The cruel irony of IVF
It can give couples babies they so longed for— but, as Justine and many others have found, the strain of treatment can tear relationships apart
FOR Justine Bold, it was only after three miscarriages, five gruelling rounds of IVF and years of financial sacrifice and anguish that she finally fulfilled her dreams of motherhood.
The moment she held her twin boys, Otto and Orin, in her arms, all the difficulties of her long journey were forgotten. ‘When they were born, I remember just smiling a huge smile and feeling so very lucky,’ says Justine, now 48.
Yet while Justine still feels lucky to have her sons, now nearly five, she also experienced a rather more unwanted side-effect of IVF.
When Otto and Orin were just 16 months old, her long-term relationship with their father broke down, partly because of the strain caused by undergoing fertility treatment. Since then Justine has found herself a single mother.
Last month marked the 40th anniversary since the first successful transplantation of an embryo grown in a test tube. Louise Brown, famously the world’s first IVF baby, was born on July 25, 1978. It’s estimated six million children globally — and more than 300,000 in the UK — have been born from IVF, or fertility treatments developed from it.
This gift of parenthood is surely one of the defining inventions of the 20th century. And yet there’s no denying the IVF revolution has come at a price. As Justine’s experience illustrates, it’s by no means a straightforward solution to the fertility problems that currently face one in seven British couples.
What’s often not heard about is the impact the often cripplingly expensive, not to mention physically demanding, treatment can have on the couples involved. Danish researchers, for example, estimate those who go through failed IVF are three times more likely to separate than those who go on to have a baby.
Jennifer Edwards, a relationship therapist with more than 20 years of experience, sees many couples who are trying to pick up the pieces of relationships broken by the expense and intrusion of fertility procedures.
She says: ‘Infertility is still a subject lots of couples do not discuss with friends and family. Many couples only disclose that a child was conceived through IVF when they’re well into their pregnancy and confident nothing is likely to go wrong. I still hear women and men express a sense of shame that they are not able to conceive a child.’
Men, in particular, can feel left out by female partners intent on conception. They are often more willing to accept children just won’t happen and move on, while their wives remain determined to become mothers at any cost.
Musician and former Strictly Come Dancing winner Harry Judd recently spoke of the disconnect that often occurs, after his experience with wife Izzy. ‘She so desperately wanted to be a mother. As soon as we realised there was a problem, it took over her life,’ Harry said.
‘The dynamic changed because all the focus was on getting pregnant and in a way I lost her a little bit. I lost that smiley, confident, beautiful wife.’
The couple now have Lola, nearly two, who was born after IVF, and a three-month-old son, Kit, who was conceived naturally.
But even successful treatment is not always enough to heal the rifts, as Justine, from Worcestershire, discovered. She had wanted to be a mother since her early 30s, but suffered a miscarriage aged 32 while in a previous relationship. After meeting her partner at 37, they started trying for a baby around ten months later. At 39, she went to her GP.
‘I was told I had a good ovarian egg reserve and got pregnant naturally in 2011 but had a miscarriage.
‘I then had an early miscarriage after a cycle of ICSI (where the sperm is injected directly into the egg).
‘More tests revealed I had Hughes syndrome, which makes the placenta fail, and my immune system was attacking embryos. Finally, with a fifth cycle of IVF, the treatment worked.’
But she says: ‘Struggling with fertility problems and going through fertility treatment was more of a strain on our relationship than I’d expected. Having a baby was more of a focus for me. My partner started to resent it. The fertility drugs made me feel fat and emotional.
‘It became harder to deal with the grief that was accumulating each time I had a miscarriage or an IVF cycle failed.
‘I kept wanting to try, but my ex got less keen as time went on, so this was a problem that built up between us. Then when I did get pregnant with twins, he was very apprehensive about coping with two.
‘I think a lot of people believe the journey stops when you get pregnant and it’s plain sailing from there, but my experience is the journey doesn’t stop then. There can be loss and surprises on the way — like twins — that add to the pressures, particularly on relationships.
