This paper actually came from personal experience with IVF and the hundreds of couples striving to have a child by artificial means in a Chinese hospital in Shanghai. At the same time I was being asked to give a psychologists view of IVF procedures from a tele-health company with a subscription channel to 1,000’s of parents and potential parents. The outline of the content is not about the procedure of IVF (In Vitro Fertilization) but the stress of going through the process from wanting a baby to the actual birth. All the tribulations and disappointments along the way until the eventual success of a pregnancy leading to an eventual birth or not! Also a case for psychological care of IVF patients.
Introduction:
IVF treatment along with other artificial ways of getting pregnant are becoming more and more common for couples who cannot wait for nature to takes its course through normal reproductive sexuality. The Stressors come from many areas to the couple who wish to make this their chosen route to a family. In most Western countries IVF is offered to childless couples and older couples who have tried for some time to get pregnant normally. However in many other countries it is a way to ensure the birth of a boy (cultural assertiveness) effectively by sexing the fertalized eggs for gender (even though illegal in most countries). In India young couples who feel under family pressure to have a child (potential grandparents not willing to wait), choose IVF as a fast track method to pregnancy and fulfilling their traditional roles. The one child policy to control over-population was relaxed in 2017 and now there is a two child policy in force. Most couples who have one child already did not want a second as the expense of bring up a child in India is enormous. However especially where the one child was a girl, the family pushed the wife to commit to the second child in order to get a boy. The birth if a second girl would be seen a shameful. It is quite amazing to attend a maternity hospital in India and see the huge amount of young couples under 30 years old trying to get a second child. Those there trying for their first are also trying to avoid divorce. Women who cannot produce for the family would certainly be shamed by the family and the mother in law on the boys side would be pushing for a divorce in order to find a more suitable child bearing girl for her son.
Lets look however at where it all starts – not getting pregnant normally through sexual contact. In a lot of cases the blame game begins with who’s fault is it? Men often feel it must be the wife’s fault as they cannot face the embarrassment of knowing they are the ones with a problem – medically or psychologically. So initially it is often the wife (or partner) that goes to the doctor and has all the checks – internal – blood tests – scrapes and more – all leaving a feeling of inadequacy to the woman. If however all is well and no medical or biological reason can be found for her not being pregnant then the next step of course is the male. For men given a little cup and a room with a few suggestive pictures on the wall and asked to ejaculate sperm is not the easiest thing to do. However with a little imagination and sometimes a little help from the wife things move along and the cup has a spoonful of sperm and semen to hand into the hospital laboratory. It is actually discouraging to watch the nurse throw most of it away (they only need a minute specimen) as you had a time producing it. A sense of humour is often the best protection against embarrassment. At this point after the agonizing wait – the results come in the form of a print out that you cannot understand and told to take it to the doctor for analysis. The man quietly hoping that his sperm are strong active swimmers and so he can relax.
All being well with both parties then the procedure starts in earnest with most the females going for many (and I mean many) appointments over a period of months to go through the complex process of preparing her body, womb and eggs for the inevitable fertilization by the males collected sperm. (Often frozen and waiting for the right moment).
Stress Along the Way:
1. Blaming – the initial who’s fault is it. The stress of the unknown cause of the lack of pregnancy – the need to follow complex monthly cycles that still do not seem to produce the desired results. Blaming can happen at many stages of IVF mostly about the female partner’s inability to give the family the desired outcome.
Fear – fear of failing to produce the baby everyone is asking you for! Fear that there is something wrong with you. Fear that you might end in divorce or separation. Just like blaming – fear is a constant throughout the time of IVF treatment. At any point you can be asked to start all over again from the beginning as something has not take properly or a missed moment was not taken.
2. Disappointment – despite several tries the pregnancy is not happening – the cost and economics of chasing a baby has become no longer affordable. The risk of stopping – and trying again later – the cultural outcome of being a failed woman and poor wife.
3. Failure – as above the moment when the doctor tells you that is never going to happen and that you should think of alternatives such as adoption or being childless. For many this is the ultimate failure and again can lead to the blaming game and the end of the marriage. This can also effect the persons self esteem in that I am not normal – I am a failure as a woman or man. It may also mean after a divorce for non-fertilization that your chances of re-marriage are practically nil.
4. Success – you would think a successful implantation would be the dream come true but you are in the same position as any pregnant couple – what else can go wrong – many IVF insertions can be aborted, rejected by the body and have medical problems in the womb bring other decisions about birth or aborting.
5. The baby is finally born – now parenthood begins – the stress of being a new mother of an IVF child – the stigma of secrecy – pretending everything was normal. Family pressure to start again for the second child.
6. Multiple births – the idea was one baby to start a family and ending up with twins and triplets even – the financial burden alone in some countries increases the stress felt by everyone.
All the above points are a common experience of IVF couples – and more so the younger the couples are (under 30) as older couples tend to be more realistic of the chances and outcome from the start. For every 100 couples (at a decent hospital) only 18 are successful to bring the procedure to birth. Of those age makes a huge difference to your success. Between age 22 to 34 an average of 30% have a live birth, from there the statistics go down rapidly from 38 to 42 about 20% after age 46 only 1% are successful. (1. Division of Reproductive Health USA 2001)
Another aspect of IVF is the increase of multiple births for older couples – aged 38 to 40 each try increased the chances of multiple births for twins to 25% on average. (2. USA Government Health statistics 2001). It is very hard to gain meaningful statistics in India in any form.
Summery:
The procedure is long – from 6 months for a lucky few first try, to several years and many failed attempts to succeed. To giving up at some point with all the cultural and social risks involved or to keep going and the inevitable financial burden of each attempt and failure.
Even a successful outcome can bring its stress such as being new parents of one baby or two or three even! It also unfairly can come down to just good luck that everything seems to go OK – as in the case of the Irishman of 62 and his Chinese wife of 31 – he had a vasectomy in his late 20’s and so had to have the sperm extracted from his testicles (without anesthesia) and implanted 9 sperm into her eggs – 7 took and 2 where implanted – and bingo the wife is pregnant with twins – eight months later – a healthy boy and girl fraternal twins are born. (3. Myler 2017) This would be a dream outcome for many young couples who fail over and over again.
The Role of Counselling:
It is important to note that not once in all the hospitals or clinics that did IVF offered any form of counselling to the couples going through the stress of the procedures. Yet clearly there is a very important need for such support – understanding the procedures from the medical doctor can help understand what will happen to your body and the outcome chances – but that cannot prepare you for the ups and downs of the emotions you feel from blame, failure, self esteem issues and fear of the future – these issues need a listening caring supportive counsellor or psychologist. It is a well known fact that stress hormones and psychological stress can greatly effect the outcome of medical procedures in all sorts of areas. Psychology should not be seen as a luxury but an essential part of all IVF procedures.
