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"Look what I've done to myself... I am 47 years old. What was I thinking?"

When you’re over the age of 40 and trying IVF, what are your chances of getting pregnant?

 

 

Janine, like all the women interviewed for this article, insists her real name not be used. As she pulls up her shirt to show the red marks like shotgun shrapnel that angrily speckle her abdomen, she attempts to explain why.

“Look what I’ve done to myself,” she says, incredulous at the sight of the hundreds of needle marks from almost a year of injecting herself with growth hormones as part of her numerous attempts at IVF.

“I am 47 years old. What was I thinking? That’s the problem really, I don’t think I was in the end. I was like a gambler or a junkie that didn’t see anything or anyone but what they wanted. Only, for me, it wasn’t a hit or a drink, it was a baby.”

You don’t read a lot of stories like Janine’s on the many fertility-over-40 websites and forums on the net. Sure, there are the cries of desperation, heart-breaking stories of unsuccessful attempts to conceive both naturally and with medical help, and the singular focus if-I-don’t-have-a child-I won’t-have-a-reason-to-live alarms.

However, stories that, like Janine’s, don’t have happy endings? They’re just too depressing and something women still trying to conceive a much-wanted baby just don’t want to hear – her 14 unsuccessful IVF attempts in under 18 months, most of which she kept a secret from her family, friends and even, towards the end, her own husband.

Her rapid plunge into depression and contemplations of suicide each time another chance at motherhood was dashed by the onset of her period, aided and abetted by rapid weight gain, dramatic mood swings and the realisation even more thousands of dollars were lost along with her dream.

Instead, older women with their eyes still on the prize of motherhood prefer to hear the stories of hope, luck and success: the woman in Russia who had a child at 62; the Hollywood celebrity who gave birth to twins at 46; the woman on a blog who said she had given up hope but then, after that last try at IVF, gave birth to the healthy child…

What also seems to be ignored by Janine and other women over 40 undergoing numerous attempts at IVF are the statistics which, despite the remarkable advances in Assisted Reproductive Technology (ART), are as irrefutable as they are dismal – around a 10-15 success rate per cent per cycle for those aged between 40-43, 1-2 per cent between the 44 and 45 and just a fraction of a per cent beyond 45.

IVF over 40

Yet, when Janine’s doctor outlined her chances of conceiving when she first signed up for IVF, she wasn’t listening either. For once Janine, who runs her own accountancy firm, refused to listen to the numbers.

“I was tra la la la la, I can’t hear you,” Janine says, her fingers firmly implanted in her ears.

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“As long as there was any chance, I was going to grab it. As long as I read about someone – anyone – my age and over having a baby, I felt I was in with a chance too.”

“I would have been better off putting all that money into Lotto. The chances would probably have been better in hindsight.”

Melinda, 41, also says she refused to think of herself as a statistic. “I honestly thought I would be the lucky percentage,” the Melbourne-based lawyer says. “I probably still thought it would happen even after my third try. Now, I am approaching my fifth it’s harder to stay upbeat about my chances.”

So, with the likelihood of conceiving and carrying a baby to full term as low as it is and the financial and emotional costs so high, why are so many women still buying a lottery ticket in a draw they have little to no chance of winning?

The answer, is that no one, it seems, is about to stop them. According to Associate Professor Peter Illingworth, (who did not treat the women interviewed), Medical Director at IVF Australia, doctors are only required to point out the statistics and allow women to make up their own minds. In other words, if a woman is willing to pay up, there are doctors out there ready and willing to take their money.

“The first thing that should be acknowledges here is that the decision to go through treatment in her 40s is very, very difficult indeed. The prospects are extraordinary low and it’s responsible for a doctor to point this out,” Dr Illingworth, who is also a member of IVF Australia’s Ethics Committee, says.

“Some doctors refuse point blank, while there are others who will very readily treat women that age. Personally, when I see a woman of 45 whose success is very, very low, compounded by the fact IVF is a difficult and emotionally demanding experience, those factors alone would lead me to advise her not to attempt IVF that age.”

