Becoming a mother is a personal, emotional, yet exciting chapter in a woman’s life. However, in many women and their partners who are experiencing infertility, this chapter could be full of challenges, heartbreaks, and uncertainties.

The burden of infertility

According to the Centres for Disease Control and Prevention, infertility is a condition in which pregnancy is not achieved even after regular unprotected sexual intercourse for 12 months or more. The World Health Organization (WHO) classifies infertility as a disease. Male or female conditions can cause infertility.

Problems in the male reproductive system that can cause infertility include problems in semen ejection, low sperm count, or abnormal movement or shape of the sperm. In the female, abnormalities of the uterus, ovaries, fallopian tubes, and hormones can cause infertility.

Around 48 million couples or 186 million individuals experience infertility worldwide. Infertility impacts the physical, mental, and emotional well-being of couples and their families.

The World Health Organization (WHO) emphasizes that it is important to address infertility because it is a significant component of attaining the highest possible standard of health, which is a basic human right. Being able to conceive and decide on the number of children is a universal right.

The promise of IVF

In vitro fertilization (IVF) offers hope to individuals and couples who wish to conceive. IVF is the most common form of assisted reproductive technology. Approximately 2.5 million IVF cycles are performed every year with over 500,000 babies delivered successfully.

IVF is a viable method to conceive naturally despite various health conditions that cause infertility. For instance, fertility doctors recommend IVF to women who experience infertility due to fallopian tube damage. Diseases such as pelvic inflammatory disease and bacterial infections result in occlusions or adhesions, which then damage the fallopian tubes.

IVF is also recommended for women with endometriosis, which can also cause adhesions, as well as inflammation, irregular follicle development, and low embryo implantation. However, IVF in women with endometriosis has lower success rates compared to other causes of infertility.

Couples who cannot conceive due to low sperm count or poor semen quality can also benefit from IVF. The sperm will be extracted from a semen sample and washed in protein-rich media to improve sperm quality. The sperm will then be directly injected, or inseminated, into an egg cell, thereby facilitating fertilization.

Women with diminished ovarian reserve or ovarian insufficiency can also become pregnant with the use of IVF. However, this specific IVF process would require egg donation or embryo donation.

IVF is also helpful for women who want to delay childbearing and cryopreserve their eggs. Women who have cancer and must undergo radiotherapy or chemotherapy can opt for egg cryopreservation and later on, IVF.

Mistakes and problems you might encounter along your IVF journey

Despite the availability, benefits, and success of IVF, getting pregnant remains elusive to many. The IVF journey is not fool-proof. Strictly speaking, IVF treatment is still a trial-and-error process. Mistakes happen along the way which could further decrease your chances of getting pregnant.

Here are some of the possible mistakes and problems you might encounter as you go through IVF:

• Relatively few IVF clinics that you can consult from your locality.
• Many IVF clinics offer a limited range of procedures because of local laws and guidelines on fertility treatment.
• Clinics may opt not to conduct further diagnostics and examinations because IVF treatment is not covered by your health insurance.
• Some clinics may publish fabricated information about their success rates and some may suggest that you get “add-on” treatments.

This short guide on infertility, IVF treatments, and IVF clinics will help you navigate and avoid mistakes as you go through your IVF journey.

How to avoid mistakes during your IVF journey

1. Widen your options and consider IVF clinics abroad.

One of the problems that arise during IVF treatment is that there are relatively few IVF clinics that you can consult from in your locality. For example, in the United States, there are only 498 fertility clinics, with 10 states having only 1 to 2 clinics.

Women and couples from these states would then be forced to transfer to another state just to receive the appropriate fertility treatments that will allow them to conceive. Still, even after relocating to another state, the options would be limited by the expertise of the attending fertility doctor and the techniques available in a specific IVF clinic. Some clinics do not even conduct necessary tests that are not covered by health insurance. Couples then have no other choice but to spend thousands of dollars for fertility cycles, with low success rates, and just hope for the best. This results in a huge financial and psychological burden for couples and their families.

One way to avoid these problems is to consider getting fertility treatments abroad, specifically, in Europe.

Why Europe?

Europe has the greatest number of fertility centres and the highest IVF success rates in the world. It is estimated that in 2018, there are 1,279 fertility clinics, which make up almost half of all the fertility centres around the globe. These centres have an average IVF success rate of 30%, which is significantly higher than those of the US and Latin America.

With such data, it is safe to say that Europe has the best IVF clinics in the world. It is therefore not surprising that a quick Google search with the keywords “best IVF clinics in the world” would show a list of IVF clinics located in Europe. These clinics have been rated and recommended by patients and fertility experts.

Expanding your horizons and learning about the other options offered by highly recommended clinics in Europe can help you increase your chances of becoming pregnant.

