Preparing for I.V.F. Series: Take Inventory as a Couple

Infertility is defined as a couple’s inability to get pregnant after one year of having unprotected sex. However, if you are over 35 years old and have been trying to get pregnant for more than 6 months, you may also want to consider going in for an infertility evaluation with your doctor. The Centers for Disease Control also recommends that couples seek an evaluation with their doctor sooner if the woman is experiencing irregular periods, or no periods, painful periods, has a history of endometriosis, has a history of pelvic inflammatory disease, or if the couple has already experienced one or more miscarriages. If the man has a history of testicular trauma, chemotherapy, hernia surgery, low sperm count, or has had a history of infertility with another partner, the couple may want to speak to a medical practitioner sooner.

Couples who have been having trouble getting pregnant will often begin exploring their infertility options by speaking to their primary care physician and by visiting a specialist known as a reproductive endocrinologist or a urologist (for men) who can further evaluate their situation and determine which course of treatment might be best. According to the Centers for Disease Control, infertility is a common issue with 6% of married women struggling to get pregnant after one year of trying. You are not alone.

One of the options that couples might consider in their journey to become pregnant is I.V.F. I.V.F. is an involved medical process that requires testing and diagnosis, multiple doctor’s visits, a financial commitment, a course of hormone treatments, and surgical procedures to retrieve and implant eggs that can lead to stress and have an impact on individuals and the relationship. Many couples will require more than one cycle to become pregnant. Access to I.V.F. treatment in the era of COVID-19 will depend on medical resources in your area and the prevalence of COVID-19 in your community. Each couple will need to decide for themselves whether now is the time to begin a cycle.

Before embarking on their I.V.F. journey, couples should take inventory of their fertility options, finances, emotional well-being, the impact of COVID-19 in their communities, and certain ethical considerations that I.V.F. raises before moving forward.

This step-by-step guide is designed to help you and your partner take inventory as a couple. If you have been trying to get pregnant and haven’t been able to conceive, your I.V.F. journey will begin with your infertility evaluation, so we will start there.

Step 1: Your Infertility Evaluation—Taking Stock of Your Infertility Options.

Various infertility treatment options may be available to you, and I.V.F. may not always be the first choice. According to Harvard Health Publishing, there are over 40 different ways to treat infertility and I.V.F. is only one of them. Only about 3% of couples use I.V.F. Couples who have been having trouble getting pregnant will often begin exploring their infertility options by speaking to their primary care physician and by visiting a specialist known as a reproductive endocrinologist or a urologist (for men) who can further evaluate their situation and determine which course of treatment might be best.

During a medical assessment, or infertility evaluation, your doctor will try to determine the causes for your infertility. While the causes of infertility can often be diagnosed, this is not true in all cases. Causes of infertility in men often are due to low sperm counts, and causes of infertility in women often involve issues with ovulation. Sometimes no clear cause of infertility is found and this is referred to by the American College of Obstetricians and Gynecologists as “unexplained infertility.” Life choices can also impact fertility and sperm counts, and your doctor can help you understand what changes you may be able to make to improve your chances of getting pregnant. According to the American College of Obstetricians and Gynecologists, tests for infertility include imaging tests and laboratory tests. Understanding the underlying causes for your infertility can help a doctor evaluate whether I.V.F., or another treatment is right for you. During initial assessments, your doctor will check sperm count and sperm motility in the man, and perform tests to determine how many eggs the woman might have in reserve. Hormone tests, thyroid function tests, and other kinds of lab work may also be performed.

There are many potential causes for low sperm count, no sperm count, and inability of the woman to ovulate. The kind of treatment you’ll need for your infertility, will depend on the causes of your infertility. If I.V.F. is presented as an option to treat your infertility, you and your partner will need to take stock as a couple to determine whether I.V.F. is right for you. I.V.F. may be presented as your only option or as one of many options.

