I’ve been re-reading the IVF consent and information forms. They break the seven-week long protocol process handily into: two weeks on the pill, two weeks on nasal spray to down-regulate (put your ovaries out of action temporarily), two weeks of stimulation (to get follicles growing) and one week to collect eggs and transfer back the fertilised embryos.
You’d never take a pill or undergo a procedure if you were to analyse all the potential side effects, but there’s some scary stuff among all the info. The most important risks are listed as failure, ovarian hyperstimulation and multiple pregnancies.
The risk of miscarriage is higher in IVF than for the normal population, around 29% v 25%. I don’t know if that’s because a good portion of the patients have known fertility problems anyway. One-third of the clinic’s pregnancies end in miscarriage or ectopic pregnancy, apparently. It’s helpful to have a reality check, I guess, but that’s a quite bleak statistic I don’t plan to dwell on. The risk of an ectopic pregnancy in IVF is about 1 in 100; however, at least it’s generally detected quite quickly with the early scans.
Hyperstimulation is a scary prospect, “although the risk in the international experience of death… is estimated between 1 in 50,000.” If hyperstimulation occurs, you’re likely to have to abandon the cycle, freeze the embryos and drain any excess fluid from the chest or abdomen. Torsion doesn’t sound great either – this is where the ovary twists on its blood supply, causing severe pain and, in some cases, has to be removed. The risk of torsion is around 1 in 5,000.
If you opt for blastocyst culture before transferring the eggs back in (ie wait for five to six days after egg collection, as opposed to three days, to see how the embryos are doing), there is apparently a slightly increased risk of identical twins (over and above the higher risk that appears to be caused by IVF and ovulation induction drugs anyway). However, you can rest assured that the “small risk of triplets can be minimised”. Triplets, oh wow.
Doctor O said they would probably transfer two embryos. One of the info sheets says you’re advised to consider the transfer of just one embryo if you want to minimise the risk of a multiple pregnancy; you should particularly consider single blastocyct culture and transfer if you’re under 37 and have no previous history of IVF failure. I’m not under 37, obviously, but this is something I want to ask them about. The thought of having twins scares the daylights out of me. Then again, the blastocyst culture could create identicals. Imagine having two embryos transferred as a single mother and ending up with a pair of identicals and a third. This woman seems to manage having triplets as a single mother but she must be incredibly strong. And I don’t want to be a drama queen, but what if some of the babies have gestational problems and/or genetic defects, which when you think about it (which I’m trying not to) would not be beyond the bounds of possibility in a multiple pregnancy with potential early delivery at my age.
And in case you are completely freaking out after reading all of that material, the clinic throws you a bone in a rare instance of humour on the topic of the nasal spray, the effects of which are mainly related to your mood and hot flushes (hot flashes if you are state-side): “In other words, the mini menopause… will affect your mood – something your partner may well notice!”. Or your family, or your friends, or your clients in the middle of a sales pitch. Or your internet date over the peach flambé.
As I say, I’m not going to dwell on any of this but it’s worth reading the literature before you embark on this process. ‘Tis a serious business, ladies and gentlemen, no getting around this point.