Who needs IVF?
Case studies of 5 couples
Fertility problems is more common than people realise, with an estimated 16% or 1 in 6 couples having trouble getting pregnant after trying for a year. In Asian countries, ‘fertility problem’ is still considered something shameful or embarrassing, thus, leaving couples (mostly the wives) suffering in silence despite the availability of effective treatments.
Infertility is a medical condition, and has many underlying causes. It may be due to infections, congenital condition (born with the problem) or due to aging process itself. We don’t laugh at people who contract dengue fever, or needs spectacles, or even lose hair, do we? Similarly, we shouldn’t be biased against people with fertility problems.
There are many treatments options for couples who need assistance to conceive, including fertility pills, surgery, and more advanced methods, such as IUI (Intra-Uterine Insemination) or IVF (In-Vitro Fertilisation).
IVF has been around for almost 40 years. The first successful IVF baby, Louise Brown was born in 1978. Since then, IVF technology has undergone tremendous improvements, with success rates reaching 70% in good IVF centres around the world, including in Malaysia.
The following stories are about couples (names have been changed) who have benefitted from IVF:
Story 1:
“Melissa is 28 years old, and have been having painful periods since her secondary school years. She has always thought that painful menses were normal and regularly take pain killers during her worst days. After being married for 3 years, she decides to see a gynaecologist as her period pain has become unbearable. An ultrasound examination reveals 2 ‘chocolate’ cysts near her ovaries and a key-hole (laparoscopic) surgery is planned.
During the surgery, her gynaecologist finds multiple ‘chocolate’ cysts, or endometriosis affecting her ovaries, with scar tissues blocking her right fallopian tube completely. IVF is advised as she only has one working fallopian tube, and the risk of endometriosis cyst recurring again is high. She is currently 5 months pregnant after a successful IVF cycle.”
Endometriosis is a cause of infertility in 20% of women having problems conceiving. Endometriosis commonly presents as severely painful menses although some women may not have any symptoms at all. Inflammation happens every month and this causes scar tissues and affects the quality of eggs. Endometriosis may recur up to 50% of patients even after successful surgery, and are therefore advised to conceive as soon as possible.
Of course, not all painful menses are due to endometriosis, as there are other causes such as fibroids, polyps and infections. Cysts (swellings in ovaries filled with fluids) can also appear at the ovaries from time to time.
Story 2:
“Mia is a 38-year-old, successful businesswoman, who has recently gotten married. After trying to get pregnant for 6 months, she visits her gynaecologist who advises her to try IUI (Intra-Uterine Insemination) as ‘everything is okay’ with her womb. After 3 failed IUI cycles, she decides to try IVF. Her 1st IVF cycle is unsuccessful as the embryos produced is of poor quality. After recuperating and slowing down her busy lifestyle, her 2nd IVF cycle responds better, and she is now expecting a baby boy.”
Age is the greatest ‘enemy’ of female fertility. The supply of eggs women are born with is limited. The number of egg available progressively fall with age, noticeable even as early as 30 years. Not only the quantity is reduced, the quality of eggs is also affected. The declining quality of eggs is why the rates of miscarriages and babies having abnormalities (like Down Syndrome) go up after 30 years old.
Even though IVF gives the highest chance of getting pregnant, some couples will need more than 1 cycle to be successful, especially if the quality of eggs are below average.
Story 3:
“Micheal and his wife are both 28 years old. After trying to conceive for 3 years, they go for a check-up with their GP. A sperm test reveals that his sperm counts are very low. He remembers having mumps infection which also affected his scrotum when he was a teenager. IVF-ICSI was done, and the couple is expecting twins”
Male problems may be found up 30 to 40% of couples who are unable to conceive naturally. A few causes are inborn (developed in the womb) problems, while most are due to external factors like infections, cigarette smoking, lifestyle, etc.
Sperm problems can be overcome with a special step during IVF procedure called ICSI (Intra-Cytoplasmic Sperm Injection), whereby only a few good sperms are needed (vs millions during a natural cycle). These sperms are carefully selected and individually injected into the collected eggs after an IVF cycle. The embryos are grown and observed for a few days, and the best embryos are then transferred into the womb.
Story 4:
“Mandy is 24 years old. She is pregnant within 3 months of getting married. Unfortunately, at 7 weeks of her pregnancy, she is diagnosed of having an ectopic pregnancy. Her left tube has ruptured and surgery is performed to remove the damaged tube. Her (remaining) right tube is found be blocked, likely due to previous appendicitis infection. A year later, she conceives with IVF treatment.”
Despite being young, Mandy’s problem whereby both tubes are affected, makes it almost impossible to conceive naturally. Fortunately Fallopian tube blockages are conditions that respond well to IVF, as IVF bypasses the tubes when collecting the eggs. As she is young, egg quality is not an issue for her.
Story 5:
“Monie is 29 years old, and have been married to George, her childhood sweetheart for 4 years. The couple is very active in sports and lead healthy lifestyles, regularly going for yoga and gym. The couple has done all the necessary tests including sperm test, fallopian tube test, hormone tests, and have passed with flying colours. Tests confirms that she ovulates every month, and her eggs respond well to fertility pills. Finally after trying fertility pills for many months and 2 ‘promising’ IUI cycles, she opts for IVF, and is pregnant at 6 months.”
Some couples, despite having normal parameters and good fertility test results, just can’t seem to get pregnant. These ‘Unexplained’ couples may actually have conditions that science are not able to test and diagnose yet. IVF may help in these situations by overcoming these unknown factors.
IVF safety
IVF technology is a mature technology, and no longer something experimental or risky. It has helped millions of couples conceive worldwide and is a treatment path worth exploring for couples who need help getting pregnant.
Dr Chong Kuoh Ren
This article first appeared on TMC Fertility’s blog on the 22nd of February 2016