2. Be critical of your IVF clinic. 

Nearly all clinics say that they have high success rates, charge reasonable fees, have short waiting times, and have high-tech equipment. However, this is not actually the case. Recent reports have described how some fertility clinics manipulate their success rates, commit mistakes in embryo implantation, recommend unnecessary procedures, and have faulty laboratory equipment. These lapses have serious implications not only on the financial burden of IVF treatments, but also on the psychological and emotional well-being of couples who dream of having their own baby.

As early as 1999, Dr. Sam Thatcher, former director of Center for Applied Reproductive Science, warned about how clinics report their obscure success rates. Some clinics reject patients with low chances of becoming pregnant, saying that such patients might compromise their statistics. Similarly, patients with low likelihood of conceiving are removed from the reported statistics, to create a façade of high success rates. Clinics even offer sales promotions to increase sales. Some IVF programs offer incentives for couples who deemed eligible based on their stringent acceptance criteria, which actually pre-selects couples with the highest likelihood of becoming pregnant after just 1 cycle. These “deals” are designed to increase the success rates of these clinics. 

Reports of clinics mixing up embryos have made headlines in the recent years. A fertility clinic in California mixed up the embryos of two of their patients, which resulted in two mothers giving birth to each other’s babies. Months after giving birth, DNA tests confirmed the identities of the babies, and the mothers agreed to have their biological babies. Another fertility clinic in California also mixed up the embryos of their patients, as it has been confirmed that the embryo of one couple was given to a Korean American couple, who gave birth to a baby who is not of Asian descent. Such type of mistake has caused considerable pain, confusion, and despair to couples and their families.

Equipment malfunction in IVF clinics, which jeopardized thousands of eggs and embryos of patients, have also been reported previously. In 2018, a liquid nitrogen tank failed in a fertility clinic in San Francisco, causing damage to eggs, embryos, and tissues of approximately 500 patients. That same year, a refrigerator malfunction in an IVF clinic in Cleveland, Ohio jeopardized more than 2,000 frozen eggs and embryos.

Fertility clinics also tend to offer “add-on” procedures as part of their promotions. Procedures such as endometrial scratching, embryo glue, platelet-rich plasma injections, and intralipid are still poorly studied and have not been tested thoroughly. Even egg freezing, which is being marketed by a lot of IVF clinics as a fertility procedure, is not recommended by the American Society for Reproductive Medicine as a means to delay childbearing. The committee actually warned about the marketing of egg freezing to delay pregnancy, as it could give women false hope.

How will you know if your IVF clinic is reliable?

• Doing your own research about fertility clinics is very important. Do a quick online check on the profile of the clinic. Check if your clinic had any FDA violations or reports of malpractice.
• You can also check the procedures done by your fertility clinic. A high rate of multiple embryo transfers is actually a red flag. Fertility clinics perform multiple embryo transfers to increase their success rates. However, multiple embryo transfers result in multiple gestations, such as twin pregnancies, that are associated with increased risk of complications that can endanger the health of both the mother and the baby. Also note whether the clinic carries out questionable procedures such as organ trafficking or surrogacy.
• While at the clinic, observe your surroundings. Assess if the clinic is clean and if the staff knows what’s going on. Check if the files are organized. These little things reflect the practice of a clinic.
• Do not hesitate to ask questions. You can directly ask the staff and the fertility doctors if they have committed mistakes before, such as mix-ups of embryos or other problems.
• Make sure that the IVF clinic you are consulting with is duly licensed to perform fertility procedures. If you live in the US then you can check the website of the Society for Assisted Reproductive Technology to check whether your clinic is licensed.

Educate yourself about IVF treatments.

The IVF journey is a difficult one, and it is always better if you equip yourself with the right information, considering not only the clinic’s success rates but also learning about the specifics of the different fertility procedures.

How can you improve your knowledge about IVF?

Only trust reliable sources and fertility specialists.

Nowadays, almost all the information we need can be found on the internet. Using online sources to learn about fertility has been shown to be helpful when making decisions about IVF treatments. A study even reported that online educational materials can empower patients in making more informed decisions and having better discussions with IVF doctors.

Still, you should be careful of what you read on the internet. The internet is a good and quick source of information, but not all that is published online is reliable. Many IVF centres would publish cherry-picked success rates to boost the reputation of their clinic. Online forums and social media groups would feature the opinions and recommendations of couples who underwent IVF. These published experiences, mostly sad, disappointing stories, could affect how you view IVF. Instead on relying on the websites of clinics and the testimonies of other couples, it is better that you consult a fertility specialist. You can still read about IVF via the internet, but make sure that you are getting information from reputable online sources.

Research about the “add-on” treatments being advertised by IVF clinics.

Some clinics may advertise their “add-on” IVF treatments through blogs and social media posts. Do not be deceived by these eye-catching posts. Always do your research about these treatments. Check reliable sources about the scientific basis, efficacy, and possible side effects of these additional procedures.

The United States Federal Trade Commission even warned the public in 2021 to be wary of fertility products and supplements that claim to improve fertility and increase IVF success rates, as these products are mostly not backed by science and do not meet FDA standards.

Learn about the IVF process.

