5 Things Everyone Should Know About IVF
10 minutes
This interview of me was first featured in Medium’s Authority Magazine.
Can you please tell us what IVF is?
IVF, short for In Vitro Fertilization, is a medical procedure that assists individuals or couples in conceiving when natural conception and other less invasive forms of fertility treatments have proven ineffective or are not viable options. Common reasons for pursuing IVF include blocked fallopian tubes, low sperm count, PCOS, unexplained infertility, or the need to preserve fertility before undergoing treatments such as chemotherapy. Additionally, LGBTQ couples may utilize IVF to establish genetic ties to their offspring. The process typically involves medication to stimulate follicle growth, leading to the retrieval of mature eggs during a surgical procedure. These eggs are then fertilized with sperm in a laboratory dish, and resulting embryos are transferred into the uterus in hopes of achieving pregnancy.
What are some common misconceptions about IVF that you have encountered, and how do you address them?
Many view IVF as a mysterious process unless they have direct experience or know someone openly sharing their journey. Common misconceptions include:
IVF guarantees pregnancy.
It’s primarily for older women nearing the end of their biological clock.
It’s the first-line treatment for fertility issues.
It’s a quick process.
Due to the insecurity people feel about having fertility challenges, education on the topic is often lacking. To address these misconceptions, it would be helpful to integrate comprehensive fertility education into high school or college biology curricula and encourage more open discussions between healthcare providers and their patients. Early education provides information about how common infertility is and empowers individuals to understand their options. This would help to destigmatize infertility and make it more comfortable and common to discuss.
Can you discuss some of the emotional challenges individuals and couples may face throughout the IVF process, and what strategies you recommend for coping?
Anxiety: The IVF process is incredibly stressful, with numerous appointments, injections of medications, uncertainty, and financial pressures adding to the strain.
Emotional Rollercoaster: IVF is notorious for its emotional highs and lows, not only in the hope of achieving pregnancy but also in all the unexpected challenges that are part of the IVF journey. Body responses to medications may not align with expectations, leading to canceled cycles, complications like cysts, or no follicle growth. Even during the days following retrieval while anticipating embryo formation, initially, a source of hope can result in feelings of defeat.
Grief and Loss: IVF outcomes are not guaranteed and can include failure to conceive, ectopic pregnancies, chemical pregnancies, or miscarriages. While these experiences can occur in any pregnancy, they are more common in individuals undergoing infertility treatments like IVF. Furthermore, the extra monitoring involved in IVF means that early losses become known whereas in natural pregnancies the pregnancy itself may have gone unnoticed.
Relationship Strain: The emotional toll of IVF and heightened stress levels can strain relationships, causing tension, breakdowns in communication, and feelings of isolation between partners.
Financial Stress: IVF is rarely covered by insurance in the United States, leading to significant financial burdens for individuals and couples. The costs associated with IVF can create additional stress and anxiety throughout the process.
Infertility setbacks can be immensely challenging and fraught with painful emotions. Recognizing that these intense emotions are present and normal is important when trying to cope. Additionally, open communication with a partner or a trusted family friend can help alleviate some of the emotional turmoil one might be harboring alone. One of the most helpful coping strategies is joining a support group with others going through the same process because they will truly be able to relate and offer support in a way others can’t due to their lack of experience. Furthermore, trying to maintain some normalcy in daily life and routine, such as exercising, even if it needs to be modified, seeing friends, continuing hobbies, or exploring new ones, can help shift focus away from the IVF journey. Lastly, seeking guidance from a therapist specializing in infertility can provide an essential space to be fully heard and supported, thereby alleviating some of the intensity of the feelings as well as the isolation.
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How do you approach the topic of ethics in IVF, particularly regarding issues such as embryo selection and genetic screening?
Approaching the complex topic of ethics in IVF, particularly concerning embryo selection, genetic screening, and third-party reproduction, requires creating a safe and non-judgmental space where individuals and couples can openly explore their beliefs, values, and concerns. As a therapist, my role is to help clients navigate their own beliefs with accurate information and encourage introspection so they can make decisions that feel best for them.
What recent advancements or innovations in IVF technology have you found most promising or exciting, and how do you see them impacting the field in the future?
While I stay informed about advances in IVF technology to better support my work addressing mental health concerns, I will refrain from discussing specific medical advancements outside my scope of practice. However, significant progress in mental health has emerged through increased sharing of personal stories, particularly on social media platforms, which has been instrumental in raising awareness and normalizing the struggles associated with infertility. This openness also sheds light on available options, particularly benefiting younger women who may not be ready to start a family but can now consider options like egg freezing, potentially reducing stress from discovering fertility issues later in life. Furthermore, heightened education and awareness efforts may contribute to challenging conservative laws in certain states that impede access to fertility treatments, while also advocating for insurance coverage in more liberal areas.
