BACK TO BASICS: An embryologist examines an embryo at a London fertility clinic. Since the first test-tube baby was born four decades ago, in vitro fertilisation has become a sophisticated process with pricey incubators, specialised techniques and extensive screening. Now, scientists are going back to basics and testing a simpler and cheaper method intended mainly for use in developing countries.
For Justine Bold, it was only after three miscarriages, five gruelling rounds of in vitro fertilisation (IVF) treatment and years of financial sacrifice and anguish that she finally fulfilled her dreams of motherhood.

The moment she held her twin boys, Otto and Orin, in her arms, all the difficulties of her long journey were forgotten.

"When they were born, I remember just smiling a huge smile and feeling so very lucky," says Bold, now 48.

Yet while she still feels lucky to have her sons, now nearly five, she also experienced a rather more unwanted side-effect of IVF.

When Otto and Orin were just 16 months old, her long-term relationship with their father broke down, partly because of the strain caused by undergoing fertility treatment. Since then Bold has found herself a single mother.

Last month marked the 40th anniversary since the first successful transplantation of an embryo grown in a test tube. Louise Brown, famously the world’s first IVF baby, was born on July 25, 1978. It’s estimated that 6 million children globally have been born from IVF, or fertility treatments developed from it.

This gift of parenthood is surely one of the defining inventions of the 20th century. And yet there’s no denying the IVF revolution has come at a price. As Bold’s experience illustrates, it’s by no means a straightforward solution to the fertility problems that face one in seven British couples.

What’s often not heard about is the impact the often cripplingly expensive, not to mention physically demanding, treatment can have on the couples involved. Danish researchers, for example, estimate those who go through failed IVF are three times more likely to separate than those who go on to have a baby.

Jennifer Edwards, a relationship therapist with more than 20 years' experience, sees many couples who are trying to pick up the pieces of relationships broken by the expense and intrusion of fertility procedures.

She says: "Infertility is still a subject lots of couples do not discuss with friends and family. Many couples only disclose that a child was conceived through IVF when they’re well into their pregnancy and confident nothing is likely to go wrong. I still hear women and men express a sense of shame that they are not able to conceive a child."

Men, in particular, can feel left out by female partners intent on conception. They are often more willing to accept children just won’t happen and move on, while their wives remain determined to become mothers at any cost.

Bold had wanted to be a mother since her early 30s, but suffered a miscarriage at the age of 32 while in a previous relationship. After meeting her partner at 37, they started trying for a baby 10 months later. At 39, she went to her doctor.

"I was told I had a good ovarian egg reserve and got pregnant naturally in 2011, but had a miscarriage. I then had an early miscarriage after a cycle of ICSI (where the sperm is injected directly into the egg).

"More tests revealed I had Hughes syndrome, which makes the placenta fail, and my immune system was attacking embryos. Finally, with a fifth cycle of IVF, the treatment worked."

But she says: "Struggling with fertility problems and going through fertility treatment was more of a strain on our relationship than I’d expected. Having a baby was more of a focus for me. My partner started to resent it. The fertility drugs made me feel fat and emotional.

"It became harder to deal with the grief that was accumulating each time I had a miscarriage or an IVF cycle failed.

"I kept wanting to try, but my ex got less keen as time went on, so this was a problem that built up between us. Then when I did get pregnant with twins, he was very apprehensive about coping with two.

"I think a lot of people believe the journey stops when you get pregnant and it’s plain sailing from there, but my experience is that the journey doesn’t stop then. There can be loss and surprises on the way - like twins - that add to the pressures, particularly on relationships."

Fertility treatment can also play havoc with the physical side of a relationship. A Stanford University study found that 40% of women struggling with infertility experienced low libido, even though they previously had no difficulties when it came to intimacy. It wasn’t clear whether IVF drugs or psychological issues were the main factor.

Bold, a lecturer in nutrition who has edited a book on infertility, concurs: "There are long periods where you can’t have sex after treatment or feel too sore. Years of timing sex around ovulation also takes a toll as it destroys spontaneity."

The detrimental impact of fertility treatment on a couple’s love life is something that’s not talked about enough, says Jessica Hepburn. Now 47, she went through 11 failed cycles of IVF because of unexplained infertility before she accepted biological motherhood would not happen for her.

Hepburn, who now campaigns for improved care for infertility patients, believes couples are often not prepared, emotionally or financially, for what can be a very long journey.

A single IVF cycle has an average success rate of 32.3% for those under 35, dropping to 5% for women aged 43 and 44 and only 1.9% for those 45 and older.

Hepburn says: "Taking into account all the tests and three cycles of IVF, that means it’s likely to be a journey of anywhere between three to six years."

She admits that over the years her relationship with her partner Peter has been pushed to the brink.

"Going through IVF is definitely a catalyst for separation," she says. "Infertility is treated as a clinical problem. But what’s not considered is the psychological trauma which starts the moment you discover you have a problem.”

Then there are the financial pressures on a couple. Hepburn’s unsuccessful treatment cost a crippling £70000 (R1.3 million), while nearly eight years on from her first IVF cycle, Bold is still paying off the £50000 (R900000) bill for her treatment, despite help from relatives.

As Hepburn, a writer and arts producer, puts it: "You’ll do anything if someone says it will give you a baby. You’ll take the extra treatments or medications that are recommended. You’d cut off your arm."

Over the past 40 years the landscape of motherhood has changed dramatically, with the average age of mothers climbing ever higher. It’s now 30.3 years, compared to 26.4 in the mid-70S.

More worryingly, latest statistics show women in their mid-40s are almost twice as likely to be childless as their parents’ generation.

So has IVF inadvertently contributed to the infertility problems that it set out to resolve? Does it give women a false sense that they can delay conception? After all, if they fail to get pregnant, there’s always IVF. Despite IVF being most effective for the under 35s, 57% of IVF cycles are undergone by women 35 or older.

To Hepburn’s mind, knowing you can have fertility treatment encourages the impression that it’s fine to delay motherhood. She was 34 when she decided to start a family.

"People are leaving it later to have children, and they’re not having them at the biologically optimal age," she says.

"We’re told that as women we should go to university, get on the career ladder, be picky about a partner, and that our mid-30s is the perfect age to have a family, but that’s when your fertility starts to drop off."

Hepburn adds: "IVF can’t cheat nature, it can only get everything in the right place at the right time.”