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Child at heart: A brief look at ‘IVF addiction’

“The quest to have children can become a vortex that gets faster and faster and sucks people in. Women will sell everything and anything to have the treatment if they are short of funds. They will risk their lives, there’s no doubt about it. I have treated young women with cancer who have refused to have treatment for their illness until they have got pregnant and given birth, knowing they are risking their lives. Some of these women do, indeed, go on to die [from cancer], but they die happy, feeling that they have achieved something greater than their own continued existence. Everyone involved in these scenarios is trying to do the right thing, but the extraordinary energy of a couple’s determination creates a vicious circle. [Some couples are driven by] an urge stronger than addiction and more powerful than obsession” (Professor Sammy Lee, Chief Scientist of the IVF [in-vitro fertilization] programme at Wellington Hospital, London; The Guardian, 2009).

Today’s blog started as an email from one of my PhD students, Manpreet Dhuffar, who sent me an interesting article in the New York Times entitled ‘Addicted to IVF, or addicted to hope?’ The opening quote by one of the UK’s pioneers in IVF egg donation certainly believes that the urge for childless couples to have children is stronger than the urges addicts feel for their drugs or behaviours of choice and that their pursuit is obsessive. In the UK, the maximum number of IVF cycles is three but Professor Lee admitted that some couples had gone through 12 cycles and that he knew of clinicians that had continued providing IVF treatment even when they knew there was little chance of pregnancy success.

On one level, I obviously don’t believe that undergoing IVF can be a genuine addiction. To me, undergoing IVF treatment appears to be similar to those people who claim to be addicted to plastic surgery or having more and more tattoos. These are activities that are salient and preoccupying but are not activities that are engaged in day-in, day-out. Although there are no papers on ‘IVF addiction’ a 2002 paper in the journal Nursing Inquiry by Dr. Sheryl de Lacey analysed the discourse of women with infertility problems and that had undergone IVF and discontinued. Dr. de Lacey reported:

“[IVF treatment was described as] a metaphor of lottery in discourses of infertility…showing how when women are situated as gamblers, the metaphor is instrumental in polarising them into ‘winners’ or ‘losers’ in relation to the subjectivity of motherhood. I further deconstruct these subjectivities, showing how ‘winners’ are valorised and ‘losers’ are pathologised. But importantly, I show how infertile women who are not mothers resisted locating themselves as ‘losers’ in a metaphor of lottery and instead situated themselves in a contesting metaphor of investment as diligent ‘workers’ and as active agents in choosing the best employment of their bodily and monetary resources”.

I found these types of discourse myself in various online parenting and infertility forums. For instance, at websites such as babycenter.com and the Pursuit of Motherhood blog, women wrote:

  • Extract 1: “I once read/heard a storyline that started with ‘Addicted to IVF’. I never thought that I might be one of them. The hope that comes with each cycle erases all the negativity, pain, injections, miscarriages, etc. that has already happened. The hope makes you think that it’s possible, even when no one really knows why my babies are sticking around long enough to grow. Each time, I say that I’ve had enough, yet I find myself going back. Even now, I’m ‘taking a break’ to lose the 30 pounds I’ve gained and lower my now raised blood pressure. Now that I’m 4 months off and halfway to my goals, I’m ready to jump in to IVF again. But, really, what’s different? There are no answers to why I can’t seem to hold on to a healthy pregnancy, yet my prognosis is ‘favorable’ since I have always responded ‘textbook’. Am I doing this out of vain, or is there, sometime in my future, a baby waiting to be mine? Thank goodness my insurance limits my tries to 6 fresh cycles because I don’t know if I’ll ever lose hope or stop trying
  • Extract 2: “I’ve been thinking about New Year’s resolutions. I know it’s only the 29th of December but there’s nothing I like more than a resolution. I want to be brave enough to make Number 1 on the list: Give up IVF. And if that sounds like IVF is an addiction as much as drugs and alcohol that’s because it is. In fact, it’s definitely more expensive than a Class A habit. Even as I think and write it, my heart starts to palpitate because where IVF is concerned maybe I have become an addict. Just like an alcoholic who is convinced that happiness lies in that next drink, I’ve become convinced that happiness lies in our next round of IVF. I should start a support group. IVF Anonymous”