‘But I think if you are lucky and you bring new life into the world, you just have to deal with whatever happens, even if it means doing it on your own, as then you have a child to think about and their needs are more important.’
Fertility treatment can also play havoc with the physical side of a relationship. A Stanford University study found that 40 per cent of women struggling with infertility experienced low libido, even though they previously had no difficulties when it came to intimacy. It wasn’t clear whether IVF drugs or psychological issues were the main factor.
Justine, a lecturer in nutrition who has edited a book on infertility, concurs: ‘There are long periods where you can’t have sex after treatment or feel too sore. Years of timing sex around ovulation also takes a toll as it destroys spontaneity.’
The detrimental impact of fertility treatment on a couple’s love life is something that’s not talked about enough, says Jessica Hepburn. Now 47, she went through 11 failed cycles of IVF because of unexplained infertility before she accepted biological motherhood would not happen for her.
Jessica, who now campaigns for improved care for infertility patients, believes couples are often not prepared, emotionally or financially, for what can be a very long journey.
The National Institute for Health and Care Excellence (NICE) estimates three rounds of IVF will cumulatively give a woman under 40 up to an 80 per cent chance of a successful pregnancy.
A single IVF cycle has an average success rate of 32.3 per cent for those under 35, dropping to five per cent for women aged 43 and 44 and only 1.9 per cent for those 45 and older.
JESSICA says: ‘Taking into account all the tests and three cycles of IVF that means it’s likely to be a journey of anywhere between three to six years.’
She admits that over the years her relationship with her partner Peter has been pushed to the brink.
‘Going through IVF is definitely a catalyst for separation,’ she says. ‘Pete and I have had some really dark times and for a while he moved out because he was unable to cope with my violent mood swings. During one row I poured a bottle of wine over his head.’
She adds: ‘Infertility is treated as a
clinical problem. But what’s not consid ered psychological trauma which starts the moment you discover you have a problem. ‘I regularly get emails from women who are very depressed; some are even sui cidal. The Human Fertilisation and Embryology Authority (HFEA) recomne treatment shore comne going through fertility could have one session of counselling, but that wasn’t something I was offered, and is it enough anyway?’ Then there are the financial pressures on a couple. Jessica’s unsuccessful treatcrippling £70,000, while nearly eight years on from her first IVF cycle, Justine is still paying off the £50,000 bill for her treatment, despite help from relatives. As many discover, bills for IVF can soar. A single cycle costs upwards of £5,000, and often far more. With some 60 percent of IVF cycles paid for privately, it’s perhaps unsurprising the fertility industry — now worth an estimated £600 million in the UK — faces accusations of exploiting that desperate urge for a child. As Jessica, a writer and arts producer, puts it: ‘You’ll do anything if someone says it will give you a baby. You’ll take the extra treatments or medications that are recommended. You’d cut off your arm.’
Yet an investigation by Panorama last year revealed some ‘add-on’ treatments being offered by some clinics simply do not have the clinical evidence to back up the claims being made.
Over the past 40 years the landscape of motherhood has changed dramatically, with the average age of mothers climbing ever higher. It’s now 30.3 years, compared to 26.4 in the mid-Seventies.
More worryingly, latest statistics show women in their mid-40s are almost twice as likely to be childless as their parents’ generation. One in five women born in 1969 is childless today, compared with one in nine women born in 1942.
So has IVF inadvertently contributed to the infertility problems that it set out to resolve? Does it give women a false sense that they can delay conception by a decade or more at little personal cost? After all, if they fail to get pregnant, there’s always IVF…
Despite IVF being most effective for the under 35s, 57 per cent of IVF cycles are undergone by women 35 or older.
To Jessica Hepburn’s mind, knowing you can have fertility treatment encourages the impression that it’s fine to delay motherhood. It’s something to get round to when all the other elements of our lives are in place. She was 34 and successfully running a London theatre when she decided to start a family.
