When nature fails

Walking into Mary’s home it is clear that family is a number one priority. Children’s toys lie scattered about everywhere, as three-year-old Marcus runs around at his mother’s feet as she tends to her seven-month-old twins.

This was not always the reality, however, as Mary and her husband Paul were unable to have children naturally.

Both are concerned at how the regulation of IVF treatment being discussed by lawmakers is going to affect the people who actually need the treatment.

“It’s easy to talk about ethical concerns when you are not going through the emotional turmoil that is involved when you have problems conceiving naturally,” Mary begins.

“We have very liberal views when it comes to freezing – of eggs or embryos – as many other parents undergoing IVF treatment, because we actually need it. Pregnancy does not necessarily occur at the first treatment and collecting gametes is not an easy process. Celine Dion, who had IVF twins this year, got pregnant on her sixth attempt. For us in Malta it is not so easy.

“When an attempt at pregnancy fails we have to go through the entire process of gamete collection over again, and the implications are painful, both physically and emotionally, as well as expensive. If we were able to freeze either oocytes or embryos, then this part of the process could be omitted.”

As for the issue of aborting embryos, she says is irrelevant because nature aborts embryos all the time.

“During my first pregnancy three embryos were implanted and nature only allowed one to be carried to term. The services in Malta don’t allow for freezing of embryos just in case the first ones don’t take. Only three to four embryos are created so there is no unnecessary destruction. However, if embryos were allowed to be frozen then failed attempts would not involve so much wasted effort.”

Paul feels strongly about the fact the lawmakers criticise something they don’t fully understand. He says: “Nobody can understand the situation we’ve been through unless they’ve been through a similar situation themselves. I don’t think it’s fair of them to criticise something they know nothing about, and not allowing freezing only reduces the success rate.

He infers that politicians are very choosy about which issues merit moral values. “There is a lot of unethical behaviour out there, yet IVF is just one area they choose to impose their own moral values based on what they’ve read, rather than on real life experiences. If they could see the heartache and frustration that is part of infertility treatment I’m sure that their moral values would change.”

Mary was 32 when they decided to go ahead with fertility treatment, after a year of trying to get pregnant naturally.

“I felt like my biological clock was ticking and the wish to have a baby started to turn into desperation. Before we started any sort of fertility treatment we both got tested to try to find out where the problem was. When the tests came back revealing that everything was normal we weren’t sure whether to be relieved or more worried.

“If the tests identified where the problem was then there would be something to work with, as it is was it just intensified the fear that no matter what we did we might not ever have children.”

In-vitro fertilisation (IVF) is not a matter taken lightly by doctors. There are a number of treatments that are tried before embarking on the costly procedure.

“After a number of tests, we were given dates when to try to conceive naturally, when I was most fertile and conception was most likely to occur. Failing that, we tried intratubular insemination (ITI) where sperm is injected into the fallopian tubes, so that the sperm does not have to travel up the cervix to fertilise the egg.”

When none of the procedures worked they embarked on IVF treatment. Before the procedure could be done Mary had to take a course of hormone pills every day and a daily injection of the hormone gonadotrophin, to encourage multiple ovulation.

The eggs were then gathered and placed together with the sperm. In their case intra-cytoplasmic sperm injection (ICSI) was not used and sperm and egg were just left together to fertilise. Three embryos were eventually graded well enough to be implanted into the uterus.

Following the procedure there is a 10-day bed rest period during which the only thing to do was worry whether any of the embryos had implanted.

Mary does not describe her pregnancy as normal. Hormone supplementation had to be continued throughout the pregnancy, and every little twinge resulted in huge panic that she might miscarry.

“We are so appreciative of our doctor who was absolutely stellar in his patience with us. He was so understanding and gentle with us knowing the emotional trauma we were going through.”

Nine months later Marcus was born.

“Our first IVF treatment wasn’t successful and we had to go through the entire process a second time. There are no words to describe the feelings of disappointment we felt when, after all we went through the first time round, I did not get pregnant. The human body is designed to reproduce and when you can’t do that you feel like a failure as a human being.” 

When Marcus turned two, the couple decided to try a second time and the following IVF treatment resulted in twins. Multiple births are often the consequence of IVF as a number of embryos are implanted to increase the chances of carrying at least one foetus carrying through to term. The incidence of twinning from normal conception is approximately 2 – 3%; but IVF increases the probability of having twins to 20%, and triplets or quadruplets to 2 – 3%.

Mary talks of the experience of going through the pregnancy as one of emotional and physical hardship for the couple but more so for the mother.

“The injections are painful, and there is always the nagging feeling that this might not work, that I am going through all this for nothing.”

Another issue involved in IVF treatment is the expense. The procedure in itself costs between €3,000 and €4,000, including hospital visits and the birth of the child. However medication prior and during the pregnancy are quite costly. The injections that Mary took for a month prior to the procedure cost approximately €30 per day, while during the pregnancy, hormone supplementation cost approximately €200 per month.

“We feel privileged that we could afford to undergo the treatments. I know it is not affordable to everyone. If we were at least allowed to freeze embryos, then part of the cost of collecting gametes and fertilisation would not have to be incurred every time a pregnancy failed.”

*Names have been changed for the protection of privacy