The stakes couldn't be higher... your health, your wealth, your relationships. Yet your chances of hitting the jackpot could hardly be slimmer
Above the door of every IVF clinic should hang a sign that reads:
'Welcome to Las Vegas.' When you step inside and start playing the fertility game, your chances of losing thousands of pounds far outweigh your chances of hitting the jackpot.
But like hopeless gamblers, unable to shake the idea that they might win with the next throw of the dice, an ever-increasing number of British couples are putting their emotions, their financial stability, their relationships and their own health on the line - all for the chance of a baby.
After more than 20 years in the industry (and I use that word quite deliberately), I have yet to find the words to persuade a couple to give up that dream. I can hit them hard with the bleakest facts I have to offer: that even in the most capable hands, roughly two out of three IVF cycles fails.
I often look them in the eyes and say: 'The only guarantee I can give you is that your treatment is more likely to fail than succeed.' Or: 'Keep your money. You'd be better off spending it on a holiday to help you come to terms with the inevitable.'
But after the tears (and on one memorable occasion, after a patient thumped my desk in frustration and yelled: 'We didn't come here to hear this, we came here for a baby!'), they come back more determined than ever to go ahead.
For wherever there is sliver of hope, there will be men and women queuing for IVF treatment.
It is inevitable that specialists like me come in for criticism when we are seen to treat and take money from people whose chances of conceiving are slim to none.
Making a living from desperate people who want to achieve a pregnancy at any cost can look something like exploitation, and any clinician worth his salt will worry that it is. We take their last pennies and allow them to take unquantifiable risks with their health, all for the agony of yet another failed cycle.
Forcibly removing those rose-tinted spectacles and making them question the blind faith that led them to my office is the only way I have found to ease my conscience. It releases me to do my very best for them, without the worry that i have given them false hope.
And, in my mind at least, it allows me to stay on the right side of the line that we all walk in fertility treatment between help and abuse.
Unlike other areas of medicine, it is a potent combination of money and emotion that fuels IVF and other fertility treatments. But while every treatment - successful or unsuccessful - fills our coffers, it is the emotions involved that drive us to try again and again, if at first we don't succeed.
'We take their last pennies and expose them to risk'
When patients look at me helplessly, it becomes impossible to abandon them. There are times when I think I should refuse to treat couples for whom the treatment just isn't working, but I can't ignore their desperation.
After all, doctors are human, too, and their desire to become parents grabs at our hearts and reels us in. It means that when the time comes to decide whether or not to go for it again, I don't want to say, 'Let's give up,' any more than they do.
But the fact of the matter is that if I turn a couple away, they will often go across the street for treatment. And when the clinic across the street can't help, they will go abroad, making them even more vulnerable to abuse. Abuse in which they, of course, are complicit.
When I know that a couple are prepared to invest everything - not just financially - into achieving this almost impossible dream, how could I not feel that I was failing them if I did not try everything in my power to help?
Add to this the fact that, generally speaking, IVF clinicians are a high-achieving and highly competitive breed who do not easily accept when a cause is lost, and you begin to see the complexity or the moral maze that we navigate with every patient.
Britain's oldest mother Elizabeth Adeney, 66, went to the Ukraine for IVF as the UK refuses to treat women over 50!
Some 15 years ago, as a young fertility specialist, I wrote that we were in the grip of a fertility cult, in which advances in our knowledge and capabilities had made having a baby seem not only possible, but vital. That is truer today than it ever was.
I have heard of three recent cases in which pregnant women with cancer decided to forgo all treatment until after they'd had a baby.
They knew that in delaying crucial treatment they might be condemning themselves to death, but believed so strongly that having a baby was their sole purpose, there was no stopping them. If they died, they died happy, knowing that they had achieved motherhood, despite leaving their children motherless.
Cases like that of Maria Bousada, who died from cancer this summer at the age of 69 leaving two-year-old IVF twins, are the thin end of the wedge in terms of this ever increasing worship of assisted pregnancy, no matter what the cost to the mother or the resulting children.
In effect, the development of IVF has turned people like me into high priests and priestesses, and our clinics into temples filled with the blindly and fervently faithful, unwavering in their conviction that we can make miracles happen.