Echoing the thoughts of many, Jessica admits: ‘I thought making the decision to fit a baby into my busy life was the hard part. I was wrong.’
She sees IVF contributing, in part, to a fundamental societal disconnect from the reality of conceiving a child — that it’s just more likely when you’re young.
‘People are leaving it later to have children, and they’re not having them at the biologically optimal age,’ she says. ‘We’re told in schools how not to get pregnant, but we’re not told what we need to know about our fertility life cycle.
‘We’re told that as women we should go to university, get on the career ladder, be picky about a partner, and that our mid-30s is the perfect age to have a family, but that’s the point when your fertility starts to drop off.
‘This problem is only going to get worse. Think of all the women in their 20s who are still living at home and struggling to find a job. IVF can’t cheat nature, it can only get everything in the rightplace at the right time. Just as in nature, not every embryo makes babies.’ Jessica feels so strongly about this that she co-founded Fertility Fest, an annual festival that provides support for those going through treatment by bringing together artists and fertility experts, as well as educating teenagers about the realities of fertility. ‘I am in no way anti-IVF,’ she says. ‘It’s given so many people I know families. But there are lots of issues that we need to talk about.’ Adam Balen, professor of reproductive medicine and surgery at Leeds Teaching Hospitals NHS Trust and chair of the British Fertility Society, which works to promote standards of fertility care and research, agrees there needs to be improved education around fertility for young people. ‘Women come to the clinic and are surprised when you say to them, “Actually your chances aren’t that high as you’re now 43”,’ he says. Concerns have even been raised that children born from IVF may face health problems later in life. Some argue that, in overriding the ways a woman’s body decides whether conception should succeed, IVF increases the risks of abnormalities in embryos. But Sally Cheshire, HFEA chair, is keen to stress that there is only one study relating to health complications for IVF children she considers credible. It found that boys born through ICSI go on to have lower sperm counts themselves.
DESPITE all these complex issues, IVF has brought joy to the lives of so many — like Su Lawrence, 46, who passionately believes IVF should be available on the NHS. Her daughter Amy, ten, was the result of her one round of free IVF.
Su, a textile designer, started trying for a baby with her husband Simon at 30 after being diagnosed with endometriosis in her late 20s. Apart from an ectopic pregnancy at 33, which resulted in the loss of one of her fallopian tubes, she had no success. A year later she was referred for IVF.
‘Fertility treatment takes the fun out of your life,’ she says. ‘It’s very stressful and you can’t enjoy life until you see a heartbeat. But we are so thankful to have Amy. She’s everything we wanted.
‘I don’t know what we would have done without that IVF. This was our one chance at parenthood.’
Professor Balen sees the ‘amazing revolution’ of IVF as a cost-effective one. Financial pressures mean just one in eight commissioning groups now offers the recommended three cycles, with some regions ceasing to fund IVF.
‘People throw their hands up in horror and say IVF is a luxury. The reality is that it’s not that expensive,’ he says. ‘If you go into hospital for a day or two, you can easily rack up the same sum.
‘It’s cost-effective and there are huge benefits to society, not just because of the children born and the taxes they pay when they work, but also the wellbeing of the patients who require the IVF. There’s much evidence of the huge amount of distress and time off work for people who suffer infertility problems.’
Yet we still know relatively little about the potential long-term effects of IVF. For example, some have questioned a lack of studies monitoring the long-term effects of fertility drugs on women to stimulate egg production.
Add to this the fact that scientists now have the ability to ‘edit’ an embryo’s genes, as well as screen for abnormalities, and we are very much in ‘brave new world’ territory. For while this development has the potential to eradicate cruel genetic illnesses, it also has the power to change the human race permanently.
Forty years on from that first ‘testtube’ baby, the true legacy of IVF remains unknown. For many who have already been through the experience, it has been a mixed blessing.