If you are an Oprah fan or you read the tabloids, you have no doubt heard about Nadya Doud-Suleman or the infamous -Octomom who gave birth to octuplets in January 2009 through In Vitro Fertilisation. Initially the birth was celebrated but it didn’t take long for the public to shake their heads in disbelief when it was discovered that Nadya already had six children and was struggling financially. However, for thousands of infertile couples, in vitro fertilisation has allowed them to experience the joys of parenthood, which this amazing medical breakthrough has made possible.
In vitro fertilisation or IVF was first carried out thirty years ago in 1981. Since this time, IVF has been responsible for the births of thousands of babies. Once referred to as -test-tube babies , as the man’s sperm and woman’s eggs are combined in a test-tube where fertilization occurs. IVF was created to give infertile couples the opportunity to produce a child who is biologically related to them.
However less than 5% of infertile couples opt for IVF as this procedure is typically the treatment of choice for a woman who have blocked, severely damaged, or no fallopian tubes. The procedure is elected to overcome infertility as a result of endometriosis or in cases where the man’s sperm is problematic (like a low sperm count). Couples who have failed to conceive and have attempted other infertility methods which have been unsuccessful may try IVF as a last resort.
The IVF procedure
Before IVF takes place, the woman may need to take drugs to stimulate her ovaries to allow them to produce several eggs. When couples elect to undergo this procedure, the woman’s eggs will be surgically aspirated from the ovaries, which is done with the aid of an ultrasound device. During or prior to the woman’s eggs being removed, the man is requested to provide a semen sample. In a laboratory setting, the sperm is separated from the semen and is used to fertilise the extracted eggs.
The extracted eggs are then combined with the male’s sperm in a laboratory dish or a test-tube. Forty hours later the eggs are checked to see if they have been fertilised by the sperm and if they are dividing into cells. If fertilisation has occurred, the eggs are then referred to as embryos, and the embryos are inserted into the woman’s uterus. The transferring of the embryos into the woman’s uterus is done through the cervix using a long slender tube (essentially a catheter). Once the insertion is complete, the woman will need to remain in a resting position for an hour.
After the embryos are inserted, the woman is put on hormones for a period of 2 weeks. The implantation is considered successful if the embryos attach themselves to the uterine wall and start to grow and develop into a foetus.
A number of studies suggest that in vitro fertilisation is very safe. However there are certain risks which are linked to IVF, such as ovarian hyper stimulation which results in mild abdominal bloating and tenderness and in very rare cases, liver and kidney disorders. Rare cases have also been reported of bleeding from the ovary caused by the needle that is used to retrieve the eggs. Transferring of the embryos into the uterus may lead to mild cervical and uterine irritation. During most IVF procedures, multiple embryos are transferred to improve the chances of a successful implantation and this also greatly increases the woman’s chances of a multiple pregnancy (twins, triplets and higher multiples) and IVF also raises the risks of an ectopic pregnancy.
Apart from the mother’s safety during and after the procedure, children who are conceived through IVF have been found to be as healthy as children who are conceived naturally. However other contradictory studies which are available indicate that children who are conceived through assisted reproductive technologies may have elevated rates of rare birth defects along with other health problems. Many countries, including the US, the UK and Australia have set up medical groups who are investigating claims relating to IVF children being at an increased risk of birth defects or health problems.
IVF South Africa
In South Africa, as in other countries (such as the US and UK) there are no regulatory boards to oversee IVF. Legislature has taken action to impose guidelines and regulations which restrict the number of embryos that can be implanted during IVF. Overseas, control or regulatory boards such as the Human Fertilisation and Embryology Authority oversee and monitor all artificial fertilisation practices and due to this fact, South African IVF clinics are not strictly and closely monitored.
The cost of an IVF cycle, as it is known, is in the region of about R15 000.00 to R35 000.00 (per cycle), and this figure is largely dependent on where in South Africa the couple is situated. Semi-government hospitals do offer in vitro fertilisation and the procedure is offered at a far lower price tag, but private IVF clinics are able to offer the guarantee of a higher success rate.
Couples, who are considering IVF, are urged to bear in mind that the procedure is not only very costly, it is stressful and emotionally taxing and a lot of expectations are placed on the procedure succeeding. Many private IVF clinics are prepared to give a success rate of just 25-30% and this equates to the failure rate being a high 70-75%.
Treatment can fail at any stage – at ovarian stimulation, egg collection, fertilisation and implantation. It cannot be said beforehand just how many cycles a couple will require for a pregnancy to result. There are those couples who are lucky enough to become pregnant after just one cycle, others after two, while some may need three. The norm for the majority of healthy couples is to successfully conceive after as many as four or five cycles. Even if the lowest cost (R15 000) for the treatment is used, the five procedures may very well end up costing a minimum of R75 000.00.