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Are ‘infertile’ women rushing to IVF too quickly?
New research shows one in five women with unexplained infertility go on to conceive naturally after IVF
When Alice Rose’s son was 15 months old and her waist began to expand, she didn’t think for one moment that she might be pregnant: both her children had been conceived by IVF. “I wasn’t feeling like myself; I was bloated and gaining weight, which was getting me down,” she says. “I took a pregnancy test: when the two pink lines came up it was a huge shock.”
Doctors had told Alice that, because wasn’t able to ovulate, she couldn’t get pregnant naturally. But here Alice she was, eight weeks along, at the age 39. This seemed like a miracle, given the lengths she’d gone to conceive in her two previous pregnancies, including uterine fibroid surgery, four rounds of IUI and the two IVF cycles.
Yet Alice’s experience is far from unique; according to a new study by University College London (UCL) 20 per cent of women go on to conceive naturally after having a baby through IVF, mostly within three years.
“We need to challenge the perception that this is rare – it really isn’t,” says Dr Annette Thwaites, from University College London, whose research was published in the journal Human Reproduction. “We don’t know exactly why surprise pregnancies after IVF are so common but there are various theories.”
Infertility is defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse. Around one in seven couples in the UK have difficulty conceiving and every year more than 55,000 turn to IVF, which was first introduced in 1978 and has led to the births of more than 10 million babies worldwide.
IVF was originally developed to help couples unable to conceive naturally due to fallopian tube disorder or poor semen quality, preventing sperm from reaching an egg. Now, though, many IVF patients are “subfertile” rather than permanently infertile. Conception is not impossible for these couples, although they have a lower chance of conceiving due to conditions including mild sperm deficiencies, ovulatory dysfunction or damaged or blocked fallopian tubes or, in the case of “unexplained subfertility”, no cause has ever been found.
Some GPs believe that “rusty gate syndrome” could account for why some women go on to conceive naturally after a baby via IVF; once the body has been pregnant once it finds it easier a second time. “There is evidence that pregnancy can induce hormonal changes; for example some women suffer less from endometriosis once they’ve given birth,” says Thwaites. It could also be down to IVF drugs leaving them “hyper fertile”. “It is biologically plausible that ovarian stimulation from IVF cycles may improve ovarian function. The most common overall cause of female infertility is the failure to ovulate, which occurs in 40 per cent of women with infertility issues.”
Lifestyle factors could also make a difference: couples eat more healthily, sleep more and give up alcohol, caffeine and smoking during IVF cycles. “Studies show that improved lifestyle habits can enhance egg and semen quality,” Thwaites says. And while it’s difficult to measure the effect of stress on fertility, several studies have found links between women’s stress and lowered chances of conception. Hence, it could be that once they’ve had one baby, they feel less stressed.
Or perhaps they just needed to give it more time.
According to the Human Fertilisation and Embryology Authority (HFEA), about 95 per cent of women aged 35 who have regular unprotected sexual intercourse will get pregnant after three years of trying. “Sometimes we might intervene too early,” agrees Marta Jansa Perez, director of embryology at the Bridge Clinic in London. “Statistics show that for women we start treating after one year of trying, 50 per cent will fall pregnant naturally if they keep trying.”
The dangers of false hope
Alice Rose, 40, who works as a fertility counsellor (fertilityliferaft.com), puts her natural pregnancy down to “luck and magic”. She made all the recommended holistic changes to her lifestyle before and during IVF, yet she does not believe they led to her natural pregnancy as at the time she was stressed and exhausted with two young children and had long given up her healthy preconception lifestyle.
Rose does note, however, that her body changed physiologically after she’d had her first IVF baby: she began to get regular periods, something she’d never experienced before. She thus tried to conceive her second baby naturally for 12 months although this didn’t result in a pregnancy, and she conceived her son through a second round of IVF.
“I laughed when afterwards the health visitor asked me about contraception – we’d been having unprotected sex with no pregnancy for years,” she says. “As a fertility counsellor, supporting couples through fertility issues, my surprise natural pregnancy put me in a strange situation. Suddenly I was going to be someone with three children, one natural – I was happy about it but it was a big shock that threw everything out the window for a while.”