Based on your experience and research, can you please share “5 Things Everyone Should Know About IVF?” If you can, please share a story or an example for each one.
Everything in the IVF process tends to take longer than initially anticipated, and often more than one cycle is required for success. While the procedure may seem straightforward — going on medications, developing follicles, undergoing egg retrieval, and creating embryos — in reality, it rarely unfolds so smoothly. From my experience working with clients, unforeseen delays and complications are common occurrences. For instance, I had one client who appeared to be progressing well until a few days before her scheduled egg retrieval, when one follicle unexpectedly grew too large, overshadowing the others. As a result, the retrieval had to be canceled, and she had to wait for her menstrual cycle to restart the process. However, further complications arose when it was discovered that she had developed a cyst, requiring her to undergo a month of birth control in the hopes of reducing the cyst’s size before resuming treatment. This is one example of the hundreds of other situations that result in delays.
Attrition throughout the IVF process, from start to finish, is unpredictable and can be profoundly disheartening. For instance, a patient may begin with 20 promising follicles before their egg retrieval, only to yield 16 mature eggs. Then with fertilization, it may be the case that only 14 successfully fertilize. As the embryos develop over several days, more will likely fail to progress properly, and perhaps seven blastocysts will result by the end of the typical five-day period. Finally, there is genetic testing that is optional, but most couples choose, where there will likely be further reduction, leaving perhaps two euploid (i.e., normal) embryos for transfer.
IVF is not an exact science; there’s an art to it. If you consult three different doctors for IVF, you’re likely to receive three different protocols regarding the types and dosages of medication, as well as the duration of treatment. Each doctor aims for the best success based on their assessment, but given there is a subjective component, outcomes could differ based on which doctor you choose. For example, one of my clients sought two opinions on which protocol to follow. One doctor recommended starting with birth control as part of the treatment, while the other suggested immediately stimulating the follicles. Additionally, they prescribed different medications to stimulate hormones, leaving my client feeling uncertain about which protocol to choose and fearing if the cycle wasn’t successful, it was because she had chosen wrong.
The IVF journey involves a significant amount of rumination and uncomfortable waiting. You’ll wait anxiously between ultrasounds to monitor follicle growth, eagerly await updates on fertilized eggs, and hold your breath as you learn how many embryos have progressed to blastocysts. Then comes the wait to hear how many embryos are deemed normal. After a transfer, you’ll endure an agonizing nine to eleven days wait for the blood test result. Following a positive result, you’ll anxiously await your second blood test to ensure your HCG levels are progressing in the right direction signaling a viable pregnancy underway. Subsequently, there’s the nerve-wracking wait for the first ultrasound to confirm the presence of a gestational sac and a heartbeat. This continuous cycle of waiting, filled with anticipation and fear, consumes your thoughts and emotions, making it challenging to focus on anything else during this time.
It does work. The journey to becoming a parent through IVF can be intense, grueling, heartbreaking, frustrating, hopeful, and painful; however, those who have success, all say they would do it all over again. There are times when, unfortunately, it doesn’t work, but even then, I usually hear they are thankful they tried, or they would have had regrets. One couple, who ultimately used a donated embryo, felt that despite enduring numerous unsuccessful IVF attempts, they found solace in their decision to proceed with a donated embryo. This choice led to the birth of a successful baby that they couldn’t imagine not being a parent to.
In your experience, what are some of the key factors that contribute to IVF success, both medically and psychologically, and how can someone optimize these factors?
I will focus solely on the psychological aspect of navigating the IVF journey. Success in this context doesn’t necessarily mean achieving a pregnancy, although coming to terms with that would be very painful, of course. Success entails coping with the challenges of IVF and its potential outcomes, while also accepting the reality that much of the outcome is beyond one’s control. Success involves prioritizing self-care, as IVF entails physical discomfort from tests, medications, and surgeries, along with unforeseen ups and downs. Engaging in activities that bring joy and comfort can help maintain spirits during this journey. Having a supportive partner, friend, support group, or therapist — preferably someone with experience or knowledge of IVF — can greatly alleviate feelings of isolation. Furthermore, successful coping includes refocusing the mind when self-blame arises, a common pitfall among individuals undergoing IVF. Clients often question their choices or behaviors, attributing failure to factors such as diet or activity level. To navigate the IVF journey successfully, it’s essential to accept that setbacks may occur and to reassure oneself that whatever the outcome, one will be okay.
You are a person of great influence. If you could start a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. :-)
When it comes to IVF, the initiative I would propose is ensuring that every fertility clinic provides a free support group for individuals undergoing the process. Going through IVF can be incredibly isolating, especially when friends and family may not fully grasp the experience. From my experience running support groups, particularly within specific fertility practices, the most frequent feedback I receive is, “I’m so grateful this exists because I don’t have anyone else I can share this with who truly understands.”
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