Everything You Need to Know About IVF – An Expert’s Perspective
This is the first of three interviews we had with her to better convey the IVF journey from an expert’s perspective.
Read our other interviews with Dr. Marion here:
Please introduce yourself! Tell us about your background, your experience, and what issues you commonly treat?
I’m Dr. Marion Valkenburg. I’m a Dutch national but I have been working in Belgium for over 30 years. I did my medical studies and my residency in the Netherlands. I met my American husband and we moved to Belgium. I was actually a medical student when the first IVF was developed.
There was hardly any IVF when I did my residency, but Belgium was always a front leader in the IVF experience so when I decided to work there, I chose a fertility clinic as I thought I might be able to learn some new things. I moved to Antwerp, where I started an egg donation program while working at a fertility clinic there.
Do the people who come to see you already know they want to do IVF?
There is a big variety of people who come to see me. I had recently had a patient who saw specialists in 7 other countries while trying to get pregnant. I also had a patient who did 12 IVF cycles over the course of 9 years. After looking at her uterus, we got her pregnant after the first trial with one embryo.
Because we also look at the uterus, we have had a lot of success. I am convinced that this could be a new approach for the future. The issue is a lot of clinics only have fertility specialists looking at the eggs and the embryos, with no gynecological training.
Who should consider undergoing IVF? Are there any specific requirements, like age etc.?
This is dependent on a few factors. Age, existing health conditions that affect fertility, such as low sperm count and endometriosis, how regular your cycle is, your BMI, your sexual health, or how long you’ve been infertile for.
Defining an infertile period is important. It starts when either an individual or a couple stop using protection, and it is not dependent on the current partner. Other factors might affect this as well, for example, if there are any interruptions, like travel.
Not everyone who is infertile will need to go through IVF. Infertility can be solved first via hormonal treatments, or ovarian drilling, etc.
A couple is believed to be infertile if conception does not happen:
- After one year of unprotected sex
- After 6 months in women over age 35
- If there are known problems causing infertility
IVF is not the only solution.
Every decision made before starting IVF needs to be made in collaboration with the patient.
Some couples do avoid IVF for religious reasons, or for the price. Some people come in asking for IVF when they don’t actually need IVF – they have an ovulation problem, for example, which can be treated with medication.
Others may find that they have endometriosis after undergoing an ultrasound, which needs to be operated on first. If you have a fibroma that is growing in the cavity and bleeding regularly, it needs to be dealt with first as it might not only prevent you from getting pregnant, it might also cause you more discomfort.
If a patient gets pregnant after trying for two years but have had 3 miscarriages, the reason for this should be investigated. Why did this happen? Genetics? Bad luck? Your husband’s sperm quality? DNA fragmentation? Are you just tired? Do you have diabetes? Qualified doctors need to investigate the patients. It’s not always about the sperm and the egg. What is your general health like? What’s your BMI? Are you having sex regularly?
IVF is quite technical. Women that step into the IVF clinic often don’t have much experience with doctors. It’s mostly new to women who have never had children before. Why is one type of hormones used over another? What is the difference between them? All this new information can be overwhelming and scary.
What exactly happens during IVF? Could you give an overview of the different protocols available? How might one choose which protocol to undergo or is this recommended by the doctor?
In Belgium, we see more and more of the antagonist protocols being used. If you have serious endometriosis or adenomyosis, you have the agonist protocol, also known as the ‘freeze all’. Good quality embryos are produced, frozen, and transferred at a later date when the endometriosis is better.
Also, we see more and more that we first do an IVF treatment, freeze the embryos, then treat the uterus, especially when time is of the essence.
Now, the new trend is the antagonist protocol. This can prevent overstimulation, which might lead to liquid in the belly, which can be life-threatening. Women typically produce one egg a month, but if overstimulated, up to 20 to 30 eggs may be produced, which is not ideal and can also lead to discomfort.
How does IVF differ from the other fertility options? How can a patient determine if IVF is right for them?
This is totally dependent on the policy of the country, the doctor you visit, for example. It cannot be said for sure. Sometimes, surgery is a better option, sometimes hormones or insemination is a better option than IVF.
Deciding on IVF has to be made with the couple and the doctor – it’s different for every patient. Unless there is a very clear case of tied tubes or poor sperm, for example, in which case the best option would be ICSI.
What are the most important things someone considering IVF should know before starting the procedure?
Having access to a good quality clinic, your physical distance to that clinic, your financials are important considerations.
It’s also important to know that different people react differently during the treatment. Some people are methodological and view it like buying a fridge. These are the steps that need to be taken, let’s do it. Some are more emotionally invested, face more complications, and have more difficulties.
Some couples or individuals are referred to a psychologist before starting IVF.
Regardless, it’s always extremely important to meet the couple or the individual in person before starting the procedure – medical records and questionnaires are not enough.
