The changing face of IVF
Fertility treatments have come a long way since the first IVF baby was born in New Zealand thirty years ago. Dr Karen Buckingham looks at how those seeking assistance with fertility have changed as well.
Three decades ago the first IVF clinic was established at National Women’s Hospital in Auckland, and one year later, in 1984, the first baby was born. Fast forward thirty years and it’s an industry of huge growth with more than 5000 IVF cycles performed in New Zealand each year and assisted reproductive technologies accounting for more than two percent of all live born babies in this country.
Over that time, while the number of patients undergoing IVF has changed, so too has the range of scenarios that prompt people to seek treatment. Why the change? Well, in part it is due to advances in technology, but changing attitudes in society are also playing a role.
In terms of the science, the ability to freeze sperm, embryos and oocytes (eggs) allows increased opportunities for fertility preservation for both men and women. Preimplantation genetic diagnosis (PGD) provides the ability to select embryos that do not have a specific inheritable condition or chromosomal abnormalities. PGD may also offer hope to couples experiencing recurrent miscarriage or implantation failure.
Alongside that, there is also growing acceptance that it is ‘family functioning’ that’s important when it comes to embarking on parenthood and not necessarily a ‘traditional’ nuclear family structure. Single women, gay/lesbian/bisexual and transgender individuals are able to use this technology to complete their dreams of a family. Compared with other countries, New Zealand has relatively permissive laws in terms of what fertility treatments may be practised and who can be treated. Fertility clinics in this country do not discriminate on grounds of gender or sexual orientation. By comparison, several European countries, such as France and Italy, forbid single women and lesbian couples from using artificial insemination or IVF to conceive. In Turkey IVF is only available to married heterosexual couples, while France requires couples to be in a ‘stable’ relationship for more than two years.
Compared with the early days of IVF in New Zealand, people seeking assistance with fertility now come from a wide range of backgrounds with varying medical issues.
Here are some of the patients who are benefiting from the range of IVF treatments now available:
- Alice is a 38-year-old property developer who had always planned to have a family but never met ‘Mr Right’. When she reached her mid-30s she decided it was “now or never”, opting to go it alone and seeking assistance from her local fertility clinic. After investigation and counselling she undertook fertility treatment using a clinic-recruited sperm donor. Several donor insemination cycles were unsuccessful and so she opted to move to IVF, due to its higher success rate per cycle. Fortunately, she conceived with this treatment and was lucky enough to also have two ‘spare’ embryos frozen. Although her decision caused, in her words, a few “raised eyebrows” among her friends and co-workers, for Alice, treatment in a clinic was by far a safer and easier choice. Considering her alternatives were to either remain childless or “go out and have a one night stand with a stranger in a pub”, her choice to undergo treatment through a clinic was right for her. She’s now the proud mum of an eight-month-old son and is planning to return for a frozen embryo transfer next year to try and give her son a sibling.
- Jenna has been discussing her recent diagnosis and treatment of breast cancer with her fertility specialist. At the age of 33, the diagnosis of cancer came as a total shock to Jenna and her partner. Together for two years, they had planned to get married and start trying for a family, but that future is looking less likely unless Jenna undergoes fertility preservation treatment prior to commencing chemotherapy. She has just had a mastectomy and now faces chemotherapy to beat her illness. Her prognosis with treatment is good but comes at the cost of reducing her natural fertility to near zero levels. She is considering undergoing an IVF cycle and freezing any embryos created for use once her cancer is in remission.
- Ray and James are a gay male couple who have been in a relationship for eight years. They have longed to start a family together and have close female friends who have offered to donate eggs and act as a surrogate. Until recently, however, this was not permissible in New Zealand. Amended surrogacy guidelines issued in December 2013 means surrogacy can now be considered for men in their situation. Ray and James are in the process of completing their application to the Ethics Committee for Assisted Reproductive Technology (ECART) and if successful, hope to start treatment soon afterwards.
- Claire and Tom are not infertile but are planning to start an IVF cycle soon. Their first son, Liam, was conceived easily but sadly was diagnosed at birth with Cystic Fibrosis (a life threatening genetic disorder that causes severe damage to the lungs and digestive system) and passed away at the age of two. Claire and Tom are very keen to have another child but know they have a 1:4 chance of having a similarly affected child. They are therefore planning to undergo IVF with preimplantation genetic diagnosis (PGD). This laboratory technique will test the embryos that are created through IVF to see if they are affected with Cystic Fibrosis or not. A non-affected embryo will then be implanted in Claire, hopefully giving rise to a child without this lethal condition.
Changes and advances in the field of reproductive medicine have been significant in the last few decades, and these are but a few examples of the scenarios addressed at modern fertility clinics, also showing that there is no such thing as a ‘typical’ fertility clinic patient. It will be fascinating to see what the next years bring.
Dr Karen Buckingham trained in New Zealand and the United Kingdom as an obstetrician and gynaecologist. She has been working in the area of infertility management and treatment for the past fourteen years and is currently in private practice at Repromed and Auckland Gynaecology Group.
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