IVF essay

Question: Is IVF worth the risks and possible side effects for the mother and child?

The process of conception is open to a myriad of complications, starting from fertilization. If an individual, male or female, is infertile, they are biologically unable to contribute to the conception of a child. According to McArthur 's 'Infertility statistics ' (2007) one in eight couples are infertile. Ordinarily a fertile couple in their twenties having regular unprotected sex has only a 25% chance of conception each month. Thus, it is difficult to tell whether or not a couple is infertile. Only after 12 months of regular unprotected sex should couples under the age of 35 consult a physician about their fertility, this period allows enough time for conception to take place for a fertile couple. While couples over the age of 35 should see a doctor after only 6 months, this is because with time, the physical and physiological factors working against conception grow stronger, thus older couples should seek help sooner (McArthur 2007). Over the years, a series of medical procedures have developed, collectively known as assisted reproductive technology or 'ART ' to help grant infertile couples with biologically related children. Common procedures of ART may include Gamete intrafallopian transfer, Zygote intrafallopian transfer, Intracytoplasmic sperm injection and In Vitro Fertilization, more commonly known as IVF (MedicineNet 2013). IVF has been successfully used since the first IVF baby was born in 1978, since then it has been estimated that over 3 million IVF babies were born around the the world between 1978 and 2006, and by 2012 that number was published to have reached 5 million (International Committee for Monitoring Assisted Reproductive Technology 2012). In 2008, it was recorded that 3.3% of all Australian babies had been conceived through assisted reproductive technologies (Oxford Journals: Human Reproduction 2010). The process of IVF involves a procedure from which eggs are removed from a woman 's ovary and fertilized with sperm in a laboratory procedure, the embryo is then returned into the woman 's uterus with the hope of continuing a natural fetal development. (MedicineNet 2013). IVF however, is still a procedure that requires a significant amount of physical, emotional, financial and time commitment and it is common for couples to face stress and depression whilst partaking in it. In addition to this, there are a number of potential risks for the woman and baby throughout the course of the treatment. Common risks associated with IVF include ovarian hyper stimulation syndrome (OHSS), Ovarian Torsion, ectopic pregnancies and multiple pregnancies.

IVF is the most successful ART procedure but is often only attempted by couples when other, less expensive techniques or procedures have failed. It 's used to treat many causes of infertility such as damaged or blocked fallopian tubes, endometriosis as well as factors effecting male infertility such as a decreased sperm count or blockage. According to the U.S National Library of Medicine, the IVF treatment process is broken down into four stages: Ovulation induction, egg retrieval, insemination and fertilization and embryo transfer. Ovulation induction involves prescribing the female patient with medication designed to encourage the development of eggs in her ovaries. Once multiple eggs have developed, an injection of the hormone hCG is taken to help the eggs mature. Typically, 36 hours after the hCG injection, the woman is ready to undergo egg retrieval. This a minor surgical procedure known as follicular aspiration, that is done to remove the eggs from the woman 's body. It involves a needle being directly inserted through the vagina 's back wall and into the ovarian follicles. The needle 's connected to a suction device that pulls the eggs and fluid out of each follicle, one at a time. The procedure is then repeated in the other ovary. If the woman is not producing any eggs, donor eggs are available, the child would then however, not be biologically related to the mother, this is the same for a male not producing adequate sperm. The received eggs are identified and taken to the laboratory to begin the insemination and fertilization process. They are placed in a petri dish in a special liquid medium for 2 – 3 hours. During this period, a semen sample is collected from the male to be placed into the petri dish along with the eggs to allow fertilization. The combining of the egg and sperm is known as insemination and the sperm will usually enter (fertilize) the egg a few hours after this. If the doctor believes there will be a low chance of fertilization, the sperm may be directly injected into the egg, this process is known as intracytoplasmic sperm injection (ICSI). The eggs will be constantly examined for the occurrence of fertilization, if fertilization has been successful, after 3 – 5 days healthy embryos may then be transferred directly back into the woman 's uterus to allow them to continue growth until a child is ready to be born (Storck 2012). It 's important to know that IVF treatment does not lead to a guaranteed pregnancy and birth. In fact, on average, there is only a 20% success rate in an IVF cycle and while it is possible to repeat the cycle, the process comes at a high financial, emotional and physical cost with a number of potential risks and side effects for the woman and baby.

It is not uncommon for patients to experience complications throughout their procedures. Occasionally ovulation stimulation drugs may lead to Ovarian Hyperstimulation Syndrome or OHSS, approximately 3-5% of patients develop OHSS and symptoms may range from mild bloating and tenderness to the abdomen to, in rare cases, liver and kidney disorders, ovarian torsion, blood clots and death. Clinics are attempting to reduce this number by carefully monitoring their patients, cutting down doses of hCG and if a patient has developed an excessive amount of follicles as an outcome of their fertility drugs, the doctor may suggest the cycle be canceled before undergoing egg retrieval. If the doctor believes the patient/baby is at risk after egg retrieval, they may choose to freeze each embryo and transfer them once the ovaries have returned back to normal. Ovarian Torsion is a rare complication with it 's overall risk amounting to about 0.2%, however in the presence of OHSS, this risk does increase. Ovarian torsion may cause severe pain to the patients abdomen and if not treated properly or early enough, the ovary may die. Ectopic pregnancies are potentially life threatening for both the mother and foetus and occur when an embryo grows somewhere outside the woman 's uterus. Ectopic pegnancies can occur naturally, however IVF treatments does increase the risk. Fertility specialists believe ectopic pregnancies occur when the transferred embryo is placed too high int the womb cavity, here the embryo has a greater chance of moving and implanting itself somewhere where it shouldn 't be such as the fallopian tubes. The embryo may also make it to the fallopian tubes if was injected into the womb with too much force. Health statistics however, show that only approximately 1% of all pregnancies are ectopic. Other complications may include bleeding infection and injury to other internal organs from egg retrieval and side effects from general anesthesia, sedation and medication. However according to the Victorian Assisted Reproductive Treatment Authority (2011), severe physical complications of IVF treatment, requiring the hospitalization of a patient, are rare and occur in around 1% of all treatment cycles.