An in-person meeting helps to determine the relationship between the couple and their priorities, to raise awareness that personal experiences affect the attitudes and reactions of the individuals. Meeting in-person to go over the couple’s medical history to understand the context of those medical situations is also useful in providing the specialist with the full picture of their health.
One thing you should definitely not do is travel after procedures!
Will there be any big lifestyle changes they will have to make? How can they balance their career after starting IVF?
Apart from the cost of IVF, patients have to be disciplined with their daily medication and doctor’s visits. Starting on IVF will definitely have an effect on their professional life. Work meetings will have to be scheduled around doctor’s visits, for example.
I’ve heard bloating is a very common side effect. What are some common side effects of IVF? How can patients overcome them?
People can get allergies from the medication. This is most serious when rashes appear, and the medication will have to be changed if this occurs.
Nausea should be expected, but this should be mostly manageable. Be sure to avoid sports during the stimulation period as your ovaries will increase in size. They usually are the size of a walnut, but they will become the size of a melon during stimulation, creating a bloated feeling.
Some psychological effects, arising from stress or hormones, may occur. Reduce the amount of stress felt by being assured in your decision making and trusting your doctor and partner. Stress levels can also depend on what kind of partner you have, the stories have you heard from those around you, if you are you anxious to have twins and hence pressured to transfer two embryos, if you have lost a child before, or if you have had a premature baby before, etc.
Many things can influence the levels of stress.
Circumstances around the whole process typically make you moodier than the hormones itself. The burden of finances, of organizing, of remembering to take hormones at the right time, of making appointments, of considering the number of eggs and embryos all cause stress.
But the treatment itself is a routine thing.
Anesthesia is provided. There is much less overstimulation today due to better stimulation protocols and increased doctor experience. For example, in our clinic, we have very good paramedical people. They are very comforting and nice to the patients, providing support, which helps.
What are the key things that a patient should look out for when choosing a doctor/clinic for IVF?
You have to ask, what are the results of the clinic? What is their result of pregnancy per transfer? How many multiple pregnancies do they have? If they have a lot, it means that they transfer a lot of embryos, which is not always good because having twins has its own issues.
I make my patients take a blood test, a sperm test, a hysteroscopy to make things go faster. We basically do one embryo on all the first trials, unless you have only two viable ones. if you’re under 38, we do one embryo. The doctors that give two embryos don’t have to raise the kids, so they don’t see the long-term effects.
Do you have any other advice for people who want to start IVF?
Listen to your friends, go on the Internet for references, make sure the websites you look at are professional. Look at their results, the number of twins they have produced, their ongoing pregnancies per transfer (or baby take-home rate), how many people who start treatment in the clinic have a baby at the end per trial.
Does the clinic take in a younger or older population of women? Having a mostly younger population of patients will have a higher take-home rate.
You also need to be realistic. If you have had a low embryo count and are getting older (42 e.g.), you should look towards alternatives, like egg donation for example, for a much better chance. Ask yourself when it makes sense to go on and when to stop. It’s a difficult choice but you have to set priorities for your treatments and understand that it cannot go on forever.
IVF is science. Success is basically determined by the quality of your embryo, the quality of your uterus, and your age.
If you’re 43, go for egg donations.
If you’re 28 and you have an issue with your husband’s sperm, try IUI before spending all this money on IVF.
If you have a fibroma and have a lot of bleeding, first remove the fibroma. If you’re 32, you might be able to get pregnant spontaneously after trying this.
How do you think patients can best cope with undergoing IVF, be it physically or mentally?
Confront and understand the risk factors that come with pregnancy and brace yourself. Although the risk of something happening is low, nothing is guaranteed. Trust in and listen to the advice your doctor gives.
Do you have any particularly memorable experiences that you’ve had with couples undergoing IVF that you think could be inspirational to others who would like to try it as well?
We had a patient that had 6 eggs at age 40. The clinic she went to in Holland said it wasn’t enough to do an IVF, but she came to us and she got pregnant from a frozen egg.
I had a 39-year-old patient who came to see me before COVID. She tried IVF thrice in Holland, but she had a big fibroma. I told her to get the fibroma removed or it might cause problems when she got pregnant. Her husband was smoking so I told him to stop or she wouldn’t get pregnant. She was also 10 kilos overweight. She had an IVF just before COVID, with zero embryos. I told them to try spontaneously after fixing these issues and now, she’s pregnant. He stopped smoking, she lost the weight, and we removed the fibroma. She didn’t actually need IVF. Nature was actually better when we changed the circumstances.
I saw another rather young lady who had an ectopic and a T-shaped uterus. Her insurance didn’t want to subsidize the cost of the treatment because of her age. She underwent surgery to correct the shape of her uterus and she got pregnant within the first IVF trial. The magic is not only in the embryos, as there are healthy embryos everywhere in the world, but also the uterus, especially for older women.
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