IVF Tales

It’s ironic that while in vitro fertilisation (IVF) was pioneered in Bristol, resulting in the birth of Louise Brown, the world’s first “test tube baby” in 1978, the city remains one of the most difficult areas in the country for couples to receive free fertility treatment via the NHS.
As if the chances of conceiving in the laboratory weren’t already stacked against infertile couples, they also have to contend with an IVF post code lottery.
To make matters worse the practice in Bristol is to exclude women over the age of 40 from treatment.
On the surface this may make sense given the numbers of couples looking to IVF - fertilisation of an egg by sperm in a laboratory dish - as a solution and the resources stretched NHS.
But, many couples see IVF as last chance to conceive and may not make the decision to apply for treatment until their mid 30s.
The average waiting list for treatment in Bristol is four years long, by the time their number is up they may well be pushing or be 40, at which point they are no longer eligible for help.
While the local NHS IVF programme should be applauded for its work, there’s little wonder that many couples will re mortgage their homes, take out loans or spend their life savings in order to avoid lengthening the already emotionally draining period of treatment.
D, a Bristol based teacher in her mid 30s, and her partner had already tried the inter-uterine insemination (IUI) technique, whereby the sperm are washed and then placed directly into the uterus, three times without success before being placed on the NHS IVF programme waiting list. In IUI, a treatment available through the NHS, the success rate is around 20%.
At 25% IVF offers better odds but, emotionally and physically the process is similar, and the waiting list is agonisingly long.
“In Bristol it’s a four year waiting list on the NHS, and also you won’t receive NHS treatment if you are over 40. It’s a big issue here and it’s very unfair because, of course, some women apply for IVF in their mid thirties and by the time their turn comes around they’ve just turned 40 so they just drop off the list. It’s cruel and it can be heartbreaking.”
While waiting for their number to come up D and her partner decided to go private.
The benefits of not having to endure years of waiting come at a cost though. Around £3,500 a procedure, and with no sure fire guarantee that the result will be a successful pregnancy.
“We went to Bath, we’d been recommended the clinic by friends but also, we’d been in Bristol for all the IUI treatment and it was nice to have a change of scene, like a fresh start.
We talked about success rates with the consultant, mine was one in four for my age, which obviously changes the older you get, and then, basically the procedure starts”.
The procedure starts with what’s known as ‘sniffing’. A drug, called a GnRH agonist, is administered via nasal spray, it temporarily shuts down the hormonal lines of communication between the brain and the ovaries and prevents ovulation.
In simple terms it creates a blank canvas for conception by flushing away all the hormones a woman produces to make way for fresh hormones created by a course of injections.
Says D, “The sniffing basically causes a mini-menopause and it can make you feel awful. So when I started injecting hormones back in you actually start to feel great, it’s a kind of artificial high, not all women get that, but I responded pretty well to it. I was using a drug called Menopur, it’s the hormone that helps you produce the egg and it’s one of the real costs of IVF because it’s really, really expensive. So I did that for about 10 to 13 days, but some women may take longer to produce their eggs so you have to keep buying it as you go along, it’s around £200 a packet and obviously the cost of your cycle keeps increasing. But once you have a satisfactory number of eggs, I think for me it was about 15 days”.
When the eggs are ready to be harvested the patient is put under a local anaesthetic in the clinic and the eggs are removed. It was ironic, because the day I had my eggs removed there was four of us on this little ward all waiting for the same procedure. The chance of success are about 1 in 4, I remember thinking that, in theory at least, one of us was going to be the lucky one. It was an odd feeling, there was one couple there, you don’t really get to know the other people in for treatment, but there was this one couple who had been through the process a few times and it was obviously a very desperate time for them, it is very emotional. The thing is, when you’re going through the procedure you feel ok about it, because you feel in control and that you’re actually getting somewhere. Infertility can make you feel like you haven’t a hope so when you start the treatment, there’s always a bit of hope at the end of it.”
Although the treatment gave D a feeling of progress, what she, and her partner, didn’t anticipate was the utter helplessness that would dictate the days that proceeded the removal of her eggs. “They take the eggs, put them in a Petri dish and add the sperm and then you have to wait for the ‘phone call to tell you how many embryos have formed. And there might not be any. It’s agonising waiting to hear. Really, it’s horrible. But it gets worse. Because even though I got the phone call to say that five embryos had formed they have to be graded, so it could turn out that none of them would be healthy enough to be implanted. So we sat in this room a couple of days later and were told the grades of the embryos, it was like getting your exam results at school. We had two that were good enough to be implanted and three that literally didn’t make the grade.”
With a healthy embryo implanted another two weeks of uncertainty follows before a pregnancy can be confirmed. “It makes you feel like you are no longer in control again, suddenly it feels like it could all come crashing down. You feel like you daren’t do anything, bending down, running up the stairs, carrying shopping... which, if you think about it is silly because you wouldn’t feel like that if you were pregnant at that stage and you hadn’t gone through the treatment, but...y’know, looking back I know why I felt like that, it is devastating if it’s not successful, I know from the experience of the IUI how awful it is when it doesn’t work, so I suppose I had that in mind and you’re on tenterhooks the whole time, you don’t want to get too excited or too hopeful because for every 25% that do work, 75% don’t, which isn’t good odds, is it? And you don’t even want to think about all the odds stacked against the pregnancy going full term itself. The word nervous doesn’t do it justice.”