Having the knowledge about the IVF process can help you make better decisions and easily spot possible mistakes and problems during your IVF journey. Read about how different factors such as age, weight, ovarian reserve, sperm quality, and co-existing health conditions, could affect your IVF success rate. Learn about the ideal hormone levels and sperm quality for a successful IVF cycle. Educate yourself about the specific steps in the IVF process, such as ovarian stimulation, egg collection, sperm collection, fertilization, and finally, embryo transfer or implantation. As mentioned earlier, only trust reputable medical and scientific sources when you do your research.

Always get a second opinion.

When you finally consult with a fertility doctor, remember that the rule of thumb before going into any treatment is to at least seek a second opinion. Why? Some doctors are limited by the available equipment in a particular clinic. Some doctors may lack the knowledge or refuse support when it comes to topics that are taboo, such as single or lesbian motherhood, secondary infertility, male infertility problems, gender selection, egg donation, or pre-implantation diagnostic procedures. Seeking a second opinion from another doctor in another clinic can open up more viable options for you and can give you the right support that you need.

Find a fertility expert who will guide and support you on your personal IVF journey.

Fertility experts are knowledgeable about the science of infertility, the best IVF clinics in Europe, and viable fertility procedures, making them the ideal coaches that you can rely on as you make your journey toward motherhood. Fertility experts aim to empower women and couples to make informed decisions about their reproductive healthcare, raise awareness about the available IVF options, and provide emotional and social support that you need.

With the help of fertility experts, you can get acquainted with the right facility and treatment that is suitable for you. They will help you understand the different alternatives available to increase your chances of conceiving, including how these treatments work and the possible risks associated with them. A reliable fertility expert will help you avoid possible mistakes during your IVF journey.

References

CDC. (2019, January 16). Reproductive Health: Infertility. Retrieved from Centres for Disease Control and Prevention: https://www.cdc.gov/reproductivehealth/infertility/index.htm.

WHO. (2020, September 14). Infertility. Retrieved from World Health Organization: https://www.who.int/news-room/fact-sheets/detail/infertility.

Choe, J., Archer, J., and Shanks, A. (2021). In vitro fertilization. In: StatPearls [Internet]. Treasure Island: StatPearls Publishing. PMID: 32965937.

Fauser, B.  (2019). Towards the global coverage of a unified registry of IVF outcomes. RBMO. 38(2): 133-137.

CDC. (2020). State-Specific Assisted Reproductive Technology Surveillance. Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/art/state-specific-surveillance/index.html.

Thatcher, S. (1999). ART Success Rates – All That Glimmers. Retrieved from IVF Costs: http://www.ivfcosts.com/sam_thatcher/

Kubota, S. (2021). After ‘nightmare’ IVF mix up, 2 mothers give birth to each other’s babies. Retrieved from Today: https://www.today.com/parents/after-nightmare-ivf-mix-2-mothers-give-birth-each-other-t238168

Madani, D. and Kent, J. (2019). Couple says fertility clinic that mixed up their embryos put them ‘through living hell’. Retrieved from NBC News: https://www.nbcnews.com/news/us-news/couple-says-fertility-clinic-mixed-their-embryos-put-them-through-n1028396

Weaver, J. (2018). Egg freezing industry reeling after two major malfunctions. Retrieved from NBC News: https://www.nbcnews.com/health/womens-health/egg-freezing-industry-reeling-after-two-major-malfunctions-n856016

Tsigdinos, P. (2018). As the dark side of IVF slowly comes into focus, even more transparency is needed. Retrieved from Stat News: https://www.statnews.com/2018/07/27/as-the-dark-side-of-ivf-slowly-comes-into-focus-even-more-transparency-is-needed/

Strodel, R. (2020). Fertility clinics are being taken over by for-profit companies selling false hope. Retrieved from NBC News: https://www.nbcnews.com/think/opinion/fertility-clinics-are-being-taken-over-profit-companies-selling-false-ncna1145671

Breen, K. (2021). Could an IVF ‘mix-up’ happen to you? Experts explain what to look for. Retrieved from: https://www.today.com/health/womens-health/ivf-mix-happen-experts-explain-look-rcna5236

Dowling-Lacey, D., Jones, E., Mayer, J., Bocca, S., Stadtmauer, L., and Oehninger, S. (2007). Elective transfer of two embryos: Reduction of multiple gestations while maintaining high pregnancy rates. J Assist Reprod Genet. 24(1);11-15. https://doi.org/10.1007/s10815-006-9085-6.

Jones, C., Mehta, C., Zwingerman, R., and Liu, K. (2020). Fertility patients’ use and perceptions of online fertility educational material. Fertility Research and Practice. 6(11). https://doi.org/10.1186/s40738-020-00083-2

Lake, L. (2021). Considering fertility products? Spot the fake claims. Retrieved from Federal Trade Commission: https://www.consumer.ftc.gov/blog/2021/05/considering-fertility-products-spot-fake-claims.