Creating your own family. Fertility treatment and other options to assist pregnancy for couples
The painful truth is that pregnancy is not easily achievable for every couple and many can find themselves in a difficult and upsetting situation where they may have to find that having a family will not be possible for them. However the situation is not as bleak as it was some years ago, couples facing a struggle to start a family and single-sex couples now have options available to them. Remaining childless or having an incomplete family does not always have to be the only option.
This article will look to take away the mystery and confusion about fertility treatment.
What fertility treatments are available?
There are a number of possible options for fertility:
- Fertility drugs
- In vitro fertilization (IVF)
- Artificial Insemination
- Intrafallopian Transfers
Each is different and your doctor or consultant will be the best person to help you select the right path to take, however, it may help you to understand a little more about the options and what is involved with each.
Women suffering with infertility issues may be suitable for fertility drugs which work by causing their body to release reproductive hormones that control the ovulation process. Fertility drugs can be effective, and have a success rate between 40%–50% for women who ovulate that will get pregnant, usually within three cycles. They are often used as a first option for women who present with fertility issues before attempting IVF for example.
Fertility drugs should be avoided if the recipient has damaged fallopian tubes or endometriosis.
A course of treatment can cost between $10 — $100 per month for pills or up to $6,000 per month for a course of injections. Generally it will take between three to six months before either conception or another treatment should be considered.
Fertility drugs can cause more than one egg to develop in a process called multiple gestation, this can affect 1 in 3 women who are taking the treatment.
Surgery may be used in cases when there are blocked fallopian tubes, to remove endometriosis tissue, to treat PCOS or for other anatomical abnormalities and can increase the chances of becoming pregnant using natural conception.
The success of any surgical procedure depends on the damage to the fallopian tubes. There is an estimate that between 21–59% of women who undergo fallopian tube surgery and 40% who undergo laparoscopic surgery do conceive. There is a small risk of an ectopic pregnancy where the fertilized egg implants outside of the womb as well as the usual risks associated with surgery.
The costs for surgical procedures varies depending on the surgery required and can be between $2,000 and $10,000.
In vitro fertilization (IVF)
IVF is a long standing and well respected process which has been used for almost forty years since the birth of the first IVF baby, Louise Brown in 1978 in a process created by Nobel Prize winner Robert G. Edwards. Often known as ‘test tube babies’ there are well over 5 million children born by this process.
The IVF process involves eggs being extracted from the donor and fertilized in the lab with the partner’s sperm before being implanted in the uterus.
Before the process, your doctor will monitor your ovaries and the timing of the egg release, ensuring that your ovaries are producing eggs, and that your hormone levels are normal. It is normal to take fertility drugs during IVF, these are used to stimulate the ovaries into producing eggs. Having more than one egg available will increase the chances of becoming pregnant. In the case that the woman cannot produce eggs it is possible to use a donor to supply eggs.
The process may cause some discomfort but generally no pain and can be completed quickly. Typically, it will take between four to six weeks to complete a single IVF cycle and it may take two or three attempts before pregnancy occurs, however after this it is a normal pregnancy.
Pros and Cons of IVF
As with any fertility treatment there is not a 100% guarantee of success. The success rate is dependent on age, younger women are more likely to have a successful pregnancy via IVF, as you can see from the chart below which shows the average success rate by age.
As you can see from the graph, the success rate drops off at higher ages, however IVF can still be an option for older women to become pregnant.
One of the potential advantages of IVF is it allows screening of donors not only for genetic conditions but also for the selection of characteristics including ethnicity and physical attributes.
The average cost of IVF is $12,000 to $30,000 per cycle, with up to three cycles being required in most cases for a successful pregnancy.
This is a process where sperm is deposited directly into the uterus using a thin catheter using a process called intrauterine insemination (IUI). Artificial insemination is particularly used when the couple are unable to have vaginal sex, perhaps due to disability also for same sex couples.
For a woman to undergo successful artificial insemination, her fallopian tubes which connect the ovaries to the womb must be open and healthy as this is where the sperm will fertilise the egg and how the embryo moves down into the womb. The fallopian tubes can be checked using a laparoscopy where a fibre optic camera is inserted through a small cut in the stomach, alternatively X-rays or ultrasound may be used.
The success rate for artificial insemination depends on age, there is usually a 10% to 20% chance of conception per cycle, however this increases to 60% to 70% with six cycles of treatment. The average cost is $865 per cycle.
Doctors may recommend fertility drugs in addition to the procedure to ensure safe pregnancy. As with other fertility treatments, artificial insemination can increase the chance of multiple births.
