentation can affect your interpretation of the results. Here are a few issues to look out for 1 The denominator used Check whether the...

Examining the Possible Risks to Baby

'What's the risk of IVF to my baby ' is the most common question asked by couples considering IVF. To date more than two million children have been born as a result of IVF, so doctors have a lot of reliable information with which to answer this question. Mostly the news is good, but there are some adverse outcomes that, rare as they are, are more common among IVF children than children in general. This is often because multiple births are more common with IVF, but it's impossible to exclude the...

One egg one sperm ICSI

If you're undergoing ICSI, the embryologist gives the sperm a helping hand to enter the egg. Since it takes only one sperm to fertilise an egg, the embryologist catches a single sperm and injects it directly into the centre of an egg. If you have several eggs, the embryologist repeats the process. ICSI sounds simple but is actually a very technically advanced procedure that requires complex equipment and a highly skilled operator. To perform the procedure, the embryologist uses a specialised...

Finding solutions to a poor sperm sample

Occasionally, the quality of the sperm produced on the day of egg collection is unexpectedly poor. This can happen if you had an episode of high fever some weeks beforehand but can also be part of the normal variations in sperm quality. If this happens to you and you were planning to have IVF, your doctor may suggest trying intracytoplasmic sperm injection as an alternative procedure (I explain this procedure in the section 'Coming to Grips with All the IVF Acronyms and What They Mean' earlier...

Using donor material

Some couples need to use donated eggs, sperm or embryos to have a baby. This is called donor conception and I explain the processes involved in Chapter 13. When donor sperm was first used some 40 years ago to inseminate a woman whose partner was infertile, the common wisdom was that the procedure was best kept secret and no-one including a child born as a result of the treatment should be told that donor sperm was used. Today, attitudes have changed Most people believe a child has the right to...

Stimulating your ovaries

To understand the IVF process, ideally you need to be familiar with the relevant parts of the menstrual cycle, so here's a quick recap on how eggs are normally formed in your body. The pituitary gland in your brain regulates your menstrual cycle by producing two hormones follicle-stimulating hormone (FSH) and luteinising hormone (LH). Your pituitary gland releases follicle-stimulating hormone which, as the name suggests, stimulates the growth of several follicles in your ovaries. Follicles are...

During treatment

Depending on the nature of your infertility problem, your doctor may perform either a needle biopsy using local anaesthesia to get small pieces of tissue from your testicles or an open biopsy using a general anaesthetic to surgically remove pieces of tissue from your testicles (see Chapter 5) in both cases so that the embryologist can retrieve sperm from this tissue for ICSI (see Chapter 7). About five to ten out of every 1,000 sperm retrieval procedures result in a complication from either...

Prepping your sperm

After the embryologist has checked your eggs, he or she moves on to your sperm sample, which in most cases is produced on the day of egg collection (refer to Chapter 5). Sperm need a bit of cleaning up and sorting before they are added to the eggs. The ejaculate consists of sperm mixed in secretions from the seminal vesicles and the prostate called seminal plasma, as well as white blood cells, dead sperm and other 'debris'. The live sperm need to be separated out from this other material before...

Retrieving sperm surgically

If you have no sperm in the ejaculate (refer to Chapter 1), the sperm are retrieved via a surgical procedure under local or general anaesthesia. Depending on what type of infertility you have, the doctor retrieves either fluid or microscopic pieces of tissue from the testicles. I explain these procedures in the section 'Coming to Grips with All the IVF Acronyms and What They Mean' earlier in this chapter. Depending on the clinic and the type of procedure you're having, you may be asked not to...

Fluking it by getting pregnant without help

Some couples unexpectedly conceive another baby spontaneously even though they needed IVF to have their first baby. This can come as a bit of a shock, particularly if you get pregnant within a few months of giving birth. After the long hard road to having your first child, you may have trouble comprehending how you can possibly conceive without any help from the lab. Unless you know that you definitely can't conceive without IVF, there's always a chance that the stars will align and you'll...

Taking IVF One Step at a Time

Understanding the various technical terms Preparing for IVF treatment Taking drugs to stimulate your ovaries Collecting the eggs and sperm and making embryos Waiting for your pregnancy test results Using frozen embryos m VF treatment follows the stages of the menstrual cycle. That's why C you hear people referring to a 'treatment cycle' or an 'IVF cycle' or sometimes just a 'cycle' when they describe the steps involved in an IVF attempt. You also hear clinic staff use weird acronyms for...