For example, some women who are having trouble with ovulation or men who are having difficulty with sperm count may be able to take certain types of medications and make lifestyle changes that can increase their chances of conceiving naturally. Couples without a clear cause for their infertility or couples where the man has a low sperm count may also be able to try I.U.I. or artificial insemination, where sperm are inserted into the woman’s uterus. Other couples may try daily supplements known to provide vitamins, minerals, and herbs associated with increased fertility, higher sperm counts, and ovulation.

If you have blocked fallopian tubes, polycystic ovarian syndrome, endometriosis, an irregular menstrual cycle, or if the man has low sperm count, I.V.F. may be a good option for you. If I.V.F. is presented as the best option, you and your partner will need to take stock of whether to move forward with I.V.F. Many couples who are presented with I.V.F. as their best option to conceive, choose not to pursue I.V.F. for many reasons. Talk to your doctor about risks and side-effects of treatment. Risks can include complications due to the surgical procedures, side-effects of the hormones, and a multiple pregnancy. According to the journal, Human Reproduction, fourteen in one thousand women who undergo I.V.F. experience serious cases of OHSS (ovarian hyperstimulation syndrome). Harvard Health Publishing notes that the course of hormones administered during I.V.F. can also have side effects. Clomiphene, for example, has been connected with anxiety, sleep disturbances, mood swings, and irritability in women. Other infertility medications can also come with side effects. While the risks for I.V.F. are low, they are real. The Society for Assisted Reproductive Technology offers an online fact sheet outlining the risks of I.V.F., breaking down the risks for each procedure and medication, to help you better understand these risks.

Step 2: Take Stock of How I.V.F. Will Impact You Emotionally, as Individuals and as a Couple

Fertility treatment can be stressful. Struggling with infertility can be difficult, and choosing to embark on a course of I.V.F. treatment can increase this stress. According to Harvard Health Publishing, 15% of men said that their infertility diagnosis was the most upsetting experience of their lives, and women diagnosed with infertility felt as anxious and depressed as those who had been recently diagnosed with cancer, hypertension, or those recovering from a heart attack.

Add to that the effects that the hormones can have on your emotions and your body, and the stress can be amplified. Seeking counseling before I.V.F. treatment can be helpful. Researchers writing in Human Reproduction found that couples who sought counseling before I.V.F. were better able to discuss their relationship, discuss their treatment, and saw psychological benefits.

Planning ahead about how you’ll care for your emotional well-being is just as important as preparing for the physical rigors of treatment. I.V.F. can take a toll on your relationship. It is important to be on the same page regarding how many cycles you plan to try and how you’ll handle the challenges, uncertainty, and outcome of I.V.F..

What are some options for protecting your emotional well-being and relationship?

• Consider joining a support group or speak to other couples going through I.V.F.
• Schedule couple’s counseling sessions to help you address issues that can arise before you begin I.V.F., during your I.V.F. cycle, and after.
• Consider mind-body stress management programs. Relaxation techniques that include meditation, deep breathing, and yoga can help with stress management. According to Reproductive Biomedicine Online, women who participated in a 6-week yoga class self-reported better quality of life and lower levels of depression and anxiety.

Gender differences can also play a role in how couples cope with I.V.F. According to research in Human Reproduction, women and men may cope with I.V.F. related stress differently. Women were more likely to accept responsibility for their fertility outcomes, were more likely to confront the problem, and seek social support. Men were more likely to distance themselves from the situation and use planning and problem-solving to cope. Which strategies were actually helpful for couples dealing with I.V.F. related stress? Researchers found that planning, problem solving, seeking social support, and distancing was helpful to reducing stress.

Taking breaks between I.V.F. cycles, and taking time to distance yourself from the process can be helpful. Every conversation can’t be about I.V.F., and everything you do as a couple shouldn’t be just about getting pregnant. Take time to connect and share other activities you both enjoy.

STEP 3: Consider Your Financial Resources for I.V.F.

According to the National Conference of State Legislatures, a single cycle of I.V.F. can cost anywhere from $12,000 and $17,000. The New York Times notes that with medication, the costs per cycle can be higher, as high as $25,000. Couples may need anywhere from three to six cycles to have a successful pregnancy. You and your partner will need to take stock of your financial resources and decide ahead of time how many cycles you can afford.