In a Swedish study, 2.5 million Swedish children were studied and those born through IVF were compared to those who were conceived naturally. It was found that about 47 in 100 000 IVF born infants had developed cognitive deficits such as low IQ 's and problems in communication and socializing compared to that of 40 in 100 000 of naturally conceived infants. The study 's leader, Sven Sandin stated “For IVF there are known risks, such as birth defects and now mental retardation should perhaps be added”. (Sifferlin 2013) However, when a different research team, restricted the same children in the study to only single birth children, the link to intellectual deficits was no longer significant. This tells us that the previous study showed a greater risk of birth defects and developmental problems amongst multiple births of which are more common with IVF patients. The single, most unfavorable and common outcome of IVF treatment is that of multiple pregnancies. Multiple pregnancies are not only undesirable for the sake of a potentially unwanted baby, but for all the opposing risks it carries for the mothers and babies. Multiple pregnancies raise the risk of death and harm to the mothers and babies during childbirth. In addition to this, more than one baby in the womb results in a significantly increased risk of low birth weight and premature births, of which leads to a whole other range of problems. Westmeads IVF program in Sydney, opened since 1984, has calculated an approximate 20% of births resulting in multiple pregnancies, a result that is similar to other IVF programs around Australia. Professor Bhattacharya from the University of Aberdeen states that “Multiple births increase risks for mothers and babies. They should not be seen as inevitable and acceptable outcomes of assisted reproduction”. Hershlag, the leader of the second Swedish study says “I call it the epidemic of multiple births that our field has created by transferring multiple embryos into the uterus. It has brought up a lot of medical and health issues for the babies as well as for the moms”. The risk of multiple pregnancies occurs from the common practice of transferring more than one embryo into the uterus at a time, this is done in order to heighten the chance of pregnancy, because of the risk however clinics are being encouraged to opt for single embryo transfers as well as extendeding the embryo 's development outside the body to allow adequate pregnancy rates. The embryologist can assess the embryos for quality prior to the transfer to make sure the highest quality embryo is being used and any others to be frozen or stored for future use.

IVF treatment is quite a common treatment and is generally regarded as a mostly safe technique. It cannot be proved that the increased risks of obstetrical complications, birth defects and prematurity are caused by the technology rather than the parental characteristics of infertility and the common cases of multiple pregnancies, of which can be prevented by single embryo transfers. IVF is not a totally safe procedure and does pose risks of complications and side effects, just as would any major medical procedure, however it is safe enough. Considering the unlikeliness of such events to occur, couples should not oppose it for such reasons. “In general we tell parents that IVF is safe and to a large degree, babies born from IVF are healthy and grow into healthy adults” says Hershlag.

Bibliography http://humrep.oxfordjournals.org/content/26/2/473.full http://www.nlm.nih.gov/medlineplus/ency/article/007279.htm (storck 2012) http://www.abc.net.au/health/library/stories/2007/05/30/1919840.htm#.Ugn7NZJgc-o http://www.medicalnewstoday.com/articles/165748.php (Nordqvist 2013) http://www.medicinenet.com/infertility/page7.htm#what_are_the_different_types_of_assisted_reproductive_technology_art (2013) http://www.smh.com.au/national/health/study-sparks-health-fears-for-ivf-children-20120418-1x7j0.html http://healthland.time.com/2013/07/05/how-healthy-are-ivf-babies/ http://healthland.time.com/2013/05/30/frontiers-of-fertility/ http://healthland.time.com/2013/03/26/study-clarifies-link-between-fertility-treatments-and-neurological-problems-in-kids/

Bibliography: http://humrep.oxfordjournals.org/content/26/2/473.full http://www.nlm.nih.gov/medlineplus/ency/article/007279.htm (storck 2012) http://www.abc.net.au/health/library/stories/2007/05/30/1919840.htm#.Ugn7NZJgc-o http://www.medicalnewstoday.com/articles/165748.php (Nordqvist 2013) http://www.medicinenet.com/infertility/page7.htm#what_are_the_different_types_of_assisted_reproductive_technology_art (2013) http://www.smh.com.au/national/health/study-sparks-health-fears-for-ivf-children-20120418-1x7j0.html http://healthland.time.com/2013/07/05/how-healthy-are-ivf-babies/ http://healthland.time.com/2013/05/30/frontiers-of-fertility/ http://healthland.time.com/2013/03/26/study-clarifies-link-between-fertility-treatments-and-neurological-problems-in-kids/