What are the barriers that cause so many people to stumble on the path of IVF? The answer to this question is complex, because it is an obstacle for one person may offer no obstacle to another. It is fair to say, however, that there are general problems of concern to all potential IVF patients. First, there is the fear that IVF will not succeed, or will be bad outcomes for mother or baby. Secondly, IVF can be seen as a costly and unaffordable option. Third, the techniques may be incompatible with religious belief or moral of a couple. And finally, many patients are worried they will not be able to fulfill their professional and personal current obligations while undergoing a rigorous course of treatment, including IVF. None of these concerns is negligible. In my years of practice in the field, however, I came to recognize the many ways in which these issues can be successfully treated and overcome obstacles.
Specifically, I would say that couples who want to try IVF, but find the look daunting task with the use of methods of decision-making and cost-benefit analysis to review your options. I would also suggest that patients develop treatment plans with an end in mind, and they begin to investigate the range of family building options available to them while they are still in treatment. Finally, I have found that patients who consciously and constructively integrate IVF treatment in other life activities are able to complete their chosen course of care. This does not mean that IVF is for everyone, because it is not. The purpose of this article is to help couples who want IVF overcome personal obstacles and achieve this goal.
Decision Making It is important to recognize that decisions about a course of treatment is difficult and can be easily hurt. Reliable information can be difficult to obtain or understand, most of us do not have experience in this type of decision making until circumstances force us to do so. At that time, it feels as if the decisions must be made in a very short time. In addition, different people make decisions in different ways, some intuitively, some based on experience, and others based on direct analysis of the facts. Much depends on what kind of decisions we have had to do in other areas of our life and in our personal experience. Sometimes our values and beliefs inform our choices in ways that are difficult to explain to others. Often a bias towards profit and avoid damage in the present and the near future into our thinking. We can say that we make a conscious choice, but perhaps in reality, we are more concerned about protecting the status quo. We can develop fears or anxieties that go far beyond the actual risks. At the other extreme, there are those who believe that "I will not go" and are ready to make decisions by discounting risks substantially, if unlikely, or even significant. The distinction between reasonable and unreasonable exaggeration concern is often difficult. decisions "framing" so that the benefits and risks are overstated is a trap that can be difficult to avoid. Usually the best approach is to evaluate the available options in the search for other means to different options from different perspectives.
The first step in making decisions in infertility care is to determine their religious ethical, moral and personal. IVF can present some unique and complex problems. Their views should then be discussed openly with your partner, because it is essential that both reach an agreement on how to start or expand your family. Your doctor must also agree with your intentions. Ethical dilemmas can arise when conflict care options with the autonomy of the couple, the quality of life, or their perception of socially responsible behavior are. Should there be significant differences of opinion between the doctor and the couple, identify alternative sources of infertility treatment. At no time should a couple or a physician feel they pursue a course of treatment against their better judgment or personal beliefs.
The question of the quality of care for infertility should be addressed. Since the management of infertility can be a complicated process, it is important that your doctor has the required level of knowledge. The American Society for Reproductive Medicine has established guidelines for the provision of infertility services, with three levels of care. Some patients have evidence of diagnosis and / or initial treatment by providers with only basic capabilities. It may be appropriate if patients are sent to the most experienced providers when indicated by the guidelines. Most in vitro fertilization programs offer a very good service, but you must make sure that the clinic IVF select belongs to the Society for Assisted Reproductive Technology (SART) and be comfortable that the quality of clinical laboratory and medical care and financial services to meet their needs. You must complete a thorough medical evaluation and gain information about treatment alternatives other than IVF clinic. You must then determine a plan of action in place the details of his medical treatment, financial management, timeframes, lifestyle changes and the use of building options acceptable family for you. These many decisions are often facilitated by the use of cost-benefit changes.
Cost-benefit Regarding infertility, cost-benefit analysis is designed to compare and evaluate the eight options to expand or start a family. These options are:
1. no treatment,2. Proof of infertility treatment involving standard surgery,3. controlled ovarian hyperstimulation with "fertility drugs"4. Treatment of male partner and / or intrauterine insemination,5. IVF6. third party reproduction involving donor sperm or donor egg substitutes (surrogate home or uterus)7. adoption8. live without children.
The advantage of these options depends on the value a place on the result. Obviously, the election results are not all alike, ranging from genetic own baby himself, a baby egg donor or sperm donor, adopted baby or no baby at all. With IVF, there are many "values" that must be considered. It is important to ask the tough questions at this time is to develop a treatment plan. How do you feel about the intracytoplasmic sperm injection (ICSI) is considered by some to be less "natural" than IVF? Want frozen embryos cryopreserved ()? How many embryos do not want to replace in each cycle? To maximize your chances of pregnancy, you can replace several, but not limit the possibilities of multiple pregnancy. How do you feel about induced reduction if you had triplet or higher order pregnancy? How do you feel about the pros and cons of raising twins or triplets, even? What are your feelings about amniocentesis, birth defects and complications during pregnancy? How do you think of donor sperm, donor eggs, uterus host embryo donation and stem cells? These are all questions that require thoughtful decisions.
