Fertility treatment

Fertility treatment journey

Things to consider

Possible emotional effects of fertility treatments

Fertility treatments are psychologically and emotionally demanding.

In Australia, counselling services are available in all fertility clinics. People who have fertility treatments and their partner (if any) are encouraged to use these services if they experience emotional difficulties, particularly when:

• waiting for results after embryo transfer and/or when treatment fails
• deciding whether to continue or stop treatment
• considering what to do with unused embryos
• the strain of fertility treatments causes relationship changes
• managing and balancing employment.

Possible physical effects of fertility treatments

Physical complications requiring hospital admission occur in about one per cent of all stimulated treatment cycles.

The most common complication is ovarian hyperstimulation syndrome (OHSS). This can develop as a result of the fertility drugs which are used in IVF to stimulate the ovaries to produce multiple eggs. OHSS is a potentially serious condition which, in very rare cases, can lead to blood clots, kidney failure and death. All IVF programs monitor patients carefully to minimise the risk of OHSS. If you develop an excessive number of follicles in response to the fertility drugs, your doctor may recommend that the cycle be cancelled before egg collection to avoid OHSS. Or, if the doctor has reason to believe that you are at risk of OHSS after the egg collection procedure, the advice may be to freeze all the embryos and then transfer them, one at a time, when the ovaries return to normal.

Surgical complications which require hospital admission, such as bleeding and infection from egg collection, occur in less than 0.5 per cent of IVF cycles.

The risk of serious complications from general anaesthesia and sedation is approximately one in 50,000 treatment cycles.

Managing and balancing employment

Balancing employment, treatment and fertility clinic visits can be disruptive and challenging. Many people prefer to continue working full-time to ensure they are financially supported and to try to maintain a normal lifestyle. Others choose to work part-time or not to work at all. It is important to know that whether you decide to work full-time or not at all, will not affect the outcome of the treatment. 

Treatment can impact on your work as you will need time off for appointments and medical procedures. You are not obliged to tell your employer that you are undergoing fertility treatments, but you may need to supply medical certificates for time taken off work. If your organisation has an Employee Assistance Program you may choose to use the confidential counselling offered. 

If possible, give your employer advance warning about dates you may be absent. If you have important work dates or travel commitments, inform the clinic nurses at the beginning of your treatment cycle. It may be possible to modify your medication to suit your timetable. If not, ask the nursing staff for approximate dates and times to help with planning your work schedule. 

For family and friends

Fertility treatments is demanding, whether someone is doing it alone or with the support of a partner. Showing your friend or family member that you are thinking of them and are there for them can make a real difference. Sometimes friends and family worry that they might say the wrong thing so avoid the person altogether. 

Here are some practical suggestions to help support your friend or family member:

• Find out more about fertility treatments.
• Offer support. Some people like to talk about their treatment, others might be more private. Ask them what they prefer, understanding that this may change over time and they are likely to want to talk about things other than treatment. If they indicate that they would appreciate your support, phone calls or messages can let them know you care. 
• Practical help. Depending on individual circumstances, offering to help with meals, housework, shopping, gardening, or driving them to appointments can be helpful.
• Help take their mind off treatment. Provide opportunities to get out, but make sure you give them the chance to opt out. Special days like Christmas, Passover, Mother’s Day and Father’s Day, and events like christenings and children’s birthdays may be challenging. Acknowledge this and talk to them about it. 

Pregnancy after fertility treatments

After fertility treatments it can sometimes take a while to process being pregnant and you can worry about losing the pregnancy. If an early ultrasound has confirmed your pregnancy and everything appears normal, your chances of having a healthy baby are good. 

During pregnancy

Many symptoms of pregnancy can be unpleasant so you might find you are not enjoying being pregnant as much as you anticipated. Some women are reluctant to express any negative feelings because they feel that they have been lucky to become pregnant. Having mixed feelings is normal and acknowledging that becoming a parent involves losses as well as gains is a healthy way to prepare for the transition to parenthood. 

When the baby is born

Life with a new baby can be very challenging, even if the baby is very wanted and it has taken a lot of effort to conceive. The experiences of infertility and medical intervention can lower confidence and increase anxiety about the baby’s health and wellbeing. Accept offers of practical help and support and seek help if you have trouble feeding or settling your baby.  A website for new parents called ‘What were we thinking’  has information about common experiences in the early months of parenthood and some effective ways of thinking about and managing them. 