There are two main types of Intrafallopian Transfers:
- Gamete intrafallopian transfer (GIFT) — the egg and sperm are placed in the fallopian tubes to allow fertilization to occur naturally
- Zygote intrafallopian transfer (ZIFT). Multiple eggs are collected from the ovaries and mixed with sperm. During ZIFT, fertilization occurs in a lab and the zygotes (fertilized eggs) are inserted in the fallopian tubes rather than the uterus, which is the main difference between ZIFT and IVF.
Intrafallopian transfers can be used in cases when the woman’s fallopian tubes aren’t blocked or damaged and the man has a low sperm count, or there are problems with the sperm. It is also used where there the couple object to IVF, for example for religious reasons or where IVF has failed to result in pregnancy.
It will typically take 4 to 6 weeks to complete one cycle at a cost of between $15,000 and $25,000 per cycle. Again the success rate varies with age but generally it is around 22%. The process is considered more invasive than IVF as it does require use of a laparoscope inserted through a small cut in the stomach.
Surrogacy is when another woman carries and gives birth to a baby for a couple who otherwise could not have a child. The surrogate becomes pregnant either via IVF using the intended parents embryo or through artificial insemination using either the father’s sperm or a donor’s sperm.
Surrogacy has one of the highest success rates when there is a healthy egg, sperm and surrogate, however can take about one and a half years to complete the process of matching, IVF and pregnancy. The cost of the process varies between $130,000 and $200,000.
The surrogacy process allows for extensive screening as you can select a surrogate which will provide the best match.
As well as surrogacy being suitable for couples who are unable to safely carry a pregnancy to full term it can also allow gay couples to have children. In the US there are specific LGBT surrogacy agencies who can provide advice and assistance through the process.
How to approach fertility treatment as a couple
Of course, fertility treatment is more than just a surgical procedure or arrangement for surrogacy. The emotions involved with any form of treatment is vital to be considered and the emotional stress should not be overlooked for couples involved.
Amanda and her husband had been trying to conceive for over a year before they were referred for treatment, they found her husband had a low sperm count and so IVF was suggested as a way to have the family they so desired.
“Finding out was awful and came close to breaking us apart. I could not envisage going through the ordeal of treatments and Tony just felt like a failure.” However, Amanda found the medical staff were able to provide the support they needed. “The medical people were very good at telling me all the stages and everything involved. I also found on-line communities to find out more details.”
After the initial trepidation they went ahead with the procedure, and she found that approaching it together helped and built a stronger relationship between them. “We got through it and thankfully we were lucky by having our daughter with our first treatment. We became a great team.”
Of course, not everyone can be as lucky as Amanda and Tony to be successful in the first cycle, something she found herself as they tried for a sibling, they had two failed cycles. “We hit the rocks again as we both felt like failures. It was pretty tough.” Thankfully their next cycle was a success and they have two beautiful children.
Amanda has the following advice for couples facing fertility treatment. “Get as much advice as possible. You need to remember to never play the blame game, it’s no one’s fault you’re going through treatment, it’s no one’s fault if your treatment does not work first time, remaining positive is the only way to get through it”
Preparing for fertility treatment
Your doctor or specialist can help you find the best fertility treatment for you, however there are things you can do before you attend your first meeting to ensure they have the clearest information to help you.
- Keep a detailed chart noting when your periods start and finish — you can use a spreadsheet or one of the many apps which can help you record information.
- Record if/ when you are ovulating.
- If you experience any pain or PMT
- Note how often you are having sex with your partner and when this takes place in your cycle. This will give your gynaecologist vital clues to your whole cycle which will help in the choice of which fertility treatment will be best for you.
Other things you can do to help your fertility include reviewing your diet to give you the best chance of conceiving. Look closely at your alcohol intake and give up smoking, strive to eat healthily with lots of fruit and vegetables and if either of you are overweight see if you can lose a little, even a 10% weight loss can greatly improve chances of successful conception. Think about possibly going to the gym together, it is a great way to spend time together and it will build up your stamina for when you do have children!
Children for LGBT couples
Only in recent years has the option been available for lesbian, gay, bisexual and transgender to raise their own children. Scientific research by bodies including the American, Australian and Canadian Psychological Associations consistently shows that gay and lesbian parents are as fit and capable as heterosexual parents, and their children are as psychologically healthy and well-adjusted as those reared by heterosexual parents.
There is the option of adoption and fostering as well as surrogacy and IVF for lesbian couples.
The United States supports commercial surrogacy for same-sex couples and in those states where it is supported there is support for surrogacy contracts and automatically naming the couple as the legal parents.
You should know that, just because you are struggling to conceive it does not mean that you will never have a family of your own. As you can see there are numerous tried and tested options available, take the time to speak to your specialist.
If you would like to find out more about the various fertility treatments, you should look at this excellent infographic from Growing Generations.