While Rose’s surprise pregnancy could be seen as a beacon of hope for those trying to conceive, she warns of the nuances of the UCL findings. For many IVF couples, natural conception is an impossibility due to issues such as the woman having no fallopian tubes or the man suffering from non obstructive azoospermia, an absence of sperm.
Their only option is IVF, and while success rates are improving across all age groups, according to a recent study by the HFEA, the chances of success are still relatively low: around 32 per cent live births for women under 35 per round of treatment, according to the NHS, decreasing to 4 per cent for those aged over 44. “This is why telling women to ‘relax and it’ll happen’ is very unhelpful,” Rose says. “When people said that to me I just wanted to scream.”
Still, the findings could suggest that some subfertile couples are rushing into IVF. Many of Rose’s social-media followers say they feel frustrated by the lack of fertility tests available on the NHS, particularly for men, with IVF seen as a one-size-fits all solution for unexplained infertility, when in some cases it is using “a sledgehammer to crack a walnut”.
While Perez encourages couples to explore all options, she insists the results of the study don’t suggest delaying IVF. “There is no evidence at all to say that if you relax and go on holiday it will happen,” she says. “People get anxious and desperate and you’ve got to remember that 50 per cent won’t get pregnant naturally if they keep trying – no one has a crystal ball. I’d always advise people to prioritise their mental health and wellbeing and take control if that’s what feels right.”
Since the likelihood of IVF being successful diminishes with age, clinics encourage couples to start treatment as soon as possible. Sarah Blakelock, 42, who got pregnant spontaneously while on a holiday following two failed IVF cycles, says IVF helped her take control of her fertility at a time when she felt powerless.
“Who knows why I eventually got pregnant: it could have been that I let my hair down and stopped thinking about getting pregnant or that my body suddenly worked out how to get pregnant, or it could have been that I’d been living very cleanly or that the IVF drugs regulated my cycle,” she says. “IVF isn’t for the fainthearted but I don’t regret it: I felt I had to do something.”
The need for contraceptive advice
What worries Thwaites about the findings of the UCL study is that IVF couples aren’t receiving adequate contraceptive advice. She was inspired to carry out the research while working as a clinical doctor specialising in contraception at UCLH where women who’d conceived by IVF weren’t typically offered contraceptive counselling. “I remember being told by the nurses not to go into the side rooms as the patients there have had IVF and thus don’t need contraception,” she says.
A surprise pregnancy can be extremely challenging both physically and psychologically; many IVF women are older, they might have conceived twins and they know that the World Health Organization recommends a two-year gap between babies. Some also worry that they haven’t done the same preconception care that they did for their IVF baby, Thwaites says. Of the 22 IVF women she spoke to during her research, four considered terminating their natural pregnancy and one went through with an abortion. “Their family was complete in their eyes,” Thwaites maintains.
It’s difficult to talk about contraception to a woman who has chosen IVF after failing to conceive naturally, though, Rose points out. “People did say to me ‘it might happen’ and when they did I just wanted to scream ‘no it won’t’ because I’d tried for a whole year to conceive naturally after my first round of IVF and I ended up having IVF again. You feel defensive when you’ve been on a fertility journey and I think health professionals should be aware of this and deliver contraceptive advice accordingly,” she says.
Kirsten Pearton, 42, a mother of IVF twins who found herself pregnant again naturally 18 months after giving birth, contemplated termination. “I laughed when the health visitor tried to talk to me about contraception after so many years of trying for a baby but then I started feeling sick,” she says. “I was 39 at the time with a full-time job and 18- month-old twins. Ultimately I decided to keep the baby, but I did think ‘how the hell am I going to manage this?’,” she says.
Future research
Thwaites hopes that her study will inspire further research into natural conception post-IVF; it would be useful for women to know what their individual chances/ risks of conceiving are, she says. “I’d like to see a breakdown of different causes of infertility and how many in each category go on to conceive naturally post-IVF rather than putting them all in the same group,” agrees Perez.
Not only would this research help fertility doctors to tailor their treatment, but it would enable women to make a more informed judgment when it comes to contraception. “We have to be cautious about how we interpret the results as many couples do everything they can and still don’t get pregnant, but any new information we can get on fertility is always positive,” agrees Rose. “The more we know, the more couples can be supported on their fertility journeys.”