IVF in the US — Not All a Bed of Roses

In recent years, in vitro fertilization (IVF) has grown rapidly in the United States as a method of helping infertile couples conceive a child. It is expected to continue to grow steadily over the next decade. IVF is a scientific technique that combines a woman’s egg and a man’s sperm in a special laboratory to permit fertilization outside the womb and create an embryo that can later be implanted back into the uterus to grow into a baby. IVF is a widely used treatment in the US to help couples with infertility problems, single mothers, and others, to conceive a child. About 10 percent of US women of childbearing age have had assistance with infertility. IVF has become even more prevalent in recent years in the US due to a number of factors. These include increased infertility rates among both women and men and a growing trend in delaying pregnancy. At the same time there has also been a surge in the treatment’s success rate as a result of technological advancements in the IVF treatment and changing practices of embryo banking cycles. A rise in disposable income in the U.S has also driven the growth of the IVF services market. In 2020, that market was valued at $4.9 billion. It is expected to reach $5.6 billion by 2027. While the experimental foundations of IVF were being medically laid between the 1920s and 1960s, the first IVF baby was not born until 1978. Louise Brown, born on July 25, 1978, is still alive today. During the 1980s, what was then a controversial procedure became more accessible and affordable, and by 1986, over 1,000 babies had been born using IVF. But the procedure is not without its hardships and risks. Dr. Dina Rose, an American sociologist based in Whitefish, Montana, told MAP that when she tried to conceive via IVF twenty-one years ago, she finally had success on her fourth try. “Some of the difficulties are just that it’s a private thing that becomes public,” she said. “But shooting a lot of hormones into your body makes you go a bit crazy.” During her course of treatment, Rose experienced a series of emotional ups and downs as she and her husband negotiated each stage of the lengthy process and lived through each individual positive or negative development. IVF is a time consuming, scientific process where timing is everything. The procedure requires that everything is timed and coordinated to maximize the chances of fertilization and creation of an embryo that can then grow into a baby. You may hire a particular doctor to treat you, observed Rose, but because it’s a “science thing,” you deal with teams of people in the clinic who are “more clinical than compassionate.” Rose described in detail the process she went through. All the women who were in her IVF group went on birth control pills so that their cycles occurred at the same time. Then they were given medication to stimulate the development of eggs, and induce them to ovulate at the same time. Normally a woman’s body matures one egg. However, the women were injected with drugs to make multiple eggs mature so that they could be released from the ovary at the same time. So another medication was injected to stimulate the release of those mature eggs into the women’s fallopian tubes. Then the women had to undergo a medical procedure that retrieved the eggs through the cervix. Once the eggs were retrieved and found to be the right size, they were fertilized with sperm in a dish. This procedure had its own fertilization success/failure rate. The clinic then did genetic testing on the eggs that were successfully fertilized to check for birth defects. If multiple eggs were fertilized, the most healthy two to four were chosen to gestate. The team then monitored the cells dividing so that they could tell which were the healthiest. Then they selected the particular time to put the most healthy ones back inside the women. This was done by inserting a tube through the cervix up into the uterus and “shooting” the fertilized eggs back into the uterus so that at least one of the eggs would implant in the uterus to begin developing into a baby. “Then you hope for the best,” Rose said. “It’s a waiting game at that stage to see if you get pregnant. And there is always the possibility of a miscarriage like any other [pregnant] woman.” Women who undergo IVF take a lot of hormones. There is a suppression drug, so that the ovarian follicles do not grow too large to produce the right kind of egg. Then there is an estrogen mix to increase the growth of the eggs. And then, if a woman gets pregnant, she takes progesterone to help the placenta grow. The IVF procedure “controls your life,” said Rose. You have to take the drugs at a specific time every day. “I remember injecting myself [in the stomach] in airport bathrooms and even the parking lot of a prison once when my work took me there.” “The time that was the most difficult though,” she said, “was when the treatment failed to stimulate egg production, and we did not have insurance that covered it. It cost about $10,000 each time, and I had tried seven times!” Even now, most people need at least three to four IVF cycles to be successful. In 2021, a single IVF cycle in the US can range on average from between $12,000 and $17,000, according to the National Conference of State Legislatures, and possibly as much as $25,000, according to FertilityIQ. “It’s a roller coaster,” Rose observed. “And I still wonder whether I will get cancer down the road.” There is a correlation between infertility and increased risks of breast, ovarian and endometrial cancers, but there is no solid evidence that the infertility drugs themselves cause cancer, according to a 2018 review of evidence in the journal Current Opinion in Obstetrics and Gynecology. Asked about her decision not to try for a second child, Rose said, “There was no way I was going to [go through IVF] again. First, it was difficult. Second, I do think there was a risk to my physical health by injecting all those drugs.” Yet “all experiences make us stronger,” she added. “Once you are pregnant enough that the baby is going to live, all that other stuff is completely irrelevant.” Rose’s beautiful baby girl is now a striking young woman.