The procedure, as D’s bonny four month old baby girl can testify, was a success. But the initial weeks of the pregnancy were no less nerve wracking. “When I found out I was pregnant we were both stunned, we just went out for a curry and didn’t really talk about it . I actually felt numb, I didn’t want to feel anything, actually, just in case it all went wrong. It took until the six week scan, in fact if I’m honest as late as the 20 week scan, until I convinced myself that I was actually pregnant. I hadn’t really anticipated how stressful the first six weeks would be, with IVF they wait for six weeks to scan to see if there’s a heartbeat - which is all you can really see at that stage - but I really hadn’t prepared NYSE for how hard I would find that time. The clinic were supportive in that they were very straight and factual with us about everything that but emotionally, I think some kind of support group, with people in the same boat, would have been really useful to help you get through the waiting, and also to learn what to expect and how to deal with all those emotions, especially if it fails. IVF is like being in limbo, it’s hard to describe how draining it can be, for the both of you. But I look at my beautiful baby daughter and I know it was worth it.”
For male partners IVF is just as emotionally (and physically) draining.
K, a civil servant, and his partner also opted to go private for IVF treatment.
Now the proud parent of a healthy two year old boy, K remembers the experience as an emotional roller-coaster ride with moments of surreal hilarity.
“From the male perspective it’s, fundamentally, a case of masturbating in a public building without fear of arrest, not to put to fine a point on it” quips K, “You have to provide sperm for testing and for introducing to the eggs so at the clinic you go to this nasty little room and, well, y’know. But everybody in the building knows what the rooms is for. All the men, all the women, everybody who works there. It’s close to the waiting room and you have to walk past it on the way to the toilets. The first couple of times I went there I didn’t realise that there was even a lock. Anyway, once you’re in there, there’s a settee a curtain you can draw and, believe it or not, a box of tissues. There’s also a box file with the word ‘EROTICA’ printed on it. It was full of quite unpleasant porn magazines, which I looked at briefly and then put away feeling slightly unclean. There’s an amusing sign in the room which I’m sure the staff get fed up of people pointing out to them, it says, ‘please pull for assistance’. There was also a CD player, but only one CD, “the Best Christmas Album In The World Ever”, trouble was, this was in April. I thought, what the hell would people think if they were walking past and they heard ‘we’re having a wonderful Christmas Time’ blaring out in the middle of April. I should think they could only draw one conclusion. So it’s not a great start.”
As it turned out K’s sperm sample was healthy, but this wasn’t necessarily cause for celebration. “When people knew that we were going for IVF treatment people kept saying to me ‘oh, don’t worry 99 times out of 100 it turns out to be the woman’. It was as if you could apportion blame to infertility somehow. It was a ridiculous thing to say to someone in my place, I mean how would that make us any more able to have a baby? It makes no difference whether it was me or my wife or both of us combined who were infertile. I was surprised by the number of times men would say that to me.”
The reason why couples put themselves through the rigours of IVF is, of course, because they want to start a family. But the process puts relationships to the test.
“I’ve always wanted children and to find someone who wants to have children with you and then you both find out that there’s a strong possibility that you can’t is gob smacking. It’s a shock”. Going through the IVF process was hard going for both K and his wife. “There were times when she was quite upset by it all, it’s not a cheery process by any stretch, I tended to make light about it to cope with it, it’s not that I didn’t take it seriously, but it was just my way, otherwise you resign yourself to despair that it’s never going to happen. I’m a glass half empty kind of person, when we were told we only had a 10% chance of success I convinced myself that we had no chance at all, that way it kind of cushioned the blow for me”.
Financially, says K “it was probably better not to think about it. I mean, you wouldn’t put £6000 on a horse with a 10% chance of winning, would you? We don’t have a bottomless pit of money, and you have to accept that it probably won’t work first time, so how many times are you going to be able to pay? It’s a long process and we weren’t getting any younger, I was approaching 40 at the time, what if were still doing IVF into our mid 40s, would we even have the energy to start a family then?”
Luckily K and his wife only had to endure one IVF procedure. “It was nerve wracking, as I said, I’m a pessimist about most things and in this case, partly to defend yourself against things going wrong I’d convinced myself that it was never going to happen, even though, at the back of my mind, I knew that the 10% shot we’d been given was still better odds than we’d had before IVF. I remember distinctly one morning we were at home. My wife was in the bathroom and I was drinking coffee in the kitchen, staring out the window. I watched the neighbour’s cat climb into our garden and be sick. Suddenly I heard my wife come thundering down the stairs. She ran into the kitchen waving a pregnancy test. She said, ‘guess what?’, and I said, “I know, the neighbour’s cat’s just been sick in our garden’. Of course, I knew that she was pregnant, which was wonderful. But even then, for about a month afterwards we didn’t trust the pregnancy test, it was only when we went for the first scan that it hit home that, ‘yes, we’re having a baby.’ which was the point in my life that, in most respects at least, I became an optimist.”