One of my biggest pet peeves when it comes to medical procedures or shows on television is watching a patient flat-line and the providers yell “Let’s shock him/her!” Such a moment will have me sitting bolt upright (at best) or actually jumping off the couch (at worst) shrieking “You don’t shock a flat-line! Where the heck did you get your ACLS* certification?!”**
A close second, however, is how often cardiac arrests are successfully resuscitated on TV. A study done in the 1990s showed that around 67% of TV “codes” have a patient surviving, usually neurologically intact. Curious about the real survival rates? According to the American Heart Association, in 2013, 9.5% of adults who experienced cardiac arrest outside of a hospital setting survived to discharge. Of adults who arrested in hospital, the figure is 23.9%. These statistics, I might add, specify only that the person survived until hospital discharge. They do not address neurological status or ongoing health concerns.
Some people may think – and have told me as much – “Big deal. It’s just TV. Stuff gets exaggerated on TV and the in the media all the time.” The assertion about TV and the media is true, but I don’t think it’s as benign as that. I think when people are put in terribly stressful, painful situations and asked to make life-altering decisions, it’s harder to explain why resuscitation efforts were unsuccessful or might not be the best choice in a specific situation. It’s harder to accept death, easier to see it as a failure or something one can outwit almost indefinitely.
This isn’t to say CPR or AEDs/defibrillation aren’t useful. It isn’t to say we shouldn’t keep working to find ways to make that survival rate higher. It isn’t to say we should never intervene in cardiac arrest. It would be fantastic to reach a 67% neurologically-intact survival rate both in hospital and out.
But right now, it’s not reality.
Which pretty much sums up how I feel about IVF and the media.
For what it’s worth, IVF helped us conceive our daughter. We are, in many ways, a success story. I’m not sorry I went through the procedure given the particulars of my infertility and other such factors. My RE (the second/current one) was honest with us about our chances and the known risks. I do think, however, that there are a lot of issues surrounding IVF that need to be addressed. The media is beginning to cover some of the difficulties surrounding IVF, but there’s still a lot of glossing over the painful realities.
IVF is a useful medical treatment for certain types of infertility. It is not magic. It fails a lot – probably a lot more than people who aren’t in either the fertility industry or in treatment realize. According to the American Pregnancy Association, IVF success rates are about 41-43% per cycle for women under 35 and go down from there. In other words, it often takes more than one cycle even in the best circumstances, something my friends and family members were often surprised to find out because there’s definitely an impression out there that IVF “usually” works.
A study came out in the Journal of the American Medical Association recently, resulting in headlines from the likes of The New York Times about persistence paying off in IVF. The study basically stated that the conventional wisdom when it comes to number of IVF rounds – that after three or four with their own eggs, people should move on to other treatments or methods to resolve infertility – was wrong. Instead, the study said six rounds – and up to nine rounds – could still offer reasonable chances of pregnancy.
So much wrong here that I’m going to largely hand it over to the plenty of other bloggers who have covered many of the angles ably. Dawn Davenport from Creating a Family points out the unease she feels around such a study. Pamela Tsigdinos sums up the real ethical problems inherent in advocating six to nine rounds of IVF. Amy Klein and Dr. Jeffrey Braverman take to task the study itself and the methods used.
From where I sit, if I was reading The New York Times article without being an infertility patient and having gone through IVF myself, I would think that IVF pretty much always resulted in a baby. Even if for some people, it obviously took awhile. I would think that six to nine rounds might be a reasonable number based on the media reports. The researchers from the study certainly give that impression, as this quote from Dr. Scott Nelson implies: “For most couples – and certainly those where the woman is younger than 40 and those of any age using donor eggs – two-thirds will achieve a live birth after five or six treatment cycles. This will take, on average, two years and is similar to rates that couples conceiving naturally take in one year.” Sounds like a reasonable sacrifice.
Except that I have gone through IVF and I have a much better idea of what six to nine rounds entails. The reality is that in a country where IVF is rarely paid for by insurance and people have to save up for each round, the two year timeline Nelson mentions is laughable. It’s also nothing like people who get pregnant naturally and don’t have to take the time off work and live their lives around clinic schedules for the countless monitoring appointments, egg retrieval surgeries, and transfers. I know firsthand living around clinic schedules for a longer term takes a terrific toll on life. While the 65.65% birth rate after this many cycles is trumpeted in the article, there’s barely a mention of the 30+% who will do all of this and still leave with no baby. This is not a small number.
As an infertility patient, media coverage that largely focuses on the success rates of IVF frustrates me. I know perfectly well that we could have walked away from treatment with no baby and it would not have been from a lack of trying or from something we did or didn’t do. It angers me that so many people outside of the infertility community are given the impression that having a baby is something controllable with enough fertility treatment or persistence (again, roughly 34% did not even at the extremes in the study).
In a large part, this is why I keep blogging. I periodically go through the sort of survivor’s guilt questions inherent in having managed to conceive and give birth to a living child after infertility of whether and how I can contribute to conversations about infertility. It’s one of the internet’s finer qualities that smaller, more niche voices have a place in the conversation and are being heard more often. I figure that speaking up to offer a firsthand perspective about the many difficulties inherent in IVF and infertility and an opportunity to counter some of the misguided impressions is definitely reason enough.
It would be fantastic to reach the point where there is as much reason to be optimistic about IVF as the media depicts. Until then, I’m glad that people in the infertility community are able to correct and discuss these reports, as well as sharing their stories.
*ACLS stands for Advanced Cardiac Life Support
** It really is not ACLS protocol to shock flat-lines. Basically, a shock is done to induce a brief flat-line (asystole). The hope is that then the natural pacemakers of the heart will take over to produce a rhythm that will pump blood to the vital organs of the body. Think of it like rebooting a computer. Rebooting works when something is messed up in the system, but will not work if the computer is not on at all.