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A recent treatment option for women with multiple pregnancies is that of selective fetal reduction, in which one or more of the fetuses are selectively destroyed (usually by injecting a toxic chemical, potassium chloride, into its heart under ultrasound guidance). In most cases, the killed fetus is then reabsorbed by the body - and the other fetuses continue to grow. Of course, the risk of all the fetuses being lost because of a miscarriage (as a result of inadvertent trauma during the procedure) is also present, and is about 10% in experienced hands.
There is approximately a 54% chance of an ectopic pregnancy with IVF. This is not because of the procedure, but rather because women going through IVF already have damaged tubes, which predisposes them to having an ectopic.
IVF is physically demanding - and stressful! The effects of blood tests, anesthetic and operation are tough on your body. Hormone stimulation causes lethargy and fatigue, notwithstanding the sometimes extensive travelling required each day. Some people find treatment conflicts with their employment or other commitments.
A final risk is not physical, but psychological. The major risk for most patients is the risk of failure that even after spending all the time, money and energy required for a treatment cycle, they will not get pregnant. Couples undergoing IVF have described the experience as an emotional roller coaster. The treatments are lengthy, involved, and costly. These procedures often create high expectations but are more likely to fail than to succeed in a given cycle. The unsuccessful couples will feel frustrated in their quest for pregnancy. It is common to feel angry, isolated, and resentful towards both the spouse and the medical team. At times, this feeling of frustration leads to depression and feelings of low self-esteem. The support of friends and family members is very important at this time.
IVF techniques have now become well established, and most towns in India have one or more IVF clinics today. This is all for the best, because infertile couples no longer need to travel long distances for IVF treatment. However, because offering IVF has become a fashionable trend, there are now too many IVF clinics in competition with each other. Many of these clinics are poorly equipped, and the staff inadequately trained, with the result that pregnancy rates are poor. Many clinics have started, and then closed down in a few months, without being able to achieve even a single pregnancy dashing many patients hopes in the process. Unfortunately, this often means that all IVF clinics start getting a bad reputation. In order to protect yourself, it's a good idea to ask the clinic staff to actually show you the embryos under the microscope. Most good clinics do this routinely, and some even offer video records. Not only is this reassuring for the patient, it also helps them to "bond" with the embryos!
Another danger of too many IVF clinics is the risk of over treatment. In order to remain profitable, many clinics now offer IVF to infertile couples as a treatment of first choice (rather than reserving it for patients who truly need it). While this does help them to keep their financial bottom line healthy and to increase their pregnancy rates (since many of these patients are young couples, who never needed IVF in the first place!), it is an inappropriate use of limited medical resources. IVF treatment should be reserved only for patients who really need it. Paradoxically, while rich patients end up getting IVF even when they don't need it, poor patients are often deprived of this treatment even though they need it, because of the expense involved. Unfortunately, the Government still does not consider that providing infertility treatment should be a part of its family planning program. Hopefully, this will change in the future, and providing infertility services will be seen to be a part of comprehensive reproductive care services. This will provide many more infertile couples access to assisted reproductive technology.
© Dr. Aniruddha Malpani and Dr. Anjali Malpani www.drmalpani.com
Credits: How to Have a Baby: Overcoming Infertility
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