I have undergone numerous IVF cycles. It is a heart-wrenching experience. Infertility is a pain that is difficult to describe unless personally experienced. I have never truly known heartbreak until the failure of IVF embryo transfers. Three preimplantation genetically tested normal embryos failed to implant, and knowing my three perfect embabies (embryos that were transferred but not implanted) will not be in my arms still hurt my heart. It took two egg retrievals and two embryo transfers for my daughter and another two egg retrievals and two embryo transfers for my son. I consider myself blessed to have two children. We have more embryos for a possible third baby. I attribute our children to God’s grace, capable reproductive endocrinologists, self-advocacy, and education.
Infertility is on the rise in the U.S. Almost 20 percent of couples are unable to conceive after one year of unprotected sex, and 33 percent of Americans have undergone fertility treatments or know someone who has. The number looks worse for female physicians. In a study by Rangel et al. in 2021, one in 4 female physicians struggle with infertility, twice as the general public. The average age of first pregnancy among female physicians is 32 years; for non-physicians, it is 27 years. In a survey of 692 female surgeons in 2021, forty percent had suffered a pregnancy loss, twice the general public’s rate. I have known many physicians who have gone through IVF. Based on CDC ART data in 2019, 2.2 percent of babies born that year were via IVF.
People who have not experienced infertility often assume IVF has high success. The truth cannot be further from this assumption. IVF does not guarantee live birth. Based on 2019 CDC data, among women younger than 35 years, an average of two egg retrievals are needed per live birth; for women 35 to 37 years of age, the number retrieval goes up to 2.6; for women 38 to 40, it is 4.1 retrievals per live birth, and among women older than 40, it is 12.6 egg retrievals per live birth!
I think part of the reason for many cycles of IVF among women over 35 is insufficient patient education and lack of standard of care in the field of reproductive endocrinology compared to other medical fields, say my field of urology. In urology, a patient who comes to two different physicians will likely get the same treatment plan. For example, suppose a patient comes in with prostate cancer. In that case, his urologist will be able to tell him, based on the nomogram of past patients’ data, his risk of lymph node metastasis or invasion into neighboring structures along with his chance of cure from surgery in five and ten years. Suppose a patient comes in with a kidney mass. In that case, his or her urologist will be able to tell the patient, based on nephrometry score, the likelihood the mass is aggressive cancer and the likelihood of partial instead of radical nephrectomy.
However, a couple with infertility consults with two reproductive endocrinologists would likely get two different follicle stimulation protocols and two different embryo transfer protocols. During my infertility journey, especially for my second child, born at 43 years old, I consulted with several top IVF clinics in the country, including HFI-Aspire, CNY, Kofina Fertility, CCRM, New Hope Fertility, Life IVF, and Dallas Fertility Center. I received very different follicle stimulation protocols from each physician. Of note, this is after I informed them of the data of my past IVF cycles.
Self-education and advocacy are essential in IVF, especially in women with advanced maternal age. In addition to physician consultations, I have watched numerous YouTube videos by numerous reproductive endocrinologists, such as Dr. Geoffrey Sher and Dr. Norbert Gleicher, among others. I have also joined multiple IVF groups on Facebook and Reddit. The information I learned allowed me to discuss it with my treating physician, and together we developed more individualized follicle stimulation and transfer protocol with which I can feel confident.
It must also be difficult for reproductive endocrinologists to deal with many failures and disappointments among their patients. As physicians, we want our patients to be happy with our treatments. After several years of treating infertile couples, I wonder if some REIs may become numb and jaded toward their patients’ failures. I have unfortunately witnessed this.
I have learned a lot during my infertility journey, which led to my passion for treating my male patients with infertility and educating their partners. I have written and published a book documenting my journey and what I have learned during my struggles. It is called IVF Diaries: A Female Urologist Infertility Journey. The book contains information I have learned along my journey, including timing for hysteroscopy, endometrial scratch and other tests, supplements and diet changes needed to increase the chance of success, the timing of ejaculation before egg retrieval and fertilization, how different clinics differ in their embryology lab procedures, among other principles and pearls to increase IVF success. I hope this book can help other women avoid some of the mistakes I have made and provide much-needed patient education and encouragement in the field of IVF.
Lei Chu is a urologist.