April is the recognized month dedicated to promoting awareness of infertility, specifically April 21-27, National Infertility Awareness Week, for promoting the dialogue, opportunity, forum and awareness for the one in six individuals affected by the disease, discussing the diagnosis, treatment, societal impact, financial burden, ethical considerations, access to care, individual challenges, expected treatment outcomes, and past and future advancements of reproductive medicine.
Prior to the first successful delivery of Louise Brown, an in vitro fertilization (IVF) conceived baby in 1978, misunderstandings, questions and often controversy have swirled around ongoing scientific and medical advancements in reproductive technology. Most recently, IVF and Assisted Reproductive Technology (ART) have been a significant subject of interest and discussion across many local and national news forums, with people expressing their personal experience with IVF and some sharing stories of how IVF access (or lack thereof ) has impacted their life.
Regardless of your own experience with reproductive medicine, I expect that you know of someone, or will know of someone, who faces a challenge with infertility and needs or requires access to reproductive medicine. IVF expands the realm of assisted reproduction and offers hope to countless individuals and couples facing fertility challenges. One does not need to understand the technicalities of IVF; but more should expand awareness of how IVF encompasses profound implications for individuals’ reproductive choices, societal attitudes toward reproductive access, and ethical considerations surrounding human life and technology.
Learning about IVF isn’t merely an option; it’s an essential endeavor that fosters informed decision-making, promotes empathy and support for those undergoing fertility treatments, and encourages critical reflection on how each person may be touched by infertility and treatment choices.
Many people do not share their experiences because there is a real or perceived stigma associated with the disease and treatment. In contrast, some people share experiences that may be non-factual or overinflated inducing fear or confusion, and that too should be clarified. I have the opportunity to educate patients about available options for building a family or preserving future fertility. There are so many different reasons why someone walks through the doors of a fertility clinic, and each visit always begins with education and an open discussion of options and expected treatment outcomes.
Age is the most predictive indicator of success, so the younger someone enters into an IVF treatment after a diagnosis of infertility (or the desire to preserve fertility) the better the expected outcomes should be in their case. Similar to any other disease process, the sooner treatment commences, the better outcome is achieved. It is important to note as well, that infertility treatments may continue for months and even years.
During a given IVF cycle, only the “eggs” that are present in a woman’s ovary that particular month have the potential to be retrieved. Those eggs are only available that month and will be lost through a normal biological cycle or retrieved through an IVF cycle which includes stimulating the eggs to mature. In a given month, the hormones that are naturally produced usually mature one egg for potential fertilization, in contrast, with the use of additional hormone stimulation during IVF, multiple eggs have the potential to mature. This process of follicular development, egg maturation, and retrieval takes approximately two weeks.
Once these eggs are retrieved, they have the potential to be fertilized. In general, about 85-90% of eggs are expected to be mature, and of these about 85% are expected to fertilize when combined with sperm, but multiple factors can make this percentage lower. Once fertilization is achieved, only about 50% of these embryos will have the potential to be transferred into the uterus. This is only the first set of challenges, because the next set comes with the potential for chromosomal abnormalities within the embryo(s) which do not allow for implantation or successful pregnancies.
Even when contrasting IVF with natural conception, there are still many similarities. Any given month, a younger person in her 20’s has about a 25% chance of naturally conceiving, 20% in her 30’s, 12% at 35 and about 5% at the age of 40, and these percentages are almost always associated with chromosomal changes within the egg/embryo which makes pregnancy success more difficult with advancing age. With IVF, we see the same variables, for those less than 30, about 60-70% of embryos will be chromosomally normal, for women around the age of 35, we expect about 50% normal and for those closer to age 40, maybe only 25% of embryos are normal during an IVF cycle.
Once a healthy (chromosomally normal) embryo is available, an embryo transfer can be planned which brings the person just one step closer to success. In desired circumstances, the likelihood of success with an embryo transfer and resulting live birth is roughly 65% per embryo. To put these numbers into a real and understandable example, a person at the age of 40 would need to retrieve about 12 eggs, have 10 of those mature, have eight fertilized, which lead to four embryos, to have an expected one chromosomally normal embryo for a 65% chance of a live birth. You can quickly appreciate the rate of attrition that occurs and how many individuals have to complete multiple (often two, three or four) IVF cycles to achieve a successful pregnancy.
Given all the challenges of IVF, it can be the most life-changing experience in someone’s life! Whether becoming pregnant for the first time, having a child after multiple miscarriages, preventing the inheritance of a life-threatening disease, preserving fertility prior to chemotherapy for a young cancer survivor, or becoming a parent through the use of a gestational carrier, I believe it to be one of the most incredible scientific discoveries in my lifetime and I feel privileged to be part of a team helping people achieve their dream of building a healthy family.
My advice for those who have gone through this journey is to highlight your experience, share your stories, educate others, prompt greater awareness and support to those who need assistance. For those who may be facing infertility, seek the treatment you need, educate yourself, become proactive and be your own advocate, have your treatment individualized to your needs, dispel any concerns or confusion that you may have by starting a conversation with your women’s health provider, OB/GYN, or seeking an appointment and consultation with a fertility specialist.