For those of us who have been working in fertility since the early days, it is a very strange place to find ourselves. Although we knew that it was possible to help with conception in certain cases, there was no way of knowing that it would become so mainstream.
We could never have imagined that, one day, almost all of us would know someone who has tried it, or that we would walk into the local newsagent and see celebrities boasting about their 'miracle babies' on the front covers of magazines.
I've lost count of the number of times that someone I know, from school or university, has walked into my office. I like to let them realize for themselves that we have met before. I don't think it helps their nerves when I pipe up with: 'Hey, weren't you in my biology class?'
So how has IVF become mainstream? Well, it's certainly not because it has become affordable. It still costs up to £4,000 per cycle, at an average of £2,500 per time, and I have known two patients in my career who have invested in a dozen cycles.
Remarkably, one of those patients had a baby boy after her 12th and final try - and stories like that are the ones you remember when you are on the verge of giving up the quest.
Quite simply, the first reason for the increase is that infertility is rising. I have said in the past that it may be caused by environmental factors, such as the prevalence of chemicals in what we eat or drink, but there is still a lot of research to be done in that area.
Fertility treatments have also become part of our on-demand culture. Like it or not, making a baby the natural way takes time and effort, and won't necessarily happen within the window of time that we have set aside in our busy schedules.
I am constantly advising patients, 'Don't give up the night job', because, as obvious as it may sound, having sex is crucial.
However, because it is so hard to establish absolutely whether a couple have a fertility problem that will never result in a natural conception, many are losing patience and seeking private treatment when it's possible they don't need it at all.
Our celebrity culture is partly responsible for the boom, too. While only two or three per cent of the general population have fertility treatment, I estimate the figure is closer to 10 per cent in the celebrity population, and they are not shy of telling us all about it.
I don't know why celebrities require so much more treatment that 'ordinary people', but I do know that cocaine abuse, low body weight, drinking, smoking and being too busy to have sex, or not trying to get pregnant until you're pushing 40, will drastically reduce your chances of conceiving naturally.
And as with any celebrity trend, I believe there is now a certain cache attached to IVF. It's as if unnatural conception is cool.
But whatever the reason, we have reached a point where more patients are putting more faith than ever into what we do.
The advances of science seem to promise couples an everlasting hope. The goalposts move constantly, giving both patients and clinicians alike the belief that anything is possible, and that no problem - not even the fact that a woman is in her 60s - is insurmountable.
Before the development of ICSI (Intracytoplasmic Sperm Injection), where sperm is injected into the egg outside the womb, there was nothing we could do for male infertility. But suddenly there was a solution for that, too, and it brought with it a whole new wave of people who were desperate for our help.
It remains a highly experimental area, however, and comes with risks that are impossible to quantify.
Every new patient I see asks me whether IVF drugs increase the risk of certain cancers, and all I can say is that they might do. It is an area of science in its infancy, and we simply don't have the long-term figures to know what, if any, risks our patients take when they start the journey.
But some research that I have conducted suggests that women begin to produce certain antibodies when they hit their third or fourth cycle of treatment, which indicates that the drugs we use may have some longterm effects in higher doses.
One problem is that fertility treatment remains largely privately funded and because - regardless of the risks - patients will do whatever it takes, treatments develop very quickly. When emotions are running high and we have piles of readies under our noses, who has time for lengthy clinical trials?
It's not reckless, but it is experimental - and that is something that all patients accept.
The baby that was born after his mother's 12th IVF cycle would not be here today had I not taken a spur-ofthe-moment decision to try something new. She lay sobbing on the operating table, knowing that this was her last embryo and her last chance.
But as I looked at the embryo, the outer skin appeared a little thicker and yellower than is normal. So I asked her: 'Do you mind if I try something that has never been done before?' There was no time for clinical trials: she needed my help at that moment.
'Anything, anything!' she said, which can hardly count as formal consent. So I perforated the embryo all over with my needle, until it looked like a microscopic teabag.
It was controversial - but it was, I believe, her only chance. Not only did it give her the baby boy she so desperately wanted, but the technique, now known as assisted hatching, has helped many other women since.
Moments like that highlight the extraordinary possibilities. But as the expectations of our patients rise inexorably, it becomes more and more important to acknowledge our frailties and limits.
By Prof. Sammy Lee, UK
