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Emotional Investment in Making Babies There’s a truckload of emotion riding on fertility treatment. .FEJDBM 'PSVN spoke to fertility counsellor Cailin Jordan about helping couples ride the rollercoaster. Psychologist Cailin Jordan sees couples at their most vulnerable – their hopes wrapped in fear and uncertainty, Q $BJMJO +PSEBO so how does she prepare them for the fertility treatment journey? “Assessing their expectations of their treatment from the outset is critical. Most couples nowadays know someone who has been through a treatment – one in six couples need some form of assistance – so they have an idea how easy or difficult the journey will be. We’re even seeing couples whose parents have needed some kind of fertility assistance.” However, being informed does not necessarily equate to realistic expectations. “On average people have been trying to conceive 2 ½ years themselves before they seek treatment, so they are usually quite emotionally exhausted by the time we see them. They start treatment hopeful it will work but it depends on a lot of factors.”
“Age is key – the younger the woman the better. Over 40 and success rates decline quite rapidly year on year. So I see a range of people – with older couples it is issues of egg donation, or if it is a male-female issue, embryo donation.”
Psychosocial issues of donation Gamete donation is a deeply emotive and legal issue, which Cailin helps couples navigate. Legislation may differ from state to state and individual practices may have their own guidelines, but whatever the framework, gamete donation carries with it quite charged psychosocial implications for all the parties involved. “At our practice, we only do known donations – where the parties meet one another first … be that for egg, sperm or embryo. There are psychosocial implications for the donor, for the recipient and for any child that may be born now and in the future. People frequently say, ‘I wondered why we had to do this counselling, but now I can see there are so many things we hadn’t considered for all of us’. It is complex but we do prepare patients the best we can.” Cailin said that in WA there was a threemonth legal cooling-off period for egg
Q: “How old is too old for IVF?”
A
I will respond to this very provocative statement as a practitioner, rather than a researcher in the IVF field. Most couples attending a fertility clinic will have tried to conceive for some years. So seeking IVF treatment is not a frivolous decision. Age is a factor in IVF for both men and women but for women, age is even more critical in that it determines the number of eggs available and subsequent embryo quality and pregnancy outcomes. The statistics are quite clear – beyond the age of 35 a woman’s ability to conceive will be limited by the quality and number of eggs she produces. IVF just for ‘women with fallopian tube disorders and severe male infertility’ may have been the immediate objective for some pioneers of IVF but the new process today 20
has a broader application that is obvious to every infertility researcher and practitioner. If we reserved IVF treatment for a very specific group of patients, how would the community respond? Not just infertile couples are involved in decisions about IVF; sometimes potential grandparents are. How would they respond to their adult children being excluded from treatment because they did not meet a specific clinical need? I do not have a simple answer to the question of age but IVF is not the only treatment patients can receive at a fertility clinic. A complete medical is taken, lifestyle issues explored and appropriate investigations undertaken. From this analysis come decisions about the nature of treatment.
and embryo donation and six months for sperm donation. “If everyone is happy at the end of that time, we go through the counselling again just to make sure everyone is certain, then they go ahead.” The issue of expectations is vital here too. “It tends to work best when people’s expectations about any ongoing relationships are compatible because once a child is born it’s really all about the relationships. However, it is true across the board of fertility treatment – realistic expectations help people adjust and cope with changes.”
What is success or failure? When it comes to expectations, Cailin says they can vary enormously but discussing them helps couples examine what they think success and failure is. “I always ask couples what success means to them. For some, it is generating embryos on their first attempt, for others, it’s that and being pregnant at their first attempt; or
Dr Simon Turner, Medical Director of Hollywood Fertility Centre responds. fundamental reason for infertility, which may be exacerbated by work or financial pressures. Being overweight, recreational drugs usage and alcohol consumption are also typical factors discussed ahead of any treatment plan. Singletons are now the norm in assisted reproduction. Improvements in infertility techniques and the associated science means that results are much more reliable and the implantation of more than one embryo is available only in limited circumstances on the express request of the patient. Whilst most practices have firm policies on age limits, it is highly unlikely a woman will deliver beyond their 50th birthday, with or without donor eggs. O
Sometimes lifestyle factors are the issue. Abstinence from sexual contact can be the medicalforum