Since everyone knows that IVF is the most effective way of treating infertility, why are so many infertile couples still so wary of going in for IVF?

Some couples worry that a test tube baby is "weak" or abnormal (and others still believe that the child is grown in a test tube for 9 months and then handed over to the parents!). Fortunately, with increasing awareness, many couples now know that there is nothing "artificial" about a test tube baby. IVF is simply one of the assisted reproductive techniques, which merely allows the doctor to perform in the lab what is not occurring naturally in the bedroom. Multiple studies, done over many years, have come to the reassuring conclusion that the risk of birth defects is not increased after IVF. However, the lack of knowledge about the facts behind IVF is still a problem in smaller towns in India.

In many Indian families, decisions about what treatment to take are still taken by elders, rather than the couple themselves. Many older relatives still think of IVF as "unnatural or abnormal, and are therefore "against it".

A major concern many women have is about the adverse effects of the hormonal injections which they need to take for IVF. We need to remember that these hormones are "natural hormones" - the same hormones which the body produces normally. Some worry that the hormones will cause them to become fat, but it's important to realize that they have no long-term effects, once they get metabolized by the body; while others are concerned that the injections will cause them to "run out of eggs" as a result of which their fertility will decline even faster, or they may become menopausal sooner. Another worry was the fear that the injections would increase the risk of ovarian cancer, but fortunately, many studies have proven that this was unfounded.

A major mind-block is the fear that if IVF fails, then they will have no further treatment option left to explore. Patients know that IVF is the treatment of "final resort" - and many prefer keeping it "in reserve". The unexpressed fear is - if it fails, what next?

For some, just the fact that the doctor advises IVF itself is a major blow - this forces them to confront the fact that they have a "serious" problem which needs advanced treatment. Many infertile couples still continue to delude themselves that they have a "minor" problem which is "easy to solve" - and does not require "big-gun" therapy.

For others, just the fact that IVF is available helps to reassure them that there is additional treatment they can fall back on - and they prefer keeping it as a "reserve" option.

For a majority of couples, the major limiting factor is the expense. IVF is still extremely expensive, and beyond the reach of most average couples. Once insurance companies start covering medical expenses for infertility, hopefully, this will no longer be a major hurdle. IVF programs which offer money back (risk sharing programs) in case of failure are another innovative approach to helping patients to cope with the financial burden of IVF.

For others, the stress involved in going through an IVF cycle is a major deterrent.

While they have learnt to live with the ups and downs of a normal menstrual cycle, they feel they will not be able to cope with the anxiety and uncertainty associated with an IVF cycle - especially since so much rides on the outcome. The fact that neither they nor their doctors can completely influence the outcome also puts them off.

However, there are major dangers associated with putting off IVF. As with everything else, there is a "right time" for everything, including IVF!

If patients wait too long, their chances of getting pregnant decline as they age - and this decline can be very precipitate after the age of 38. Others get so fed up and frustrated with simpler treatments such as IUI, that they lose confidence in themselves and in their doctors, so that they are no longer willing to attempt IVF. Many will run out of money pursuing cheaper but ineffective treatments.

A practice common to many gynecologists is to repeat IUI (intrauterine insemination) cycles ad infinitum. Most studies have shown that pregnancy rates for any treatment drop after 4 treatment cycles; so that if a treatment has not worked in 4 cycles, the patient should move on to the next step (which is often IVF). However, most gynecologists who do not offer IVF, but do offer IUI, prefer "holding on" to their patients, and rather than referring them for IVF, keep on trying IUI again and again. Often, patients get fed up and frustrated, and lose confidence in both themselves and well as doctors, so that even though there may be effective treatment options available for them, they no longer want to pursue them!

Often, IVF, even though it is more expensive, may be a more cost-effective option!

Do your homework and plan your own course of action, tailored to your own conditions.

While the outcome of IVF is not in your hands, at least making the attempt will give you peace of mind that you tried your best!

Credits: Dr. Aniruddha Malpani, MD and Dr. Anjali Malpani,