IVF is not just about biology

As reported in this week's BioNews, Australian researchers have recently published a study which shows mothers who conceive following IVF are four times more likely to suffer from post natal depression. However, I would present that as only one of a number of negative factors more common to this group of women, rather than those who conceive with little difficulty.

In life we are the sum total of our experiences, all of which will have had various degrees of impact on our health and general outlook. If we experience something traumatic then it is more likely to have a long-term effect. Even a child stung by a wasp may have an irrational fear of flying insects for some time. It is perhaps therefore unrealistic to believe that long-term infertility, and the way it conditions the patient to feel and act, is something that can be turned off like a switch when a pregnancy is finally achieved.

Putting aside additional factors that have previously been shown to give rise to an increased risk of post-natal depression, such as multiple births, the question is whether the infertility itself or the treatment, IVF, is ultimately responsible. The answer is almost certainly that both will play a part. If a woman has been unable to conceive naturally then there can be a tendency toward feelings of failure and inadequacy. This is derived from the perceived inability to fulfil a basic human function - natural conception.

What may follow is a doubt that any of the remaining process will be possible. Once a pregnancy is achieved, women are often sceptical that their body will be able to sustain that pregnancy, or whether it will continue to flourish without the support of drugs. There may be feelings that sooner or later the body will notice that it has been duped and that a miscarriage will inevitably follow. Women who then give birth by Caesarean section sometimes feel it was their body's continued inadequacy that led to further medical intervention. As parents of naturally conceived children the world over will know, babies are a challenge: they do not respond in a uniform way and can be demanding beyond reasonable expectation. It can be viewed as natural, therefore, when maternal confidence is already low and hormones are wreaking their own form of havoc, if the 'maybe I was never meant to be a mother anyway' phase kicks in and leaves the woman even more vulnerable to depression.

The anxiety residual from years of failed conceptions or failed pregnancies, the financial burden of repeated IVF attempts, the uncertain outcome and the proverbial IVF emotional roller-coaster itself will all have an impact on both the pregnancy and early parenting experience. Whilst stress may recently have been shown not to figure in the clinical outcome of an IVF cycle, it will inevitably play a major role in defining the way a woman feels throughout treatment and subsequent pregnancy. So much time and effort goes into IVF, the woman is the centre of attention both at home and in the clinic environment. Most patients will not have experienced this level of medical attention previously - the daily injections, the frequent clinic visits (which impact on work and all other aspects of life) - all followed by surgery. It is a major process, it may not be major surgery but it is all consuming and all driven to one outcome - the goal of a pregnancy.

If a couple are fortunate and a pregnancy is achieved, the goal has been attained. However, a huge void then opens up before them. The support of the infertility clinic has ended, the NHS ante-natal system is not interested for some weeks and even then visits to the midwife and access to that all important reassurance are sporadic. Suddenly no one really cares that the couple finally have something to lose, something so precious to them, something which cannot simply be replaced if it goes wrong, something which is everything in the world to them. Is it therefore that realistic to expect them to 'flick the switch' and move on?

The Melbourne study suggests that those who achieve pregnancies following fertility treatment could benefit from additional emotional support before and after their babies are born: certainly they could, huge numbers of IVF parents would tell you that, but where can it come from? The UK still fails to fund access to NHS IVF treatment, our maternity services are struggling and, once a pregnancy is begun, fertility clinics have fulfilled their obligation. So support falls, sadly, to the underfunded and often undervalued voluntary sector.

Infertility and subsequent IVF do leave a lasting impression. Time does heal, but there are certainly many things that could be done along the way to lessen that long-term impact on pregnancy and parenting. What this shows is that IVF is not just about solving a biological problem.