Some have even gone as far to write a whole book on their ‘addiction’ to IVF (for instance, check out Tertia Albertyn’s (funny, yet moving) book So Close: Infertile and Addicted to Hope). In researching this article, I also came across a good article (‘Are you addicted to IVF?) on the Fertility Lab Insider website written by ‘Carole’. She made reference to the research of Dr. Janet Blenner who developed a stage theory relating to those passing through infertility treatment (in the Journal of Nursing Scholarship). Using grounded theory, Blenner explored the perceptions of 25 couples as they underwent infertility assessment and treatment. Her theory consists of three concepts – engagement, immersion, and disengagement. To me this sounds like something that successfully treated addicts also go through. Blenner also describes eight stages that individuals pass through: (i) experiencing a dawning of awareness, (ii) facing a new reality, (iii) having hope and determination, (iv) intensifying treatment, (v) spiralling down, (vi) letting go, (vii) quitting and moving out, and (viii) shifting the focus. As Carole notes in relation to these eight stages:

“They seem similar to stages of grief or stages of finding sobriety after addiction. Some patients get stuck at Step 5, ‘spiralling down’. They are the patients who are confronted with repeated failures and evidence of new hurdles to their fertility, patients for whom even Herculean efforts in terms of effort and expense can be expected to be successful less than 5% of the time. If someone told you that you should bet $12,000, $15,000, even $20,000 on a horse that has a 5% or less chance of winning the race, you’d tell them to get lost, that’s crazy…Yet, IVF patients that go in for multiple rounds of IVF, beyond two or three are doing exactly that. Most clinics have pulled out all the stops, applied all the tricks they know by the third IVF cycle. If it still isn’t working, either the clinic is incompetent or IVF is not the right solution for that patient”.

Here, there is yet another gambling analogy which – given my ‘day job’ as a Professor of Gambling Studies – didn’t pass me by. Another online article by Mia Freedman also talked of infertility treatment as a form of gambling addiction and echoes the preceding quote. Freedman asserted:

“I am writing to express my extreme distress at what appears to be the most expensive lottery ticket in town for over 40s these days – IVF. I know of four women who have undergoing the process – one for the ninth time – and it appears they are constantly being told the next time they will be lucky. At around $10k a cycle, that is a lot of money on a chance that is less than one in 10. I am seeing marriages crumble, hearts break, hormones go wild and mental and physical devastation as a result of every cycle that doesn’t produced much longed for babies. I am seeing women almost lose their minds and empty their bank accounts to feed their obsession to be pregnant. Don’t get me wrong, I think IVF is a wonderful gift and I don’t deny anyone wanting a baby – no matter what their age – to give it a go. But surely, when chances are so low there should be comprehensive counselling where financial, marital, mental and physical heath issues are discussed before a 40 plus woman buys yet another expensive lottery ticket in hope of a baby?”

Although I personally wouldn’t conceptualize persistent IVF treatment as an addiction, there are certainly addiction-like elements in most of the stories I have read. Furthermore, and irrespective of whether such behaviour can be classed as addictive, there is no doubt that the need and want for a child appears to be the single most important thing in the lives of such individuals and that based on some of the accounts that I have come across, the need for children could perhaps be classed as an obsession – at least at the time of undergoing IVF.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Albertyn, T.L. (2009). So Close: Infertile and Addicted to Hope. Gauteng: Porcupine Press.

Blenner, J. L. (1990). Passage through infertility treatment: A stage theory. Journal of Nursing Scholarship, 22(3), 153-158.

De Lacey, S. (2002). IVF as lottery or investment: Contesting metaphors in discourses of infertility. Nursing Inquiry, 9(1), 43-51.

Fertility Lab Insider (2013). Are you addicted to IVF? June 5. Located at: http://fertilitylabinsider.com/2013/06/are-you-addicted-to-ivf/

Freedman, M. (2010). When does IVF become an addiction? Mama Mia, January 18. Located at: http://www.mamamia.com.au/parenting/when-does-ivf-become-a-form-of-gambling-addiction/

Hill, A. (2009). Women are risking their lives to have IVF babies. The Guardian, September 13. Located at: http://www.theguardian.com/lifeandstyle/2009/sep/13/motherhood-fertility-treatment-cancer-ivf

Klein, A. (2014). Addicted to IVF, or addicted to hope? New York Times, January 27. Located at: http://parenting.blogs.nytimes.com/2014/01/27/addicted-to-i-v-f-or-addicted-to-hope/

Winslow, A. (2014). Addicted to IVF. Laughter Through Tears, January 29. Located at: http://laughterthroughtearsblog.com/2014/01/29/addicted-to-ivf/

Zoll, M. (2013). Generation IVF. Making a Baby in the Lab: 10 Things I Wish Someone Had Told Me. Lilith. Located at: http://lilith.org/articles/generation-i-v-f/

Fantastic or drastic? Can plastic surgery be addictive?