However, Dr Illingworth does not condemn the number of doctors who will treat patients with large hopes and little chance, having witnessed the sheer desperation in childless couples on a daily basis.

“We doctors are all very conscious that the couples who come to see us are wanting something very much,” he stresses.

“I was like a gambler or a junkie that didn’t see anything or anyone but what they wanted. Only, for me, it wasn’t a hit or a drink, it was a baby.”

“We look at every angle we can to give them their goal of having a baby and will do everything we can to make that possible. For some doctors, that could mean giving IVF another try despite the statistics as there is no actual legal limit to the amount of IVF attempts a woman can undergo.”

“But frankly, the vast amount of women I see will give IVF a few tries and if it doesn’t work, then they draw a line and walk away. Not many doctors would put a woman of 45 through 10 cycles or more but I guess it does happen.”

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Dr Illingworth is aware that for many women undergoing IVF, especially later in life, it is a matter of them recognising they tried everything possible for a child of their own – even swapping doctors, multiple procedures and alternative therapies such as naturopathy and acupuncture – that is the goal.

“Women want and need to make sure they did everything possible, to be able to say, at least I tried,” he explains.

“We do see women that make choices that seem to us as irrational [considering the extremely low chance of success at IVF] but it is not up to us to say, ‘no you can’t’. If, despite our advice, they decide to try anyway, we would strongly stress counselling however.”

Today, it is compulsory for counselling to be offered to every woman undergoing IVF in Australia; however, it is not mandatory that patients accept (except in Victoria, where counselling is compulsory).

In Janine’s case, she managed to avoid speaking to anyone about her dark thoughts, the concealment she was undergoing more cycles than she agreed upon with her husband, and her overriding obsession with failure she experienced with all 14 attempts.

“Oh, they’d ask me,” she says dismissively of offers of counselling. “All I did was say, ‘no thanks’ and the next thing you know I’m back on the table having my eggs extracted. Looking back, I wasn’t really sane at the time. I think I was quite mad really – what with all the hormones I was taking. But once I said no to counselling, that was the last I’d hear of it until the next month when I’d refuse it again.”

Melinda, on the other hand, did accept counselling but was careful about what she said.

“I did listen to the counsellor but in the back of my mind, all I kept thinking is that I had to be careful about what I said. The last thing I wanted was my counsellor to advise my doctor not to treat me.”

Perhaps even more alarming is the fact Janine often didn’t even wait a cycle between the attempts, something Dr Illingsworth says he “strongly advises” patients against. “My medical opinion is to take a break between a cycle and not undergo back to back stimulation,” he stresses. “There are two reasons for this – a woman can get hormonal problems without a break and it also gives women time to draw breath emotionally.”

“As long as there was any chance, I was going to grab it.”

However, Janine says she managed to negotiate her way around this recommendation as well. “I just wanted to try again straight away and so I did,” she admits. “I couldn’t allow myself a month to recover. All I kept thinking was my eggs were getting older every day so no time could be lost.”

Melinda agrees that the age of her eggs became an overriding issue to her own emotional and physical health. “Everything about IVF was so full-on. I just wanted it over with. I just wanted a child and, with constant talk about the age of my eggs, I wasn’t going to waste a month just thinking about a baby again. I wanted to be doing something about getting one.”

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Today, Janine says she has given up on IVF and, instead, is looking at fostering (she has learnt she is too old now to adopt) as a means to fill what she describes as maternal void in her soul.

Meanwhile, Melinda is forging ahead with “just one more round” – again.

“A woman I met at my clinic is pregnant and she’s a year older than me,” she says. “It’s so hard to see it happen to someone else and not you. I can’t walk away from this thinking, ‘if I had only given it one more try’.  But then again, I am aware that there are only so many ‘one more tries’ I can go through.”

This is a situation Linda, now 43, can relate to. Even though she has a six-month old son she is “besotted with” through IVF, the Melbourne IT consultant recalls the enticing siren call of just “one more try”.

“I look back at what I went through and wonder how I ever got through it now,” Linda says.

