Tuesday, May 12, 2009

Thoughts on IVF

I'd like to start this post by acknowledging the fact that it's likely that the majority of people who use IVF would not CHOOSE this route to parenthood. I would venture to say that nearly everyone who uses IVF to conceive would much prefer to simply conceive a healthy baby without medical assistance. I say "the majority" or "nearly everyone" because there are many reasons for using IVF, and I can't know the reasons why every couple chooses this route. (Perhaps, as in My Sister's Keeper, they have chosen IVF to ensure that the child who is a result has certain, specific genes rather than due to infertility.)

I would also like to make clear at the outset that our thoughts and feelings on this matter are just that: OUR thoughts and feelings. In no way do I wish to imply that we are right and those who chose otherwise are wrong. To me, decisions about ART are extremely personal--as personal as the decision to have a child--and what is right for others may not be right for me and vice versa.

I have alluded before to the fact that both MM and I are against IVF for us, but for different reasons. MM's primary objection to IVF is the expense relative to the success rate. I should first of all mention that our insurance covers nothing for IVF. If we end up going that route, we will be paying 100% out of pocket. We do not have $10-30K in savings that we can use for IVF, so we--like many other couples--will be in the position of either borrowing the money or asking MM's parents for the money. (My parents don't have lump sums of money they could give us; my in-laws have the money, though whether they would give it to us for this purpose is a separate, thus far unasked--and unanswered--question.)

Based on data reported to the CDC for dates from 1/1/2000 to 12/31/2007, our clinic cites an Estimated Live Birth Rate for women in my age range (38 to 40) of 40.5% with normal testing. As with most clinics I've researched, the success rate is slightly higher for fresh cycles than for frozen cycles. Some clinics in other states cite higher success rates.

Before we were even sure that we would need to use ART to conceive, when we were discussing the topic of someone else's IVF, MM once opined that he "wouldn't pay that much for anything without at least a guaranteed 50% or greater chance of success." In conversations that we've had on the matter since then, he has stuck with this opinion.

MM has a huge aversion to going into debt for any reasons, but especially when the money being spent may not even allow us to achieve our desired result. Anyone who knows anything about IVF knows that it is entirely possible to go through three, four, or even more cycles and still not have a living baby to show for your efforts.

While I don't have MM's same aversion to debt (witness the $60,000+ I borrowed for law school), I agree that IVF is, in essence, a very expensive gamble. Sure, the odds are much better than the lottery, and the "prize" is priceless and irreplacable. . . . but it is a gamble nonetheless.

My primary objections to IVF are the effects that it would have on me. Even a smooth, relatively uneventful IVF cycle means a lot of stress on my body. It will also likely mean a lot of time away from work. I am the primary breadwinner in our household, and I only get two weeks each of sick leave and vacation per year. My job also involves occasional travel, which could be extremely hard to coordinate with the regular monitoring that IVF requires.

I am fully aware that being pregnant and having a child will also mean stress on my body and time away from work. However, this just goes with the territory of pregnancy and parenthood, and the majority of people will understand that, having gone through the same experiences themselves or with their spouses. I can't see myself going to my firm's partners and telling them that I am already going to need lots of time off, even before ever getting pregnant. I do not think that that would fly.

I am also fearful of the effects that the medications used would have on my body, both in the short term and the long term. I'm not sure I can handle the medication side effects, especially as they impact mood and mentation. The increased risk of multiples concerns me. And I am a little concerned about whether certain medications might increase my risk of some cancers in the future. (I've already had to sign a release to this effect just to take Clomid.)

[As an interesting aside, MM has told me that if we "knew for sure" that IVF would work, he would want us to do it, despite the reservations I have stated above.]

If I had to try to sum up my biggest objection to IVF for me, though, I think it would be most simply stated as "Where does it end?" If I'd be willing to do one IVF cycle, why not two? Three? Four? More? A friend of a friend recently gave birth to a baby conceived on their 6th IVF cycle. Tertia, writer of the blog"So Close," did nine cycles of IVF before she was able to bring a living baby home from the hospital.