Borrowing a Uterus

Most causes of infertility are treatable with IVF or ICSI, but in certain circumstances, that's not enough and you may need to find a woman who's willing to carry the pregnancy for you. These circumstances may include 1 Chronic illness If you're suffering from a chronic illness you may be advised that pregnancy can worsen your condition or that the drugs you take for your illness are harmful to a growing baby. 1 No uterus If you don't have a uterus, obviously you can't carry a pregnancy. You...

Deciding Whether to Tell

The big question in relation to donor conception is whether you tell your child about his or her donor origin. Some people feel strongly that children have the right to know their genetic origins, while others argue that it's best for children to grow up not knowing that they were conceived with the help of a donor. Counsellors and other professionals involved with donor procedures very much advocate for telling a child, because not telling can have devastating consequences, especially if the...

Assessing the Odds of Your Dream Coming True

Understanding the statistics on IVF success rates Working out your chances of having a baby with IVF Having realistic expectations m he million-dollar question when you have IVF is Will the treatment m work There's no way of knowing exactly what your chance of IVF success is, so you have to turn to what's known about IVF success in general to help you estimate your chance of having a baby. In this chapter, I discuss the issues you need to be aware of when you're looking at how clinics present...

Producing a sperm sample

If you have viable sperm in the ejaculate, you're asked to produce a sperm sample on the day of your partner's egg collection. You're shown to a private room designed for the purpose where you produce the sample. The infertility investigation inevitably involves a sperm test, so you should have had a chance to practise ejaculating into a small plastic jar before the big day However, when the pressure is on, ejaculating can be difficult. If you have an inkling that this may happen to you, speak...

Preparing for Pregnancy Probing and Prodding

As an IVF mum, expect many check-ups, tests and examinations during your pregnancy. There are many reasons for this scrutiny 1 Doctors and midwives sometimes feel extra-protective of women who conceive with IVF. 1 IVF mums are generally older than other mums and therefore have a slightly higher risk of pregnancy complications. 1 Most IVF mums are first-time mothers. 1 Twins are more common after IVF than with spontaneous conception. If you want to enjoy the natural process of pregnancy, you may...

Undertaking Preimplantation Genetic Diagnosis

You can undergo several tests when you're pregnant to make sure that the foetus has the right number of chromosomes and, if you're at risk of passing on a severe genetic condition, that the foetus is unaffected by this condition. However, although this is all well and good if the test results come back normal, if the results reveal a problem with the foetus, you then have to make the heart-wrenching decision whether to terminate the pregnancy or continue knowing that your baby has a potentially...

Accessing IVF treatment

Various state laws cover who can access IVF, what you need to do before having IVF treatment and what happens when couples or individuals use donor sperm, eggs or embryos (see Chapter 13 for more detailed information on this process). All states and territories allow heterosexual married or de facto couples to access IVF treatment (although in South Australia you have to have lived together for at least five years to qualify ), but the situation isn't as clear cut for single women and I South...

What the Law Says About Surrogacy

For many years surrogacy was legal only in the Australian Capital Territory. In the last few years other states and territories have changed their laws and regulations to allow altruistic surrogacy and this is now legal in most parts of Australia. However, commercial surrogacy, where a woman is paid to carry a pregnancy, is banned throughout the country. When a child is born a birth certificate is issued showing the names of the birth mother and her male partner, if she has one. In the case of...

Who looks after you now

To make sure that everything is going well with you and your baby during your pregnancy, you have regular antenatal care check-ups. Your antenatal care alternatives depend on your preference, whether you have private health insurance, whether you have a straightforward or complicated pregnancy, and where you live. The options are i GP shared care Your antenatal care is shared between your GP and midwives and obstetricians in a public hospital. i Independent midwife In some places you can find...

Jumping the hurdles of IVF

You come across a range of health-care professionals on your way through IVF treatment and in Chapter 4 I introduce you to the many members of your IVF team. It's very important that you feel you receive the best possible care, so I also discuss how you can ensure that the members of your IVF team respond to your needs and what you can do if they don't. IVF is like a set of hurdles that you have to jump in order to get to the finishing line hopefully with a baby in your arms In Chapter 5 I...

Freezing Gametes and Embryos

Cryopreservation is really handy in many different situations, such as wanting to preserve some of your eggs or sperm before undergoing cancer treatment or when you have more than one or two really good-quality embryos after a stimulated IVF cycle. Although different methods are used for freezing gametes and embryos, after they're frozen they're stored in tanks of liquid nitrogen at a temperature of -196 degrees Centigrade. Material frozen at such a low temperature has no bioactivity, meaning...