“My son is the greatest gift but not enough to stop me forgetting what an ordeal the whole thing was. The sad thing was I felt I couldn’t tell my friends what I was going through. I just didn’t want to hear their concern. I think it would have made it too hard for me to continue as they would have told me to give it up or, at least, give it a break. So, my husband had to endure all the tears. And there were a lot.”

Linda glances down at the cherubic face of her baby boy and reflects. “We would ideally love another child, but not enough to go through that trauma again,” she admits.

IVF over 40

“I figure I am one of the lucky ones. Asking for another would be pushing that luck. And honestly, I don’t think my husband could cope. It’s especially hard for men I think. They want so much to help but there is nothing they can do.”

“Looking back, it is all so sad really,” Janine reflects on the toll IVF took on her relatively new relationship. “I had always wanted a partner and when I found John at 43, that should have been a wonderful time to savour but it was all eclipsed by my desire to become a mother. We swore when we started we would give it one go, two maximum,” she admits.

“Instead of accepting I couldn’t have children, IVF just kept dangling a carrot in front of me saying ‘there is still a tiny glimmer of hope, come and get it!”

It is a carrot that many more women like Janine and Melinda will no doubt don blinkers in hope of a bite of yet.

IVF in Australia – the cost

In a report published in the journal Human Reproduction, Australian researchers showed that ART costs in Australia more than doubled in the period from 2000 to 2005, from $66.3 million to $156.1 million.

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From 2002 to 20003 alone, there was a 16 per cent increase is the use of ART amongst Australians compared to 13 per cent in Europe and 6.5 per cent in American.

The report also showed that the price per baby as the result of IVF ranged from $27,373 to $39,986 for women aged between 30 and 33 on their first and third attempts at IVF to $130,951 to $187,515 for a 42 to 45 year-old women on their first and second IVF attempts.

Regardless of the high costs involved, currently the Australian government has no plans to change its Medicare subsidy for the procedure or, to limit the amount of cycles a woman can undergo regardless of age.

IVF and Counselling – the legal ethics

The Federal Government provides clear guidelines to all doctors performing ART such as IVF in Australia in regards to counselling:

The Act states:

ART involves complex decision-making and participants may find it an emotional and stressful experience. Clinics must provide readily accessible services from accredited counsellors to support participants in making decisions about their treatment, before, during, and after the procedures.

Clinics should therefore provide counselling services, with professionals who have appropriate training, skills, experience and accreditation necessary for their counselling role.

The counselling services should:

– Provide an opportunity to discuss and explore issues

– Explore the personal and social implications for the persons born and for the participants

– Provide personal and emotional support for participants, including help in dealing with unfavourable results

– Provide advice about additional services and support networks

– Reflect an integrated, multidisciplinary approach, including medical, nursing, scientific and counselling staff

– Provide participants with information, when requested, about professional counsellors who are independent of the clinic

So, how come women older women in Hollywood are having babies?

“Women very, very rarely fall pregnant for the first time using their own eggs over the age of 45 – it is an extraordinarily rare thing to happen,” says Dr Illingsworth. “When people read of 45-year-old women having babies for the first time – particularly multiple births – almost certainly there are donor eggs involved.”

Weight gain, depression, mood swings and other side effects.

While some women claim to put on up to two kilos per cycle on INF, Dr Illingsworth points out that for the majority, this weight is a build-up of fluid which will dissipate over the following weeks. However, with IVF procedures using growth hormones for example, the weight will be harder to lose.

As for depression, he sees the question as a case of what comes first, the chicken or the egg. Often, a lot of women who want children are possibly depressed by the fact it hasn’t happened so far.

“The sort of depression which psychiatrists collect data on is severe mental illness and that’s not really what were talking about here,” he says. “Were talking about normal stress reactions to a very tough situation so it’s hard to monitor.”

This “tough situation” is what he describes as “the emotional rollercoaster” of IVF, which sees the contrasting extremes of hope and anticipation followed by distress and loss. This results is mood swings which, he explains, “nobody knows whether consequence of hormones or just the extreme stress of the situation.”

Have you or someone close to you tried IVF? What was your experience?

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