When IVF is not the answer

Posted on May 9, 2013

Everybody knows somebody suffering from infertility. With one in six couples affected, there is someone in your family, your circle of friends, your office that is struggling to deal with this. For some, a simple medical procedure or the right drugs will do the trick; for others, it can mean year after year of failed treatments with no explanation why.

IVF is often hailed as a cure-all, the solution that couples turn to when all else has failed. It is not an easy procedure physically, emotionally or financially and, with only a 25% success rate, it does not always provide a happy ending.

The IVF process involves stimulating the woman’s ovaries to produce multiple eggs, retrieving these eggs, mixing them with the man’s sperm in a laboratory to facilitate fertilisation (“in vitro” literally means “in glass”), observing the embryos to determine which ones are more likely to develop and then transferring those embryos to the woman’s uterus. While there are many factors that contribute to a successful IVF, identifying viable embryos is one of the most important.

Traditionally, embryologists have observed the embryos once or twice a day and made an assessment on their development based on what they see at a particular point in time. However, this grading process doesn’t take into account the rate at which the embryo is developing. A revolutionary new technology, EEVA (Early Embryo Viability Assessment) uses a non-invasive microscope to take video images of the embryos, which are then analysed by software to determine which embryos are dividing and developing at an optimal rate.

Dr David Walsh of the Sims clinic in Dublin says that EEVA is a big step forward. “The aspect of IVF that we’ve struggled with is, which embryo wants to become a child? In effect, you’re playing Russian roulette because you don’t know which ones want to become a child so you have to put in more than one embryo in order to accumulate those probabilities.”

Dr Walsh says that thanks to EEVA, embryologists can now make a functional assessment of embryos rather than a purely structural one. “I think it’s another layer – if you have a system that depends on shape, you can get it so far, but this in terms of function gives you an additional layer.”

What this means for infertile couples is that the best quality embryos can be chosen with greater accuracy, thus increasing pregnancy rates and reducing the number of IVF cycles they may have to go through. It also means that fundamental embryonic problems can be identified and couples can move on to other treatments without first having to suffer several failed cycles. “If it doesn’t work, you have clearer evidence that this was an embryo problem and you don’t have to go chasing non-embryo issues”, says Dr Walsh.

It’s a procedure that Kathy Abbey could have done with when she embarked on the first of her seven failed cycles of IVF. Kathy and her husband, Alan, started trying to conceive when they got married in 2004. She did become pregnant in 2005 but sadly miscarried. When nothing was happening by the following year, Kathy went to her GP, who referred her to a fertility clinic. After several rounds of the fertility drug, Clomid, another miscarriage and two IUI (intrauterine insemination – a less invasive procedure than IVF) treatments, Kathy and Alan decided to move on to IVF.

“I was delighted”, says Kathy. “You think that IVF is the solution to all your problems, of course it’s going to work first time, nothing can go wrong.” When it didn’t work, Kathy was devastated. “You just can’t describe what it’s like. I don’t think you ever forget.”

After three unsuccessful IVF cycles at the Kilkenny clinic and, facing the prospect of €6,500 for another go, Kathy and Alan decided to travel to the Reprofit clinic in the Czech Republic. “It was fantastic, out of this world”, says Kathy. “It was so modern, a totally different experience to Ireland. You just feel that they’re not money-focused, even though they probably are.”

Kathy says the process was very straightforward and, with so many Irish couples travelling abroad for cheaper IVF, there was a wealth of information available online. But after another four IVF cycles, Kathy was no closer to holding the baby she had wanted for so long. Furthermore, there seemed to be no reason for this. “My doctor in the Czech Republic couldn’t understand why I wasn’t getting pregnant – my embryos looked great quality.”

Kathy was referred back to the Kilkenny clinic and underwent a hysteroscopy and a laparoscopy to examine the uterus and surrounding areas. Her doctor found Grade 3 endometriosis, a condition where uterine cells grow outside the uterus. “He told me I had wasted all my time on money on IVF as it would never have happened.”

Following treatment, Kathy decided to give Clomid another go and, on her second month, she became pregnant and finally gave birth to her son, Dylan, last April.

“It’s so hard to keep positive, to keep believing that it will happen”, she says, “but I always believed that it would happen and that every failed cycle brought me further towards success.” Kathy feels that EEVA could have saved her so much heartache. “Anything that gives you more information gives you a better chance.”

Dorothy Cavanagh

Dorothy Cavanagh has been trying for a baby since she got married almost eleven years ago. Both Dorothy and her husband, Eoin, came from big families so she never dreamed they would have problems. After four years, she decided to seek help but her GP told her to keep trying and it would happen eventually. When it didn’t happen, Dorothy and Eoin returned to the GP together and asked to be referred to a fertility clinic. After waiting months for an appointment and then for tests and waiting again for results, the couple decided to try IVF as soon as they could.

“I was full sure when they put back those embryos that I was pregnant, even though I had never had a positive pregnancy test”, says Dorothy. When she saw yet another negative test, she was distraught. “I was devastated, heartbroken, and so jealous of anyone who was pregnant.”

“When you get married, you’re expected to go on and have a family and it’s like we’ve been in pause for eleven years”, explains Dorothy. “Everyone around us is getting married and they’re pregnant or have a baby by their first anniversary and we’ve our eleventh coming up and nothing. It’s so hard, nobody understands.”

After five failed IVF cycles at the Galway clinic, Dorothy decided it was time for a change. “They told me they were top grade embryos and they didn’t know why it didn’t work. But they weren’t changing anything so I said, ‘let’s try somewhere else'”. The couple did their next IVF cycle at the Sims clinic and on the 3rd of March last year, Dorothy saw her first ever positive pregnancy test. “Our dreams came true that day”, she says.

Dorothy’s pregnancy progressed normally until her 23 week scan, where she received the worst possible news. “I was told that he had anencephaly, incompatible with life.” Dorothy decided to carry to term but her son, Billy, died at 27 weeks. “Our family was good but it was hard for them too, what could they say? What I had wanted all my life had come true and then it was taken away from me. Nobody can bring Billy back, our hearts will always be broken, no matter what.”

Dorothy was uncertain about trying again. “I didn’t want to disrespect Billy’s memory, we can never replace him. But holding Billy for those few hours made me even want it more. It had shown us what we could have.” The couple tried IVF again last month but it didn’t work. “I fell apart all over again that day”, says Dorothy.

The couple have decided to give up on IVF for financial reasons. “It’s just so hard and unless you’ve been down that path, nobody can know”, says Dorothy. “Unfortunately our path doesn’t seem to have an ending at the moment.”

There is, however, still some hope. Dr David Walsh and the Sims clinic have kindly offered to help Dorothy and Eoin, via my own Pomegranate infertility charity (www.pomegranate.ie), with an EEVA cycle of IVF. Maybe, just maybe, this will be the one.

By Fiona McPhillips. First published in the Irish Independent, 16 April 2013.

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