Before beginning any course of treatment, couples should call their insurance provider to find out what aspects of I.V.F. treatment may or may not be covered. Some plans cover parts of treatment, while other plans may not cover I.V.F. treatment at all. Once you have an idea of your out-of-pocket costs you’ll need to consider your financial resources. Some couples tap into their home equity, others take out loans, take a second job, and other start online fundraising campaigns. Some apply for grants, consider taking part in studies that might fund their treatment, and yet others even consider moving to states where I.V.F. is covered by insurance. Daily Wellness also provides additional resources about options for low-income couples. Many couples struggle to afford I.V.F. You are not alone.

Step 4: Make Decisions About Embryos and Genetic Testing

Some couples might have extra embryos after a successful I.V.F. cycle. Should embryos remain after IVF, you’ll need to decide what to do with them. The National Infertility Association lists options that include storage, compassionate transfer (which involves implanting the embryos at a time when you are unlikely to get pregnant, if you are already happy with your family size), disposition, and donation to another couple struggling with infertility, or donation to research. Storage of embryos can give you the chance to grow your family later, but there can be costs associated with embryo storage.

Another factor you’ll need to consider is genetic testing. A type of genetic testing known as translocation analysis allows your doctor to determine if one or both parents has a type of chromosomal abnormality that can lead to higher infertility rates, greater risk of miscarriage, and increased risk of passing chromosomal abnormalities to the child. This type of genetic testing can help couples conceive.

However, there are other types of genetic testing that are highly controversial and are not recommended by the American Society for Reproductive Medicine, because they can sometimes carry the risk of “false positives.” Some types of genetic testing can determine whether an embryo is at risk of certain chromosomal diseases (like cystic fibrosis, Tay-Sacks, sickle cell disease, and others) and can even allow a couple to choose the sex of their baby. Not all clinics offer this type of genetic testing due to the controversy, but ultimately each couple will need to decide for themselves on genetic testing of their embryos.

Step 5: Consider the Impact of the Coronavirus Pandemic on Your Decision to Pursue I.V.F.

Current recommendations provided by the American Society for Reproductive Medicine call for the “measured resumption of care.” This means that your access to I.V.F. treatment will depend on whether your region has been able to “flatten the curve” of infection and whether your region has the medical resources available to provide I.V.F. treatment while also managing coronavirus infections. It isn’t clear whether COVID-19 infections will rise and fall, or what levels of infection we might encounter in the future. Ultimately, it is likely that we will be living with COVID-19, without a vaccine or clear treatment for some time. Couples need to take stock of these factors when deciding whether to move forward with I.V.F. during COVID-19.

We still don’t know much about how COVID-19 affects early pregnancy. We just haven’t been living long enough with this virus to know. We don’t know what a COVID-19 infection in early pregnancy means for the baby and fetus. Patients who are at higher risk of complications from COVID-19 should be counseled about the risks. I.V.F. requires many doctor’s visits which could limit your ability to practice social distancing. Couples also need to consider how coronavirus might impact their pregnancy plan. Should infections spike, this could impact how many visitors you can have during delivery. Finally, couples need to take into consideration how social distancing, financial uncertainty, and uncertainty about the virus itself might impact them emotionally and physically.

Couples should also speak to their clinics about what emergency plans are in place should coronavirus spike and should access to I.V.F. become limited. The ASRM recommends that emergency plans for each I.V.F. facility include plans for the safety of clinic personnel and patients and a plan for the preservation of oocytes, sperm, and embryos. Patients starting a cycle of I.V.F. in the time of coronavirus should be aware that should an emergency situation warrant it, the best course of action might be to discontinue the cycle (for example, in the event of a sudden spike of infections that overwhelms the medical system). Patients may have the option to transfer their care to a facility where treatment can be continued. These factors need to be considered when embarking on a cycle of I.V.F. during pandemic times.

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