IVF and “Playing God”

There is still one follicle maturing and growing in the left ovary.

Today it measured 15mm.

I am waiting for a nurse to call and let me know when I am to have the hCG injection (to induce ovulation) and when the IUIs will be.

For now, I leave you with a post I actually wrote on Saturday. I think this post will help you understand the biggest factor for us in deciding if we should try another IVF ovarian stimulation and hope and pray for more follicles.

*****

Some people call IVF “playing God”.

I, however, see IVF as a genius medical intervention that allows a woman to essentially combine a number of menstrual cycles into one, thus allowing the medical field to sift through the harvested eggs and then embryos and find the ones that have the most potential to produce a viable pregnancy.

In order to understand why I do not believe doing IVF “plays God” in any way, you need to first understand what naturally occurs in a fertile couple trying to conceive.

I’ve mentioned that I am reading the book In-Vitro Fertilization: The ART of Making Babies by Geoffrey Sher, M.D. in a previous post. (Excellent book!) When I read the part of the book about natural conception, it blew my mind away and helped me realize that IVF adapts the principals of human reproduction to achieve pregnancy in a faulty reproductive system!

Only about one out of every three embryos implants in the uterus long enough to delay the menstrual period. This means, in two out of every three pregnancies, a woman is not even aware conception has taken place! (Sher, 2005, page 29)

The actual fertilization process is such a complex process that many times egg and sperm do meet but something goes wrong in the fertilization process and the embryo is just not capable of producing a viable pregnancy. In other words, the woman has conceived, but she will never know it! In other cases, a woman may miss her period, but will have a very early miscarriage because the embryo isn’t capable of producing a viable pregnancy (among other reasons also mentioned in the book).

One reason IVF gets a bad reputation from some people is because people have a problem with embryos being discarded. (Please understand I am not referring to discarding frozen viable embryos.) Maybe people would have a different point of view if they understand the high rate of embryo wastage and early miscarriages that occurs even in natural conceptions!

These facts should only encourage someone standing on the brink of an IVF cycle.

While a woman’s natural menstrual cycle produces on average one mature follicle, a woman (under the age of 40) undergoing IVF produces an average of 10-15 follicles. (Sher, 2005, page 63) The way I see it, IVF essentially takes approximately a year’s worth of monthly menstrual cycles and combines them into ONE cycle.

For example, let’s say a woman undergoes IVF and at retrieval, twelve follicles are aspirated from her ovaries. Of those 12, maybe only 10 follicles actually contain a mature egg. Of those 10 eggs, let’s say 8 fertilize normally after being left overnight with sperm in a petri-dish.

Of those eight fertilized eggs, more than likely, a number of them will not continue to grow and divide properly and will not be able to produce a viable pregnancy. These embryos would be the ones in a “natural conception” that would float around in the woman’s reproductive tract but would not implant for one reason or another.

In an IVF lab, embryos are carefully monitored. When the embryologist finds embryos that are not growing after several days, the embryos are discarded just like non-viable embryos are discarded in nature without the woman ever even knowing she has conceived. In the example, let’s say of the eight fertilized eggs, three of the embryos stop growing by day three after retrieval. We are now left with five embryos.

The remaining five embryos continue to grow in the IVF lab and are carefully monitored for proper growth and cell division. On day five after retrieval, the embryos are now at the blastocyst stage and embryologists look for the healthiest embryos to transfer to the woman’s uterus.

If this example was me, most likely at my age of 27, the two most viable embryos would be selected for transfer. The remaining three embryos would stay in the IVF lab and would continue to be monitored. Let’s say of the three remaining embryos, one stops growing and there are two viable embryos left. Those two embryos would be frozen for a future IVF cycle and considered an added “bonus” to the overall IVF cycle.

Do you see how IVF weeds out the follicles with no eggs, the eggs not capable of normal fertilization and the embryos not capable of producing a viable pregnancy (most likely because of a chromosomal defect that occurred during the very complex fertilization process) in the time span of one month compared to the many more months it would take for a woman’s natural menstrual cycles to do the same?

Playing God? No.

In my own personal infertility case, we believe our ability to do IVF is a gift from God. It is a well-known fact that the largest playing factor in ANY woman’s fertility is her AGE. Throw endometriosis into that mix and that woman’s biological clock is ticking louder than Big Ben because it is also believed that egg quality in a woman who has (or has had) endometriosis declines sooner than a woman who has never had endometriosis. At the age of 27, I am standing in my “window of opportunity” to conceive and give birth to a biological child. That God would put together every necessary detail to proceed with IVF at this particular time in my life is nothing short of a miracle, in and of itself.

We see this IVF cycle as a blessing from God in that IVF will allow me to harvest a number of eggs, and hopefully, at the end of this month end up with at least one viable embryo capable of implanting in my uterus and producing a viable pregnancy.

There is something else that must be taken into consideration when doing IVF. At the end, when it comes to transfer time, it is not so much the number of embryos that you have available to you, but your embryo quality, that is extremely important.

In other words, while I am praying earnestly for “lots of follicles to be retrieved”, in the end our goal is not “lots of embryos in the IVF lab” but “several GOOD QUALITY embryos available for transfer”. I would rather only have two perfect, good quality embryos at transfer time than TEN not-so-good or even poor quality embryos.

The simple fact here is that we need “lots of follicles” to start with in order to increase the odds of weeding out the “bad eggs” and continuing the IVF process with the “good eggs”.

It is not the number of embryos you have at the end of an IVF cycle that matters – it is their viability that makes all the difference in whether the IVF cycle ends in a pregnancy or not.

That and, of course, if God wills to bring another life into the world. Even taking all the meds required for an IVF cycle, harvesting many eggs and paying the big bucks to do the cycle does not guarantee a pregnancy.

In an IVF cycle, God is still the creator and sustainer of life and He will never hand that role over to any medical professional.

*****

Side Note:

Knowing what we know now, apart from a miracle of God, my ovaries are never going to produce enough eggs for my IVF cycle to mirror that of the example I gave above. Dr. L predicts, if we choose to go through IVF ovarian stimulation again, we can expect no more than three follicles to mature.

If even one, two or three follicles mature, are retrieved, fertilized and even produce one viable embryo, we have good odds of a pregnancy.

The thing is, we won’t know the quality of the eggs in the follicles until the follicles are retrieved. Retrieval is one of the most expensive aspects of IVF, which is why we cancelled before retrieval this time. At this point, I can’t justify going to retrieval for one follicle that may or may not have an egg in it!

I know God has placed this deep desire in my heart to be a mother. There is no experience that can possibly compare to pregnancy and childbirth. I was the little girl growing up with pillows constantly shoved up my shirt playing “pregnant” and dreaming of the day I would actually “have a baby in my tummy”.

I think it is pretty obvious that I am willing to fight and do whatever it takes to make this dream become a reality. However, I am surrendered to the fact that my dream may not be God’s marvelous plan and ultimately, I desire His plan, not mine.

Until He says “stop”, I will persevere and claim the promise found in Psalm 37:4.

Delight yourself in the Lord and he will give you the desires of your heart.