To me, the easiest way to avoid this "slippery slope" is to simply not start. There are things in this life that each of us want desperately which we are denied for one reason or another. If the only way that MM and I can conceive a child of our own is through IVF, perhaps it would be wiser for us to simply accept that this is something which, for reasons unknown to us, we are being denied.

Until we started seeing the RE, like most healthy young men, MM wasn't even aware of most of the options available to us. If we don't succeed in these next five cycles of IUI, we may be discussing them further. Who knows?

As it stands currently, at the start of cycle #15 TTC with no explanations for our infertility and one failed IUI under our belts, that's where we are. I cannot say with absolute certainty that our feelings on the matter won't change if/when we realize that IVF is our only remaining option. (It's not as though either MM or I has a moral or religious objection to the procedure.)

7 comments:

  1. i hope you never have to face the real decision about whether or not to go through IVF. I know one of these IUI cycles is going to work for you!

    i agree that the decision for everyone is different. when i started on this journey, i also thought if it came down to IVF, i would choose to adopt. however, once the doctor told me it was our only chance, i wasn't ready to give up on the idea of having a biological child. but i have to say, my insurance does cover it, and if it didn't, i'm pretty sure we would have saved up the money to adopt a baby, where there is a 100% chance of the desired end result, instead of 50/50.

    good luck. enjoy your "break" cycle. i just finished one myself and it was very restorative.

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  2. IVF is a daunting prospect and I understand your view. I committed to not doing more than 2 fresh IVFs early on in the process, that was my limit. Had I not conceived my son the second time around I may have changed my view on that. I really hope the IUIs work and you don't have to revisit your position on IVF. In retrospect, I wish I hadn't done 5 IUIs and instead had gone straight to IVF because I ended up wasting money on procedures with a somewhat low success rate- and the 5 IUI cycles cost more than one fresh IVF cycle. Also each IUI was as emotionally draining as each IVF cycle, and I didn't find the hormones to wreak that much havoc on me emotionally. IVF did not interfere with my work all that much; my clinic has early morning hours so I was always at work by 8:30 or 9. I took 1.5 days off for my first IVF (transfer was in the afternoon, so I went straight from work) and only 1 the second, because transfer was on a Saturday the second time. Insurance covered more than I expected it to- the meds and many of the blood tests and ultrasounds, and it even covered part of the IVF procedure that was like $2,100, I was shocked but thrilled obviously. I considered the odds of success of two cycles- which was 75% for me. For you that would be 64%. I really hope your next cycle is the one for you and you never have to contemplate IVF.

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  3. Just a little clarification:

    Adoption is not 100%. There are failed adoptions and there are many couples who give up after years and years of not being picked. People sometimes negate the pain that can happen when parents have seen a baby on the ultrasound, prepared a nursery, sometimes even brought the baby home, and then had the birth mother change her mind.

    That said, you do bring up lots of good points. We would not have tried IVF if we hadn't had the savings. Calling a halt to it is harder than it looks.

    Lets hope you get lucky though.

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  4. Frau, this blogger has indicated that if IUIs don't work she's going to choose living childfree, she's not stating that IVF is less risky/less expensive than adoption.

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  5. I can totally understand what you are going through and taking about here. The slippery slope is tough, and I'm not so sure the line in the sand between IUI and IVF is that clear, either. After investing money into three Clomid cycles, two of them with IUI, I'm loathe to throw it all away and not try IVF even once, with the chances being much higher. I, too, am scared of the slippery slope - I don't gamble, but I know that getting started can bring on the same feelings a gambler can get, that next time I will surely hit the jackpot, and how can I give up without giving it one last try?

    Still, I think you'll find that your perceptions might change as you move forward. I was sure I would be ok with adoption, and now I'm not so sure. It is a complicated process that involves two individuals with different thought processes and different goals, and there is just no easy answer.

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  6. Yes, I am not comparing IVF to adoption but rather to the less-often-discussed option of doing nothing.

    We are leaning against for adoption for us also. At some point, that will likely be the topic of a future post.

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  7. Frau, you are right- i shouldn't have said adoption is 100%, since it most certainly is not. i actually don't know what the stats are exactly, but i would assume the likelihood of actually adopting a child would be much greater than 50%.

    S- I am curious to read about why you will not pursue adoption either.

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