This is the ninth article in our series of Tubal Ligation Reversal After 40 written for patients of A Personal Choice who are considering corrective tubal surgery for blocked tubes or tubal ligation reversal to reverse tied tubes.
This series can be educational, however, for all woman trying to decide between tubal ligation reversal or in vitro fertilizaiton (IVF). This article discusses Issues and Risks of IVF.
IVF Costs
IVF is expensive. A single treatment cycle can cost as much as $15,000 (average cost $9000-12,000). If donor eggs (eggs from another woman) are required or if intracytoplasmic sperm injection (ICSI) is used, then the cost of each IVF cycle can be much $20,000.
IVF Success
On average, a single IVF cycle has a success rate of about 30%. For most women, several cycles must be attempted before a pregnancy can be obtained. Success rates for IVF depend upon the cause of infertility and the age of the patient.
When considering IVF, it is important to understand what the reported success rates is based upon. IVF success rates are reported based on patient’s age, origin of the egg (patient’s eggs or donated eggs), and whether or not fresh eggs or frozen embryos are used.
IVF and Multiple Pregnancy
IVF has an increased risk of twins and high-order multiple pregnancies (triplets or greater). High-order multiple gestations are at an increased risk of preterm delivery. Approximately 30-50% of multiple gestations will be delivered prematurely. As a result, IVF pregnancies with twins or higher are considered high-risk pregnancies.
IVF Non-responders
Some patients will undergo injections with the hormonal medications and will not form any eggs or a very limited number of eggs. These patients are considered non-responders and will have decreased success with IVF.
IVF Cycle Cancellation
Some IVF cycles will be canceled or terminated early. This means after injections of hormonal medications, the IVF cycle will be stopped and egg retrieval will not occur. This will happen either because the patient is a non-responder (no eggs were formed) or because too many eggs were formed (this increases the chance of high-order multiple pregnancies).
IVF Embryo Reduction
If a patient becomes pregnant with a high-order multiple gestation, then the pregnancy is at high risk. If this occurs, the patient will have to consider whether to have an embryo reduction procedure. This procedure causes demise of one or more of the early fetuses so the remaining fetuses have a better chance of survival and being delivered at full term.
IVF Emotional Stress
IVF can exert a tremendous amount of emotional stress on both the patient and her partner. The high doses of injected hormones can cause extreme mood fluctuations and emotional instability in some women.
The high monetary cost of the procedure and desire to produce a child adds to the stress of the process. If patients start the IVF process and are discovered to be non-responders or have a cycle cancellation, this can be difficult for some to deal with. Should a high-order multiple gestation pregnancy occur, patients may have the difficult choice of whether or not to undergo embryo reduction.
IVF Causes Pressure to Succeed
Many patients have to pay directly for most, if not all, of the cost of IVF. As a result, there is an increased amount of pressure to be become pregnant with every attempted IVF cycle.
Patients will often judge the quality of any IVF clinic by the clinic’s pregnancy success rates. The pressure to be successful sometimes causes patients to pressure their doctors to insert more than the recommended number of fertilized eggs into the uterus. The IVF doctors also feel pressure to maintain a high pregnancy success rate, both for their patients and for the advertisement of their practice. This leads to transfer of multiple embryos, which is the cause of the high rate (1 in 3 pregnancies) of multiple gestations and high-risk pregnancies.
The most dramatic example is the recent birth of octuplets in California, which may lead to more stringent regulation of IVF clinics.
The next article will compare pregnancy success rates of tubal ligation reversal compared with IVF treatment.
Submitted by Dr. Charles Monteith