Having another child

It can be difficult to decide whether to try for another child. You may face issues such as ageing, peer pressure, desire for your child to have a sibling, or simply a yearning to have another baby. If you do not have frozen embryos stored, you may feel daunted by the prospect of further fertility treatments. If you want more children but have been unable to become pregnant, this can be distressing. Speak to a counsellor if you need additional support. Here is a list of private counsellors who specialise in fertility issues.

Stopping treatment

When fertility treatments are not successful, people often feel very disappointed and sad. However, follow-up studies show that within a few years of ending treatment, there are very few differences in terms of emotional wellbeing and life satisfaction between those who had a baby as a result of IVF and those who did not.

The decision to stop fertility treatments can be more challenging than the decision to start. Even if you suspect that treatment might not work, it can be tempting to have just one more cycle.

Stopping treatment is hard. It involves sadness and letting go of the life you planned. Allow yourself to grieve for the child/ren you hoped to have. This is a particularly complicated grief as it is often intangible and hidden. Those around you may not understand what you are going through. It may be hard to put into words exactly what you have lost. It involves the loss of being a parent, of passing on your genes, being a grandparent, and being part of a wider community who have children.

Discuss your options with your fertility specialist and speak to a counsellor if you need additional support. You can also find a list of private counsellors here. You may find this checklist a helpful starting point when trying to decide if you should end treatment.

Options for unused embryos

While the choice to donate unused embryos may change over time, it can be difficult to decide what to do with remaining embryos that you do not plan to use. The most common reason that people report for stopping treatment is that they have completed their families. However, illness, separation or other circumstances may also prevent people from using their stored embryos. It is a very personal decision that may challenge your ethical or religious views and ideas about the significance of embryos. You may also have a different view to your partner, the donor (if you used one) or your family. It can be particularly difficult for couples who separate, disagree about ending treatment, or have different views about donating embryos.

There are four options available when deciding what to do with unused embryos stored in Victoria. Not all options may be available at your fertility clinic, but it may be possible to transfer your embryos to a clinic that does offer your preferred option.

Option 1 – Continue to store embryos

After five years of storage, the fertility clinic where your embryo(s) are stored will contact you and ask what you want to do with the embryo(s). If you want to continue storing the embryo(s), the clinic can provide you with an application form for a five-year extension. If, after 10 years, you still want to keep your embryos stored, you must apply to the Patient Review Panel for permission. In most cases, approval to extend storage is granted, provided satisfactory reasons are given. 

Examples of reasons that are likely to allow you to continue storage are: 

• you are still having treatment 
• you wish to have a child in the future 
• you have a medical condition that temporarily prevents you from using the embryo(s). 

You are also able to apply to the Patient Review Panel for extended storage time before the embryo(s) have been stored for 10 years. This option may be useful if you need medical treatment that may affect your fertility.

You can read more about Victorian legislation on storage limits for gametes and embryos here.

Option 2 – Disposing of embryos

The stored embryo(s) are kept in sealed fine plastic tubes known as ‘straws’. Disposal of embryos involves these straws being removed from cold storage and left at room temperature for at least 24 hours. They are then discarded. If you have specific wishes about the disposal, you can discuss these with the clinic staff. It may be possible to take the embryo(s) home after they have been allowed to succumb in the laboratory. For example, some people have buried the straws and planted a tree. 

Option 3 – Allowing the embryos to be used for research

You may donate your embryos to research or to be used by embryologists in training. Research may include investigations of why some embryos survive and others do not, new techniques and procedures, or ways to improve fertility treatments outcomes. Each person whose gametes have been used to form the embryo (including the donor in cases where donor gametes have been used) has to consent in writing to the specific research project for which the embryos will be used. You will be given written information about the research study for which your embryo(s) may be used, and an opportunity to talk to someone about it. If you decide to donate your embryo(s) to research, it is important to know that embryos offered for research may be discarded. This is because many more embryos are donated to research than are needed.

Option 4 – Donating embryos to another person or couple

You may donate your embryo(s) to someone you know or to an unknown recipient chosen by the clinic, providing the embryo(s) are suitable for donation. It is important to think through whether you feel comfortable about donating your embryo(s) because, if a child is born, this will have lifelong significance for you and your family. The meaning and significance of embryos are not the same for everyone. Some people feel unable to donate their embryos because they consider them to be potential children and connect them emotionally to their existing children. Others are comfortable with embryo donation.

If you are having difficulty deciding what to do, VARTA’s decision tool can be a helpful basis for discussion. Take time to think through all your options, including whether you want to try for another child and the impact on you and your family. Discuss your options with your fertility specialist and speak to a counsellor if you need additional support. You can find a private counsellor experienced with fertility issues here.