Fertility treatments that use high doses of hormones may be more effective in helping women become pregnant than lower-dose options. But do they also come with more risks? A recent New York Times article examining why in-vitro fertilization (IVF) clinics in the United States continue to use high-dose hormones, when IVF specialists in Europe and Japan have all but abandoned the practice, raises an important question: How willing are you to take a few chances with your health if it means pregnancy and a baby?
Debra Demidon, of Cayuga, New York, tells the Times that she thought she was willing to do anything to make IVF work. But when two days after her initial round, she gained more than 30 pounds in fluid and suddenly struggled to breathe, Demidon quickly realized that fertility treatments that rely on high doses of hormones—though in general considered safe—can lead to side effects in a small number of women. And she was one of them.
What the 28-year-old had developed is known as severe ovarian hyperstimulation syndrome (OHSS), a complication that affects approximately 10 percent of IVF patients using high-dose hormone IVF, still commonly practiced in the US and UK, according to the National Institutes of Health. OHSS landed Demidon in the hospital for five days. She ultimately missed three weeks of work, and by the time it was over, she and her husband had spent all of their savings.
"It was my first time doing IVF, and I'll never do it again," Demindon confirms. "It was awful."
Could this have been avoided? Some fertility experts say yes—if Demidon had made the request to use low-dose hormones as part of her treatment. The main difference is in the number of eggs stimulated during IVF. Women normally generate one egg per cycle, but high-dose stimulation can help women produce 20 to 30 eggs, or even more. By contrast, women receiving low-dose IVF produce eight to 10 eggs. Used throughout Europe and in Japan, low-dose IVF does not appear to carry the same level of health risks as high-dose stimulation—including the risk for OHSS.
Dr. Pasquale Patrizio, a professor of obstetrics and gynecology at Yale University and director of the Yale Fertility Center, tells the Times that he now recommends low-dose IVF to his patients—and has seen good results. "It's a shift of minds in the last few years, as we've been realizing that there's no need to stimulate ovaries so aggressively as we've done before."
But other experts say that because mild, low-dose hormones produces fewer eggs, women have lower pregnancy rates per IVF cycle. This means that it could take more IVF cycles before a woman conceives. And though the cost of lower-dose IVF runs as much as one-third lower than the cost of standard high-dose IVF, more cycles still means more time, something that may exclude many couples from their goal of getting pregnant.
"More eggs equals more embryos and a better chance of pregnancy—and standard IVF produces more eggs," Dr. William E. Gibbons, another expert interviewed in the Times piece and the director of the division of reproductive medicine at Baylor College of Medicine, names as the reason he still supports standard (high-dose) IVF.
What's the reaction from women who used or are just now considering IVF? Like the experts, they seem split on the issue.
"I'm 40, so my doctor says to stick with standard [high-dose] IVF because of the better success rate per cycle. I am well aware of the potential side effects, but remember if 10 percent of women encounter the side effect, that means that 90 percent won't. I'll take those odds," says Marilyn Highland of Santa Fe, New Mexico.
But mom Mary Martin, 34, of Boston, Massachusetts, who underwent high-dose IVF in 2010 and had a bouncing baby girl by early 2011, thinks women should at least be presented with the choice. "If I had to do it all over again, I definitely would want to know more about lower doses of hormones. I don't know if it would have changed my mind though. I just wanted a baby really, really badly—and I got her! So it all worked out."
So, slow and steady wins the race—or is a greater risk for side effects a risk you're willing to take?