IVF is often thought of as the most obvious option for a couple with fertility issues, but actually, when you embark on it there is nothing obvious about IVF. The confusing scientific explanations, endless acronyms, a million and one costs of various procedures that you’re not even sure you need. It’s like the ultimate episode of University Challenge, never mind the physical and emotional turmoil you’ll go through on what can seem like a never-ending journey.
Making sure that you’re starting IVF with all your questions answered is vitally important, because as much as having your own biological children may be important to you, there are other ways to raise a family if you feel IVF isn’t the right option. So, in hoping to make IVF that little bit less confusing, we’ve asked some women who’ve had IVF, plus charity and support groups, the Fertility Network and IVFBabble, for the 10 vital questions you should ask yourself before starting IVF…
1. Am I ready to become a human pin cushion?
‘Especially if you have an aversion to needles, seek help now,’ says Cat Strawbridge, who has had four rounds of IVF, ‘while the actual medication and means of administering them does change from clinic to clinic, you will undoubtedly end up becoming an expert at injecting yourself.
‘Finding the “smile” under your belly button, breaking through that thigh muscle or in some cases stabbing yourself right into your butt cheek, you may need some help with that one, soon becomes second nature,’ she continued, ‘In reality it sounds much worse than it is. If you’ve got to the IVF stage you’ll pretty much do anything to make it work and you definitely won’t let a little needle or two stand in the way of you getting your baby.’
But first things first, you need to make sure you’re physically and emotionally able to proceed with IVF. ‘Now that there is a postcode lottery for NHS IVF in the UK, not everyone will be automatically accepted for fertility treatment,’ says Claire Wilson, content editor at IVF Babble, ‘some CCGs have put in place new guidelines, some will not accept both men and women with a higher BMI range or who are over the age of 38. When it comes to the emotional side of IVF, be prepared, it can be grueling on your mental health. Make sure you ask the clinic about counselling services available, and use them.’
2. Can I cope with abstaining from sex completely?
‘Just when you had had enough of the monotony of every other day coitus you’re now told that you have to abstain completely, well, of the unprotected variety at least,’ says Cat, ‘It’s a sure-fire way to increase anyone’s libido. Coupled with that is the irony that part of the medication you take might be the contraceptive pill.’
‘There is a medical reason for the pill as it shuts down your reproductive system and helps the doctors to monitor your cycles more closely,’ she continued, ‘but when you are first given those packs you last relied on as a teenager and in your twenties to keep you “safe”, the irony is real.’
'To be honest sex became such a chore when we were trying, I was relieved to have a reason to abstain' says Amy, who had seven rounds of IVF before giving birth to a boy in 2017.
3. Can I trust the clinic i've chosen?
Given the IVF postcode lottery, you might not have much choice about the clinic you visit if you're using the NHS. However, what you can do to ensure you're getting the best possible treatment is a lot of your own research.
'Carry out your own research alongside what the professionals are telling you and don’t be afraid to challenge them or ask for clarification,' says Amy, 'I never would’ve gotten pregnant without doing this as I read up on Natural Killer cells [immune cells in the uterus that can contribute to infertility] and asked to be tested for it. When my first clinic refused because they didn’t "believe in it" I researched a clinic that would carry out the testing and low and behold I had them.'
4. Will my friends and family know how to support me?
When it comes to telling your family and friends something this important, this might seem like a no brainer, but actually, for Claire, whose gone through four rounds of IVF herself, it was much trickier.
‘I told most of my closest circle and family, but it proved to be more upsetting in the long term,’ Claire said, ‘I am super close to my family and friends, but each time my treatment failed I had to send an email or a message to tell them, which was painful enough, I definitely couldn't face telling them in person. Our last cycle we told less than a handful of friends.
'I am sure the joy of telling them it had been successful would have been a truly wonderful feeling, but you also have to think about how you would feel if it does not work.’
5. Am I comfortable telling my boss i'm having fertility treatment?
Equally difficult as deciding whether to tell your family? The decision whether or not to tell your boss. You’re not obliged to at all, but for Claire it was necessary to ensure she could get enough time off.
