Ivf – in vitro fertilisation

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10, 000 Australian couples are treated with IVF each year. The expensive and rather risky program (costing around $4000 excluding overheads) allows infertile couples to achieve pregnancy when conventional therapy has failed or is unacceptable. The procedure involves placing eggs that have been fertilised in a cultured dish directly into the uterus. A successful procedure will go as follows:

– Couples are counselled about their situation and informed on the procedure, their obligations and rights.

– Medical history, physical examination and other related tests are taken to determine candidacy.

– The woman receives hormone injections (Human Menopausal Gonadotropin and recombinant Follicle-Stimulating Hormone) to stimulate development of the ovarian follicles which contain eggs. Frequent blood tests are taken to

monitor hormone secretion from the ovary and pituitary gland.

– When eggs are ripe, they are retrieved by transvaginal needle aspiration, guided by ultrasound. At the same time, semen samples from the husband (or donor) are obtained. The most active and healthy sperm are selected by forcing

them to swim through a culture medium.

– The egg and sperm are placed together in a suitable medium for fertilisation to occur in a culture dish. If fertilisation does not occur after 72 hours, the oocytes (incompletely developed eggs) and sperm are disposed of. The

resulting embryos are observed for the next few days.

– A small plastic tube is inserted through cervix to place embryos into the uterus. The patient is able to go home a few hours later with minimal discomfort. During the first two weeks after embryonic transfer, hormones (such as Progesterone or HCG) may be administered.

The procedure above can bring either joy or disappointment. A successful patient from the Atlanta Reproductive Healthcare Center states: “For all of us, hearing that we are pregnant will be the most wonderful news. But remember, as easily as they told you that you are pregnant, it can be just as easy for them to tell you that you have lost your child.” Of the 10,000 people treated each year in Australia, there is a 92% failure rate. More often than not, something goes wrong and couples are left with a hefty medical bill, no pregnancy and compounded emotional stress. Every stage of IVF contains and element of risk, from the administration of drugs to the actual birth of the child.

Woman who undergo IVF are at risk of experiencing serious side effects. Many of these are caused by the administration of drugs and hormones which can result in reactions, rashes, swelling, headaches, irritability, restlessness, depression, fatigue, hot flashes (with the drug Lupron) increased stimulation of the ovary, ovarian enlargement, hyperstimulation syndrome (severe ovarian enlargement) and fluid accumulation around the lungs. More seriously, ovaries can rupture leaving blood to accumulate in the abdominal cavity and clot. Fortunately, this only happen in about 1.3% of patients and can be treated.

The figures indicate that many couples are unsuccessful with the IVF program and this can be due to problems associated with the gametes or the intricate laboratory procedures. Occasionally, the time of egg maturation may be misjudged, not predictable, may occur prior to egg retrieval or may fail to occur at all. During the transvaginal oocyte retrieval, it is possible

that the eggs are unable to be obtained. There is also a risk of bleeding, infection or injury to the bladder and other abdominal organs which may result in paralysis, brain damage or even death. Further problems may occur if the husband’s(or donor’s) semen specimen isn’t suitable or insufficiently thawed or if the eggs don’t survive the micro-manipulation process (a procedure where a few sperm are injected into the outer layer of the egg).

The embryotic stage also presents some risks. The embryo may not develop normally due to an absence of cell division, the embryo may become infected due to laboratory accidents or malfunction of equipment, the transfer of the embryo may be unsuccessful or implantation may not occur.

More problems are present also during pregnancy and birth. During the program, selected woman are required to undergo injections of natural progesterone. Synthetic progesterone injections during pregnancy increase the risk of congenital heart malformations, anal blockage, abnormalities of bones, brain, spinal cord, vertebra, kidney, oesophagus and sex organs in the child. However, during IVF natural progesterone (identical to that naturally produced by the woman) is given rather than the synthetic type in order to minimise the above risks of birth defects. Furthermore, childbirth may be affected by miscarriage, ectopic pregnancy (outside the uterus) and stillbirths, all of which are regular pregnancy and birth complications but are seen more often in IVF patients.

The chance of multiple births after transferring three embryos is 27% for twins and 3% for triplets. The prospect of having a multiple birth presents both emotional and financial strain for the family. There is a higher risk of having premature births and being hospitalised for longer periods before and after the due date. High blood pressure and miscarriage are also more prevalent in IVF patients. Selective reduction may be considered in cases where three or more gestation sacs are seen. This raises the moral issue of termination of the unwanted sacs.

There are many unresolved legal issues surrounding the procedure and the resulting child. The child or children produced is a result of the procedure are the legitimate child of the couple and they must accept the in vitro fertilisation and embryo transfer as their own act. The child or children must be acknowledged as the heir or heirs of recipients if IVF and legal custody and responsibility must be welcomed.

On evidence, successful IVF pregnancies are rare. Australian statistics indicate of the 10,000 people treated each year, only 800 are successful (less than 1 out of 10). When this is viewed together with the medical risks to both mother and child that arise during the IVF program, it is a method which requires great thought and planning on part of the prospective parents. Another factor which needs to be recognised is the financial cost to the parents and the burden upon the health system. Further ares of consideration are the legal and moral aspects. Technology surpasses the speed at which the law governing this type of pregnancy is able to keep pace and the moral implications are ones in which the mother needs to face personally and be comfortable with. It would seem that given all the above negatives, those that those who undertake IVF are happy to do so simply to experience childbirth.

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