Why conception isn’t the end of stress and anxiety for IVF couples

Proud parents Carol and Nick Ions
Proud parents Carol and Nick Ions
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It is the life-changing event that for many couples only arrives after months or even years of uncertainty and emotional turmoil.

And according to a new study, conceiving is not the end of the anxiety for parents who use fertility treatment to have a baby as their need for extra antenatal support is not being addressed by those responsible for drawing up health policy.

Couples who have conceived after fertility treatment need more antenatal care and support, a study has suggested.

Couples who have conceived after fertility treatment need more antenatal care and support, a study has suggested.

Researchers from the University of Bristol interviewed women and their partners to find out about their experiences of antenatal care following in vitro fertilisation (IVF) for a study published in the British Journal of General Practice.

Finding gaps in their care after leaving the fertility clinic for primary care and then NHS maternity services, the study suggested couples who have successfully conceived following fertility treatment need additional antenatal care and support.

Among the celebrities to have conceived through IVF are singers Mariah Carey and Celine Dion, as well as actress Emma Thompson.

Lead researcher Dr Lydia French said: “These are important messages for general practice and the antenatal care of women who have conceived after infertility treatment.

“There is definitely that worry when you leave the comfort of the clinic, you have gone through so much emotional turmoil and stress to something you have no control over because the NHS is such a juggernaut.”

Carol Ions, who conceived through IVF after 12 years of trying

“The combination of early pregnancy, few pregnancy symptoms, anxiety over possible loss of the pregnancy, and women’s lack of trust in their body to maintain the pregnancy, in some cases, had led to couples presenting at early pregnancy clinics, accident and emergency centres, or paying for private scans.

“It was also evident that both men and women found it difficult to prepare for childbirth and parenthood because they feared losing the pregnancy.

“This, combined with feeling different to the normal birth population, made some couples reluctant to join antenatal classes.”

The findings of the study ring true for Carol Ions, 43, a civil servant from Sheffield, who gave birth to daughter Neve, now aged two, in 2013 after spending 12 years trying to conceive with husband Nick.

Julian and Lisa Glossop with their daughter Gracie-Fay Glossop. Picture taken in 2011.

Julian and Lisa Glossop with their daughter Gracie-Fay Glossop. Picture taken in 2011.

The couple went through four unsuccessful courses of IVF in their battle to conceive. But it wasn’t until a doctor in Sheffield carried out a series of extra tests that the couple learned that Mrs Ions had a gene mutation.

This affected the clotting of her blood and, potentially, her ability to get pregnant. She was given daily injections of a blood-thinning drug during her IVF treatment. And soon afterwards she learned she was expecting, giving birth to Neve at the Jessop Wing Hospital in Sheffield.

She admits she was anxious after moving from the CARE fertility clinic in Sheffield, where she had received one-to-one treatment, to the care of the NHS.

She said: “When I had the initial meeting with the consultant I was really worried. I was 40 and an older mum, the baby was so precious because we had been trying for so long.

“I was really worried about going through child-birth and she offered me a caesarean because of my concerns about what might happen.

“I was worried the NHS would let me down, but they didn’t in the end, they were fantastic. I was really worried about leaving the great care I had paid for and going to the NHS.

“Part way into my pregnancy, everyone gets checked for gestational diabetes, I had a very slightly higher indicator and because of that the amount of monitoring his higher. I had more scans and that made me feel a lot better, I got to see Neve growing through the weeks.

“There is definitely that worry when you leave the comfort of the clinic, you have gone through so much emotional turmoil and stress to something you have no control over because the NHS is such a juggernaut.”

Lisa Glossop, 39, from Doncaster, spent a decade trying to conceive with husband Julian and needed a gastric bypass for her weight to be suitable for her to be given IVF, but gave birth to baby Gracie in December 2009.

She said: “There were anxieties, it took us 12 years to have our little girl. But I had a great consultant and it was brilliant.

“Once I had the various scans, to me I felt like I was pretty well looked after. My consultant was very so good, he knew how anxious I was.

“A week before my due date I said how nervous I was getting, it was chewing me up. He said that if I was feeling like that did I want to be induced, though I didn’t in the end.”

Dr Adel Shaker, medical director at the CARE Fertility centre in Sheffield, said there was no doubt that couples who conceive through IVF need extra support.

He said: “When we see couples for IVF it is like going for a journey with them. We see them for a period of weeks and months and sometimes years. We get to know them very well, we know what they had for breakfast.

“We give them what we consider is the appropriate care for their situation. They are vulnerable, coming for IVF is their last chance of having a family. We understand the pressure they are under and we offer them good support through our counsellors, nurses, clinicians and scientists.

“We feel that we look after them very well and when the time comes to discharge them, once we have done the scan and the pregnancy is viable, we refer them back to the GP and they refer them to a maternity service, they are always a bit anxious, worrying if they will get the same attention and understanding of the long journey they have been on.

“When they go out into the big wide world and are seen in maternity, obviously they are just seen like everyone else and treated the same way.

“I do believe that maybe more attention needs to be given to their needs. They are not a couple who have just fallen pregnant and achieved it within two or three months of trying. They have been trying for years and have gone through treatment after treatment, and have developed over time certain levels of anxiety.

“They do need an extra level of support, there is no doubt in my mind.”

According to the Bristol study, early pregnancy is a particularly anxious time for couples who conceive through IVF because of the possibility of pregnancy loss and because they struggle to adjust and plan for parenthood.

They also reported gaps in their care, in terms of the time gap between being discharged from secondary care and being seen in primary care, and in terms of the difference between the intense monitoring they had received in the fertility clinic and the regular, but less frequent care they received from their practice midwife.

Women also reported that they experienced difficulties in articulating their feelings of low mood to both peers and practitioners, and felt unable to complain because they thought they should be “grateful” for being pregnant.

The study concluded that the needs of couples who conceive through fertility treatment are not addressed at a policy level.

It highlighted the need for GPs and midwives to be aware of couples’ previous infertility history and suggests they should receive their first standard antenatal appointment soon after being discharged from the fertility clinic.

This research also recommends that healthcare practitioners should encourage couples who have conceived through fertility treatment to attend antenatal classes, and to talk about their experiences in order to let go of their previous infertility status and focus on becoming parents.

Findings regarding couples’ tendency to silence negative or ambivalent feelings in pregnancy should also be a concern for health practitioners.

:: The study, Antenatal needs of couples following fertility treatment: a qualitative study in primary care, is published in the British Journal of General Practice.

A Department of Health spokeswoman said: “The best maternity care takes into account both a woman’s health and wellbeing, as set out in NICE guidance.

“That’s why we encourage all women who know they are pregnant to contact their local maternity service for a full assessment of their health, risk factors and choices so that a personalised plan of care can be prepared.

“We expect all midwives to identify women who may require additional support, including for mental health issues, at the earliest possible opportunity.

“This government has committed to providing an additional £75m over the next five years for services to support women with mental ill health in the perinatal period.

“Our aim is that no couple should feel unable to voice concerns during pregnancy.”