‘I decided to tell my line manager at my job at the time what we were doing and that was only because I trusted her implicitly,’ she said, ‘you do need to get time off for a lot of fertility appointments when you start treatment and I recommend you take off at least a day after embryo transfer and the day after you find out the result of the pregnancy test. It gave me a day to process the deep disappointment I felt when it failed.’
6. Can I deal with feeling constantly confused, guilty and being skint?
‘The science of IVF is 40 years old this year, and whilst it is a miracle, the advances haven’t been as ground breaking over more recent years,’ said Cat, ‘What has luckily happened is that experts in other fields such as alternative medicine, holistic therapies, nutrition are all looking at ways to increase the chances of conception, both natural and with assisted fertility treatment.
‘However, there is little conclusive evidence that any of these things hold definitive answers,’ she continued, ‘so, depending on who you are talking to, their method is the one. The issue with that is that people can be very convincing and, once you’re in it you want to try everything you can otherwise the guilt that “it could have been the one” will consume you. Nine times out of 10 these treatments aren’t one offs and none of them are free. That’s where the skint comes in!’
7. Should I put private IVF cycles on my credit card?
‘Sadly, IVF is not as readily available on the NHS as it has been in the past,’ says Claire, ‘When we went through IVF we were offered three full cycles, but now couples are lucky to get one due to CCGs having their budgets cut and needing to find savings. If you choose to go private, IVF is not cheap and unless you have a big savings account make sure you budget for what you can afford.
‘On average IVF treatment in the UK can cost anything from £4,000 to £15,000 all depending on the type of cycle you require,’ she continued, ‘a lot of people are choosing to go abroad and this is certainly an option to look at, but again, do your research thoroughly before making that choice.’
If you do choose to go private however, Amy advises not putting any of the cycles on you're credit card. She chose to do this for the first six of her IVF cycles, and always regretted it at the end of every month. 'There’s nothing more depressing than paying off failed rounds of IVF', she said, 'so avoid putting anything on your credit card if you can.'
8. Should we set a cut off point where we stop trying?
With money concerns in mind, and your own mental health, it can be beneficial to have an end date in mind where you agree to stop if IVF isn't working. ‘Some couples go into IVF with no plan and prefer to wait and see what happens, and that is absolutely fine,’ says Claire, ‘some will set themselves a time frame or a number of cycles they will stop at. Our advice [at IVFBabble] is to have a cut-off point in mind and try to stick to it.
‘There are thousands of couples who have multiple cycles and end up in a mire of debt and nothing to show for it but broken dreams,’ she continued, ‘be realistic and communicate with your partner about your expectations and limitations. You don't need to be told how sensitive a subject being unable to conceive naturally is, so be kind to yourself and your partner.’
9. What are the success rates of IVF and what if it doesn't work for me?
‘We when started our IVF journey we were totally clueless about the success rates, so it's important to look at live birth rates of the clinic, not just embryo transfer rates,’ says Claire, ‘Do your research. A great place to start is the UK's fertility regulator, the Human Fertilisation and Embryology Authority website.’
‘Statistics show that on average IVF success rates are at about 30 per cent in the UK for women under 35, and it declines to less than 10% when a woman reaches 40 years old,’ she continued, ‘you have to be realistic when it comes to IVF and as long as you go into it with as much knowledge as possible, knowing you have done everything you can to help achieve the desired outcome, there is little more you can do.
‘But if for whatever reason it doesn't work seek counselling, talk to your partner, family and friends, be open about how you are feeling. If you decide to pursue other avenues, such as surrogacy, donor eggs or adoption, that is all fine. If you decide you've had enough, there are some great support groups that can help you come to terms with your decision, Dovecote Community and Gateway Women.’
10. Am I good at seeking help?
As Claire explained, having a good support system is vital when you're going through IVF. For Cat, it's essential not to stay silent when you're struggling. ‘So many people feel ashamed about having to seek help to conceive, yet there are 3.5 million people in the UK alone that struggle,’ she said, ‘if you haven’t got a good support network around you that you can and want to tell, find one that you can.
'Once you start looking in the right places you will find several groups of men and women who are going through it, who understand what you are feeling and who are there for you. Personally, I found this group on Instagram but others prefer forums, Facebook, support groups. Whatever you do, make sure it’s the opposite of silence.'