“Plastic surgery addiction may sound like a joke but it is actually a serious problem that more and more people are suffering from in modern times” (http://plasticsurgeryaddiction.net/)

In many circumstances, the use of using plastic surgery to help correct a facial or body deformity, whether congenital or caused by an accident of some description, is clearly a helpful and beneficial treatment to individuals. However, in the world of celebrity media, ‘plastic surgery addiction’ is up there with alcohol and drug addictions as one of the addictions that those in the public eye are most likely to succumb to. We can all think of celebrities that are known to have repeatedly gone under the surgeon’s knife (Michael Jackson, Cher, David Gest, Micky Rourke). There are understandable reasons as to why celebrities are a higher risk group for seeking out cosmetic surgery. Firstly, there is an almost obsessive need in the ‘showbiz’ world to look as (aesthetically) good as possible. Secondly, they have the money and can afford to do it repeatedly. As long as the person has the money to pay for the surgery and the doctor is willing to perform it, there are no guidelines as to when to stop (unlike the regulation of prescription drugs, and other medical and/or surgical procedures).

As I noted in a previous blog, I am unconvinced that any of these high profile celebrity cases are “addicted” to plastic surgery but like ‘tanorexia’ there is certainly the desire to look good as a way of feeling good about themselves. However, there are certainly cases of individuals who seek out constant plastic surgery because they suffer from Body Dysmorphic Disorder (BDD). As I noted in a previous blog on BDD, it typically manifests itself as a preoccupation with an imagined physical defect or an exaggerated concern about a minimal defect. Furthermore, the perceived flaw or defect may not even be noticeable to other people. This leads the BDD sufferer to want cosmetic surgery in an attempt to try to change or eliminate the perceived defect. Even people who are outwardly (and objectively) very attractive can perceive themselves to be very unattractive.

Empirical research carried out among patients undergoing plastic surgery, have typically reported that between 5% and 15% of the sample have BDD. Even if the constant seeking out of cosmetic surgery is not a genuine addiction, BDD sufferers appear to have a higher risk of developing addictions to alcohol and illegal drugs as they are often used to cope with and/or forget about the symptoms and consequences of the disorder. They also engage in more ‘safety behaviours’ (such as staying indoors and avoiding social contact) that in some cases develops into social phobias. This can then result in relationship and/or family discord, and affect education and/or work (depending upon age and life circumstances of the sufferer).

The British psychiatrist Dr David Veale (The Priory Hospital North London) and his colleagues have published a number of studies on BDD with specific reference to those seeking plastic surgery. In one of his team’s first studies, a quarter of 50 BDD patients attending a British psychiatric clinic were reported to have been successful in obtaining at least one cosmetic surgical procedure. In another study, Dr Veale reported that 25 of his BDD patients had received a total of 46 cosmetic surgery operations.

Dr Katharine Phillips (Professor of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, USA), and arguably the world’s leading authority on BDD, has also examined the relationship between BDD and cosmetic surgery. In one of her team’s studies of 58 BDD sufferers who had undergone cosmetic surgery, they reported that the vast majority of the patients (83%) felt no better or were worse after their cosmetic operation(s). Veale has also reported similar findings (i.e., that BDD sufferers experience increasing dissatisfaction following surgery).

However, Dr Veale also reports that there are some cosmetic procedures where BDD patients tend to experience increased (rather than decreased) satisfaction. For instance, operations involving the pinning back of protruding ears (pinnaplasty), and breast augmentation or breast reduction (mammaplasty), tend to show higher satisfaction ratings among BDD sufferers than those undergoing cosmetic nose surgery (rhinoplasty). However, over 50% of BDD patients often have more than one concern about their bodily appearance so even if one surgical procedure produces short-term satisfaction, this may be replaced with anxiety about another body part (resulting in a desire for further cosmetic surgery).

Dr Veale also notes that some BDD patients are very distinct from others (for instance, those with BDD seeking reconstructive nose surgery appear to be distinct from other types of BDD sufferer). Prior to seeking medical help, BDD sufferers wanting rhinoplasty often attempt ‘do-it-yourself’ surgery to correct their perceived defects and flaws. Examples of ‘‘DIY’’ surgery among this type of BDD patient include (i) using a pair of pliers in an attempt to make the nose thinner, (ii) using sticky tape to flatten the nose, and (iii) placing tissue in the nostrils to try to make the nose look more curved. Compared to patients with other body image disorders, those who have attempted DIY surgery appear to have high rates of both depression and attempted suicide.