In addition to determining the value of various results, it must accurately assess the probability of each particular result. For IVF, which requires a competent physician complete a comprehensive assessment of the man and the woman, and evaluate your chance of getting a room in the light of these conclusions birth. To determine the benefit of any result, the relative value of each choice must be multiplied by the probability that the outcome will happen: Profit = Value X chance of success. You decide the relative value of different results you and your doctor told you that the chances of achieving each outcome is. Obviously, though not value much choice or if the chances of success are low, the benefit of choice is also low. Each potential choice is then prioritized based one with the greatest benefit, the second biggest profit, the third biggest benefit more, and so on. The next step will be to evaluate the "cost" of each election, since the cost advantage is reduced. Thus, the order of your options may change.
There are four types of costs. The first is financial. IVF costs an average of $ 12,000 to $ 15,000 per cycle, which is often not covered by employee health plans. It is important to know exactly what is and is not covered by insurance, so the amount of personal expenses can be determined. You can then decide how much money, if any, that are willing to spend on health savings accounts, retirement funds or savings. Many couples delay major purchases while seeking treatment, but this is not always possible. IVF costs can be very high and may appear to some patients, especially younger ones, can afford. However, it is better for a couple to make the sacrifices to receive proper care when they are younger because their chances of success are better. Because the cost of care is such an important obstacle, some practices are beginning to offer affordable financing for treatment packages and a money back guarantee, or if the treatment does not result in a live birth. You should ask your doctor about the availability of these financial instruments.
The second biggest cost is time. If it is less, time is not as critical. After the age of the woman is over 35, however, time begins to play a more important role, which affects the speed with which we must move to a more intensive treatment such as in vitro fertilization. Women often feel a barrier to IVF is the amount of time needed for visits and office procedures, time should be removed from his work. It is important to determine in advance how best to address this issue often discussed with your employer and doctor. Time for infertility treatment can also reduce the time with your partner, family, friends and personal commitments. Again, the best approach is to discuss these issues with stakeholders, make a plan to minimize the impact of infertility treatments, and minimize unnecessary, family, personal and social commitments work.
The third largest cost is the risk of IVF. Recent articles and media attention focused on IVF results that appear to be less favorable than IVF pregnancies. However, several principles, larger studies have shown similar results. However, all these studies have design problems. In addition, the negative results in some studies cited occur at very low frequencies. In general, IVF treatment is safe and outcomes for women and babies are good. Some IVF patients subgroups are more at risk than others, well-designed studies are needed to answer some important questions. However, the risk of death or serious illness of a pregnancy, IVF or not used, is several times greater than the risk or drug used in IVF procedures.
Physical hazards can include short-term complications of royal treatment. Some women worry that fertility drugs consume more eggs than normal ovulation, but it does not work. Ovarian hyperstimulation syndrome (OHSS) with some swelling and pelvic discomfort occurs in a small percentage of patients, but severe enough to require hospitalization in one of the 300 cycles. Complications such as bleeding or infection egg retrieval occur only once every few hundred cycles, and rarely require transfusion. Obstetric complications are mainly related to maternal age and underlying medical condition and the presence of multiple pregnancy, but are not significantly different, with or without IVF when controlled by the number of babies transported . You can infertility patients have a slightly higher risk of obstetric complications unrelated to the type of treatment. Get obstetric care of high quality and bed rest during pregnancy can reduce many of these potential problems. Spontaneous abortion and rates of ectopic pregnancy are the same with or without IVF, although IVF reduces the risk of ectopic pregnancy in women with the disease of the fallopian tubes. In the past, worry about the risk of ovarian cancer after use of fertility drugs has emerged. Several well-designed studies have shown no increased risk of ovarian cancer and a possible small increase in risk of borderline ovarian tumors. In fact, the pregnancy significantly reduces the risk of ovarian cancer at once and chest. After nearly a quarter century of IVF, no other long-term known for women who have had babies through IVF problems.
Some patients are concerned about the risk of laboratory procedures. Intracytoplasmic sperm injection (ICSI) used for male infertility have the same live birth rate and non-ICSI IVF. Some men who would otherwise not have the opportunity to become parents carry genetic conditions that can be transmitted to their male offspring. Hypospadias, or localized abnormal opening of the urethra in the penis, is also more common but rarely, in babies born after ICSI. This problem is usually minor and can be surgically repaired. Assisted hatching, often used for older women, or previous failed IVF cycles is associated with an increased risk of monozygotic twins, who have a higher risk of complications than one pregnancy. Cryopreservation of embryos is associated with a decrease of live birth rate after thawing, but babies are as healthy as those born from fresh embryos fertilized in vitro. donor sperm and donor eggs babies also have the same result as in vitro fertilization with the patient and the genetic material of his own partner. Others worry about the potential loss or confusion of sperm, eggs or embryos in the laboratory. Of course, mistakes can occur but are rare. The laboratories that belong to SART undergo rigorous inspection every two years of its personnel, equipment and systems to ensure the highest quality of care can be delivered. It makes a lot of emphasis on the correct identification of semen, ova and embryos, so these problems are more unusual.
