Reshma (name changed) lives in a tiny suburb of New Delhi. The privileged daughter-in-law of a rich industrialist family in the city, she had everything going for her, except giving birth to biological children. She got married to her then boyfriend of two years, when she was just 20 years old. In the years to follow, she and her husband underwent several tests and three cycles of IVF. Finally, after a full decade, their lovely twins were born.
“It was the happiest moment of my life and they mean the world to me today. Though, looking back… the physical pain and mental stress, failing to conceive naturally and then failing twice in IVF, I shudder to think about it,” she says. She adds silently, “If I knew this is what it would take, I would have thought more about it.”
Reshma isn’t alone in thinking thus, many women are not quite prepared for the tough journey that an IVF procedure can be, says Dr Wahida Suresh, Obstetrician and Gynecologist with Apollo Hospitals in Chennai. The doctor meets several women every week who have failed to conceive naturally and are willing to suffer any pain to give birth to a baby. And yet, she tells them that they should take to IVF after a lot of thought. “The first thing we tell women is that it can fail. People ask, ‘Doctor, we can manage the pain and the cost, but can you assure me 100%?’, and I tell them I cannot,” she says emphatically.
Why IVF fails often
In-Vitro Fertilization (IVF) is a type of assisted reproductive technology which uses a combination of medicines and surgical procedures to help sperm fertilise an egg, and help the fertilised egg implant itself in the uterus.
It is a long process. The woman has to first take medication that makes several of her eggs mature and ready for fertilisation. Those eggs are then taken out of her body and mixed with sperm in a lab, to help the sperm fertilise the eggs. Then they put one or more fertilised eggs (embryos) directly into her uterus. Pregnancy happens if any of the embryos implant in the lining of the uterus. Basically, the process is only to help the woman conceive. Eventually, the body has to play its natural role and take over – and that need not always happen.
Globally, IVF failures range from 30% to 50%. “For every 4 cases, I see 2 failures. And it is a tough process for even us, as doctors, for those two weeks till we see those two lines on the screen. If we fail, we don’t know how to face them,” Dr Wahida says.
The success of IVF depends on various factors, like the age of the woman, quality and quantity of the eggs, quality of the sperm, the timing of the implantation and the receptiveness of the endometrium. Among the leadings reasons for failure are implantation dysfunction and abnormal or incompetent embryo. But, what leads to them?
“The age of onset of pregnancy trial has changed, women are starting only at 30 now. Unfortunately, women are biologically ageing by then. Women don’t produce new eggs, they have the same number of eggs as when they are born – whatever we have is what we have – those eggs mature every month, which is why for women age plays a big role,” Dr Wahida explains, adding that the earlier women try IVF the better their chances are.
Beyond that, stress, diet and body weight play a major role. “As a society, our diurnal rhythm is changing. Many women are sleeping during the day and working in the night. This affects our diet also. So, if I am doing IVF and I am so stressed, I am obese and working odd hours, the outcomes are surely poor,” she points out.
Dr Wahida Suresh
As far as diet is concerned, the obstetrician says that there are no restrictions, but women have to eat healthy. “If you don’t eat well and the right food, you are prone to diabetes and hypertension. These impact your hormones, and your cycles are going to be irregular which increases the risk of failure,” she explains.
Reducing failure and ERA
While doctors cannot point to one issue as the reason for IVF failure, they do know how they can improve the possibility of success. Over the past few years, technology hasn’t changed drastically, but a screening called Endometrial Receptive Array (ERA) has been able to significantly improve the chances of success.
ERA is a process in which doctors narrow down to the most appropriate day of the menstrual cycle for the transfer the embryo. “We do endometrial sampling on the 15th or 16th day of the cycle, and the sampling will tell us if it is a receptive endometrium on those, or is it pre-receptive or post-receptive. This gives us clarity on when to do the procedure. So, in the next cycle, we plan 12 hours ahead and surely the success rate is higher,” she says.
This testing is done only when doctors know that everything else is going good, like the quality of embryo, progesterone value, endometrial thickness etc. ERA does not assure success, but it can improve the chance of success significantly.
ERA is not for everyone, it is offered only after the couple has failed once. “There is a cost factor to everything. If they are repeating IVF after a failure, we tell them why not reduce the risk by taking the test. It is an outpatient procedure, so only lab work is the cost,” Dr Wahida says.
Be sure before you try
Despite all this, Dr Wahida insists that women should discuss threadbare with the doctor and their families, weigh all pros and cons, before opting for IVF. “Don’t do it just because someone else is saying so or people are pressuring you,” she says.
“If you are not convinced, please go back and think. We do not get married only to make babies, and adoption is also an option. Women go through so much stress – they have to take injections, they have to take a scan every second day, they have to get blood work done regularly, so women are putting themselves through a lot, and it is fine to think that we are not up to it,” Dr Wahida assures.
Husbands have to be more supportive, she adds. “Half the men run away even if I offer them an injection, they have no idea what it takes. They need to be there for the women and support them. A woman takes 5-6 injections every day, and then she has to go through anesthesia, embryo pick up, and then injections to support the pregnancy – they will be so stressed. Being there for her is important. Even holding her hand and mentally supporting her can be very helpful.”
She says, “At the end of it, the IVF journey could be smoother if there is transparency, trust and clarity on all sides.”
The article has been produced by TNM Marquee in association with Apollo Hospital.