Despite relatively consistent findings, it should be noted that most of the studies on the relationship between BDD and cosmetic surgery comprise relatively small sample sizes so the findings suffer from issues around generalizability. Perhaps of more concern – and something that Dr Veale points out – is the fact that published studies comprise people seeking treatment in psychiatric settings so there is a high selection bias of people in favour of treatment failures (i.e., if a BDD sufferer is happy with their cosmetic surgical procedure they don’t tend to come in for further treatment as their symptoms and problems dissipate and/or disappear).

A just published study in the journal Psychological Medicine examined whether people who opt for medically unnecessary cosmetic surgery are psychologically vulnerable. A Norwegian team of researchers led by Dr Tilmann von Soest began some longitudinal research two decades ago on 12,000 school students (aged 12 to 19 years in 1992) and have been sampling them periodically over the intervening years. In 2005 there were 2,890 participants left of which 106 people (78 women and 28 men) had cosmetic surgery. Their results indicated that women with psychological problems were more likely to opt for surgery. The female participants who had cosmetic surgery were more likely to have had a history of poorer mental health (e.g., depression, anxiety, more illicit drug use, self-harm, and suicide attempts. With one exception (breast augmentation), having cosmetic surgery didn’t benefit the psychological health of the women. The researchers concluded there was “no evidence that cosmetic surgery should be used to alleviate mental health problems in women dissatisfied with their appearance”.

If plastic surgery addiction exists (and I am sceptical to say the least), it is not (as some people argue) a common side effect of cosmetic surgery (i.e., if someone is considering a cosmetic surgical procedure, they should not be concerned with fear of future reliance on – or  “addiction” to – surgery. That is not to say that repeated cosmetic surgery can’t be problematic. For instance, there are reports of individuals who have had excessive rhinoplasty that has reduced the nasal cavity so many times that they can no longer blow their nose properly. There are also countless reports involving repeated reconstructive facial surgery that has resulted in muscle tissue collapse, unsightly scarring, and permanent nerve damage (leading to permanent loss of sensation and feeling in the affected area for the rest of the patient’s life).

The good news is that most studies report that people are generally happy with the outcome of cosmetic procedures (although arguably, rigorous evaluation has not been carried out). The results of empirical research have tended to conclude that more extensive (“type change”) procedures (e.g., rhinoplasty) appear to require greater psychological adjustment by patients than “restorative” procedures (e.g., facelifts). Cosmetic surgery patients who have unrealistic expectations of the operation’s outcome are more likely to be dissatisfied with cosmetic procedures.

Dr Mark Griffiths, Professor of Gambling Studies, International Gaming Research Unit, Nottingham Trent University, Nottingham, UK

Further reading

Castle, D.J., Roberta J Honigman, R.J. & Phillips, K.A. (2004). Does cosmetic surgery improve psychosocial wellbeing? Medical Journal of Australia, 176, 601-604.

Phillips, K.A., Grant, J., Siniscalch,i J, et al. (2001). Surgical and non psychiatric medical treatment of patients with body dysmorphic disorder. Psychosomatics, 42, 504-510.

Sarwer, D.B., Wadden, T.A., & Pertschuk, M.J., et al. (1998). Body image dissatisfaction and body dysmorphic disorder in 100 cosmetic surgery patients. Plastic Reconstructive Surgery, 101, 1644-1649.

Suissa, A.J. (2008). Addiction to cosmetic surgery: Representations and medicalization of the body. International Journal of Mental Health and Addiction, 6, 619-630.

Veale, D., De Haro, L., & Lambrou, C. (2003). Cosmetic rhinoplasty in body dysmorphic disorder. British Journal of Plastic Surgery, 56, 546-51.

Veale, D. (2000). Outcome of cosmetic surgery and ‘‘DIY’’ surgery in patients with body dysmorphic disorder. Psychiatry Bulletin, 24, 218-21.

Veale, D. (2004). Body dysmorphic disorder. Postgraduate Medical Journal, 80, 67-71.

Veale, D., Boocock, A., Gournay, K., et al. (1996). Body dysmorphic disorder. A survey of fifty cases. British Journal of Psychiatry, 169, 196-201.

von Soest, T., Kvalem, I. & Wichstrøm, L. (2012). Predictors of cosmetic surgery and its effects on psychological factors and mental health: a population-based follow-up study among Norwegian females. Psychological Medicine, 42 , 617-626