An important safety exception of any fertility treatments, however, is the risk of multiple pregnancy, twins happens to about 30% of deliveries and triplets with just under 5%. Although many infertile couples consider twins to be the ideal result, multiple pregnancy have an increased risk of preterm delivery and babies at birth. Even the twins are about twice the risk of death or severe disability for each infant in relation to a single pregnancy, and triplets face about four times the risk of death or severe disability for each baby. However, a healthy baby is the result of more than 95% of the time with IVF.
Above all, there are ways to reduce the risk of multiple births. The Society for Assisted Reproductive Technology (SART) launched national guidelines on the number of embryos to transfer so that the live birth rate are maximized and multiple births are minimized. Triplet rates have fallen in recent years. In addition, each patient has the option to specify that fewer embryos need to be replaced if necessary, including the decision to replace a single embryo. Supernumerary embryos can be cryopreserved for subsequent cycles if the woman does not conceive, or try a second baby later if you do. Each patient can and should discuss this with your doctor and make a decision with which it feels comfortable for the number of embryos to transfer. If multiple pregnancy occurs, spontaneous reduction or loss of a fetus with a double or triple double with single pregnancies that occur 25% and 50% of the time. In some additional cases, patients may choose to undergo an induced reduction (reduction of pregnancy, selective reduction, such decrease) triplets to twins or more. This procedure is safe and effective physically about 90% to 95% of the time, and can improve the chances of delivering healthy less, but the babies. However, issues of emotional and personal values are important in the decision to undergo this procedure.
The final cost is often the most important, and it is the psychological or emotional cost of infertility. Infertility can be a real crisis in many people's lives, which affects how they feel about ourselves as men and women, husbands and wives, mothers and expectant parents. Patients often have to suffer in silence because infertility is so misunderstood by society. Patients may have concerns about financial issues, the design "against nature" that occurs outside the body, the impact of infertility on themselves and their partner, or the effect on their marriage and sex life. They may struggle to cope with family and friends, in exchange for their gynecologist for a reproductive endocrinologist, taking fertility drugs, or lose time at work. IVF Science and description language are new and intimidating. Suddenly, one is supposed to know IVF procedures, cryopreservation, ICSI, assisted hatching, multiple births, induced reduction, and the use of donor gametes. In addition, the adoption in all its complexity, can be a problem that is on the horizon. It is normal to be anxious and concerned about the many aspects of infertility and IVF! Lots to think about.
But there are some things you can do to deal with this problem. The first is that both partners communicate them clearly what they think about these issues and how they want to address, what options are acceptable and which are not. It is also important to take care of you with a healthy diet, exercise and sleep. Meditation or yoga can be very helpful for people who deal with the stress of infertility. It is important to get as much information as possible, but we must remember that all the information is reliable. Check the power supply, and be careful on the Internet. Resolve and the American Society for Reproductive Medicine are particularly good places to get information. Your doctor should also tell you about your assessment of your specific situation. Write the questions at home so you can remember when you see your doctor, and if it is urgent, call your doctor. If you do not get the answers you want, you do not understand what your possibilities and this is the plan of care, if you feel the research and treatment of infertility are taking too long, or do are not supported by the office of your doctor, it may be time to look around. You should ask for a referral to another clinic or IVF reproductive endocrinologist. Finally, certain situations justify using trained counselors in this area. They could be useful, for example, if you plan to use donor eggs or sperm, if there are difficult decisions, or are too anxious, depressed or not handle the situation and infertility. RESOLVE may be able to give you a list of infertility counselors. Of course, join a support group will is also a great idea.
Once you have this information with your doctor to discuss in detail and make decisions with your partner what you like to continue. You may be able to do this using the "rule of 20 minutes," where infertility is discussed for only 20 minutes (or time agree) a day to reach a resolution, or you can take a week- end in a quiet place to discuss your situation. Once you have determined what is acceptable for you to know the prognosis and the treatment provided with timelines, decided how to pay for treatment, and how to manage their personal life time, family and work, you can make a written plan to address the many aspects of IVF. Patients should proceed at their own pace, with acceptable options for them in medically appropriate guidelines. Some decide not to proceed with IVF, which is perfectly adequate for patients. For others, the approach described above can help to overcome barriers to IVF, enabling them to build their families through this very successful medical techno
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