How IVF Drugs Work

Last week we talked about follicular developement and how it can take up to 8 menstrual cycles for the follicle to completely develop into a dominant follicle that contains the egg that is released in a menstrual cycle. And that the last 3 months (over 85 days) sees the follicle going from secondary to primary and then one becomes the dominant follicle. Phew! That’s a lot of development going on.

Remember that each month a woman creates several follicles on each ovary and one of these eventually turns into the dominant follicle and let’s her sister follicles know that she is the one that is going to release the egg that month. So the other follicles go through a process called atresia which basically means they get reabsorbed into the ovary because your body or Mother Nature may not have thought they were going to make it.

Have you ever wondered then when they administer fertility drugs why there are many times multiple follicles and eggs?

Before I answer this question, I do want to make it very clear that we are not against IVF. We support our patients no matter what their decision is and we also want them to make that decision based on all of the information available, not because they are afraid or feel they are being pushed into something.

So back to how all those eggs are available for IVF. Its because the medications stop the atresia (reabsorption of the follicles back into the ovary) from happening. So all of the follicles that wouldn’t have developed into the dominant follicle that month do not undergo atresia but develop further into follicles because of the high dose meds. And some of these follicles have eggs in them which they can then harvest for the procedure. The Pacific Fertility CLinic in the States describes the process this way.

In a natural cycle,  “Those eggs which are not selected for that month undergo a natural cell death process called atresia. Fertility medications override the body’s selection process, and cause many of these “rescued” eggs to grow (hopefully between 10-20 eggs). These eggs would otherwise undergo atresia. Therefore, you are not “using up eggs faster” by undergoing ovulation induction, but are “rescuing” eggs to use in that cycle, which otherwise would have expired”

I like the way they use the words “rescuing the eggs” like they were in some kind of danger before 

So some of these eggs weren’t going to make it to become the dominant follicle and therefore the body may have thought they weren’t able to produce a viable pregnancy or maybe they just weren’t developing as quickly as the other follicle that became dominant. This process is likely of the reasons that every egg that a woman creates with IVF doesn’t create a viable pregnancy. And it may also be one of the reasons that birth defect rates are slightly higher in IVF births than with spontaneous pregnancies.

November 2005 issue of Fertility and Sterility: Dr Klemetti and colleagues reported from the Univ of Oulu, Finland. This study looked at approximately 4,500 children conceived from IVF, 4,500 from other fertility treatments and 27,000 normally conceived. The major birth defect rate from IVF was 4.27% compared to 3.52% from other fertility treatment and 2.85% from spontaneous conception.

Is this study a reason to not undergo IVF. For some maybe but for most, even with this increase there is still only a very small percentage of a chance that a child will be born with a birth defect. But I still think this is even more evidence that is important to get your body as healthy as possible before going into IVF or becoming pregnant naturally as well.

OK, so really why am I sharing this information with you? 2 reasons…

1) Hopefully when you realise this you can go into IVF more emotionally balanced and stop blaming yourself for the procedures that don’t work. It may be those eggs aren’t healthy cuz they weren’t ever going to be and your body/Mother Nature knew this and was going to let them get reabsorbed if the drugs hadn’t intervened. Some of my patients have called IVF a numbers game for this very reason and I believe if you know this going in that hopefully you won’t blame yourself after each procedure and will go in with a more balanced attitude still focusing on creating a viable pregnancy but not getting yourself so high that if the procedure doesn’t work, you come crashing down.

2) Other patients of mine have likened IVF to gambling. They have compared it to you putting a lot of money into playing Black Jack at the Casino, you could spend a lot or a little time there and still walk away empty handed. I think the fertility issues that you are dealing with are much more personal than gambling. And one advantage they have over gambling is there are many things that you can do to influence the outcome.

We see so many women and men who after being in our program have shown better quality eggs, sperm, and embryos with IVF. BOth they and their doctors are pleasantly surprised many times. Do I think its just the herbs? I actually believe there are many factors that help to create this improvement and the good news is when you are with a group of professionals including naturopaths and physicians that understand the fertility process you can learn how to hopefully improve your chances by becoming as healthy as possible going in.

Remember the quantity of eggs doesn’t guarantee the quality. I have couples who have gone through 18 cycles of IVF before seeing us, producing lots of eggs but no pregnancy. And recently I have had one couple that had been trying for a baby for 13 years that produced 1 egg with IVF and after being in our program for 18 months this was their last attempt. I just spoke to them and in the last month a beautiful baby boy came into their lives. This was the result of the one egg produced with IVF (and the sperm helped too, I suppose!) and it was her own egg. So again, quantity does not guarantee quality.

I do see so many women that are going through cycle after cycle without a break. And when I tell them it might be a good idea to take a break they look at me as if I had three heads. Its almost as if these women are addicted to having cycle after cycle because of the fear that “what if I stop” what will happen?” “COuld that have been the one and I missed it?” All of this I believe is working against them and not helping them produce a viable pregnancy.

So I hope that since you are now armed with this information about how your follicles develop and what happens through the natural cycle each month and with IVF that you when you make your decisions you feel good about them and be confident with whatever decisions you and your spouse make about your situation.

Find out what you can do to make your next procedure less like gambling and more about doing whatever you can do to improve the chances that the follicles and eggs produced are as healthy as they could be.