AssistedConception.org

Introduction

Throughout the last 10 years I have come to terms with infertility and our journey into fertility treatment. It has been at times, an emotional roller coaster and an experience that has left me feeling empowered, educated and confident with our life choices. I can say with honesty that what has shocked and surprised me most throughout, was not my diagnosis and treatment, but the way in which people close to me have dealt with this. Some have surprised me in a very positive way, some more negatively, and other than the most obvious, this can often be one of the most difficult things to deal with, particularly during fertility treatment. As ironic as it may seem, our lives have been changed in some special way, with all that we have endured. Had we not been through all that we have, I would never have met so many caring and special people who have touched me in a way that I will cherish for all of my life.

Diagnosis
I began my periods when I was 16 and from day 1 they were painful and irregular. I thought this was normal and lived with it. By the time I had reached 18 things had got much worse, the pain just before and during the first 4 days of my period was debilitating and I had no idea when my period was due and this was making life difficult for me. As young as I was at this time, I was very concerned about my prospects of having a child, something that was more important to me than anything else I could ever imagine. As a biology undergraduate, I knew too well that it was unlikely anyone could conceive with the kind of menstrual cycle I had. It was either too frequent or absent.
I consulted with my then G.P, who was very caring and understanding and who immediately referred me to see a specialist gynaecologist. My experience with the Gynaecologist was not a particularly positive one. On physical examination and clinical presentation I was diagnosed with mild Endometriosis and treated medically in the first instance. Things did not get better and laser surgery was my next option. As things progressed, I had 5 years of laser treatment (4 in total) and hormone treatment to control what was then discovered to be moderate Endometriosis and Poly Cystic Ovaries. As an 18 year old it is extremely difficult to verbally communicate your concerns about fertility and be taken seriously by the medical profession. However, as I was well aware that the condition is related, as yet in an unexplained fashion, to infertility, I was prepared for what the future may hold, and although this has caused me great emotional stress at times, it also allowed me to be in control of what was to happen over the coming years.
A new consultant, whom I was referred to, as I was unhappy with my current treatment, completed my last laser laparoscopy. The words “when you decide you want to start a family you will have to come back and discuss this with us” were finally uttered. By now I knew I would need fertility treatment, so it was no great shock to me and in fact it was an enormous relief that it was no longer something which I was never completely sure about. I now felt that I could move on.

Deciding on treatment and Meeting our Consultant

My husband and I were married in September 2000 and a tiny part of me was still dreaming about becoming pregnant naturally, after all it’s not unheard of. My husband has known of my condition and what this meant from day 1, I had felt obliged to tell him and he was fantastic, he loved me, not a child we didn’t have. However, I found the topic of having a baby very difficult to discuss with him. Whenever I asked him if he wanted to have a baby, he always avoided the conversation or said, “we’ll just see what happens”. I knew then as I know now that he was only trying to protect me and did not want me to feel pressured if it was never to be. He did however suggest that I go and speak to a private physician about my Endometriosis as it was as bad as ever and I had went 3 months without a period.

I was given a referral by my G.P and I met our consultant on the 4th April 2001 when I was 26 years old. We discussed my case history, and it was as if he read my mind, but of course he did not, he had just met so many other women in my predicament. He openly asked me if I wanted to start a family, and this was really the reason why I was there. I had a physical examination and on presentation things didn’t seem too bad, so we would consider our options after a few tests. I would have to have the standard tests to check if I was ovulating (LH surge) and if so they may consider some clomid and then see what happened. My husband would have to have a semen analysis and I was very nervous about going home to first of all, telling him what we had decided without him even being there and second of all, presenting him with this little plastic tub! He was - as he always is – brilliant about it, and we laughed - and I cried - all night about it. It was finally going to happen, I was going to have some real hope of having a baby.

Our Treatment

Our tests were carried out very quickly, within a few weeks of our initial appointment. My results were not good; I was not ovulating or did not appear to have ovulated on the two occasions when they tested. This meant clomid was not an option and as I had thought, it would be IVF. We awaited my husband’s semen analysis and expected all would be fine, but we were to be struck with yet another blow. His sperm count was on the low side, at first I thought nothing of it really as we would be having IVF anyway, and this is honestly (I think) how he felt. In some ironic way I think he felt he was taking some of the pressure off me. It turned out that his sperm count was too low for IVF alone and we would have to have IVF with ICSI (Intracytoplasmic sperm injection).
Due to my irregular cycle we were able to specify our treatment start day, it would usually be day 21 of your cycle. We decided to start in June 2001 and that would give us time to have all our pre-IVF health checks, Hep, B, C, Rubella, Smear tests and now HIV testing completed. Awaiting all these results was quite nerve racking even though I was pretty sure there was nothing wrong with either of us, I was till waiting for something to get in the way. All was well and we commenced our treatment.

The Up’s and Down’s of fertility treatment

I can honestly say that on the whole the treatment was OK. From Down regulation (when all your natural hormones are suppressed using a nasal spray or monthly injection) to embryo transfer, it took just 4 weeks. It took about 11 days until I was down regulated and then I began my injection and again about 10 days, then the hCG booster was administered 36 hours before egg retrieval. We got 8 eggs. The egg collection was fine I slept through the whole thing and pretty much the rest of the day. 5 eggs fertilsed but only 2 were viable on day 3. We had those two embryos transferred and we were happy with this.
At times during our treatment I felt a bit lonely, I did not at that time know anyone else who had been through fertility treatment and sometimes I found it difficult to express my concerns about the outcome with my mother and brother as this is just one of the areas of fertility treatment that people find difficult to deal with. They also were not fully aware of what was happening when and this was a decision that we had made, in order to take the pressure off. No one else knew what was going on, and I also felt that, was the treatment not successful, no one would know what had happened. I would feel like I had lost a baby and I would have to continue as normal. I also developed OHSS, Ovarian Hyperstimulation syndrome toward the end of my treatment and this was very uncomfortable and worrying as I thought they might abandon the cycle. Luckily they did not and my injections were stopped as soon as my symptoms appeared. I drank lots of water and had plenty of rest and the pain and bloating subsided.

We are expecting a baby

The next 2 weeks were long we were both excited and anxious. We tried to remain very positive. Our clinic provides the facility of guided ultrasound during your embryo transfer and this enabled us to see the embryos being replaced into my womb. I felt immediately attached to this tiny part of us. I know that this is not an experience that every woman going through fertility treatment of this nature is comfortable with, as if the outcome is negative they may find it even more difficult to come to terms with. I however took the positives from it and sincerely think that it contributed towards my positive frame of mind. We talked about pregnancy, babies, what it would mean, how our lives would change and we even talked of baby names. We believed we would be parents one day, if not this time then it would happen for us eventually.
We discussed doing a pregnancy test before returning to the clinic on our outcome day, and we eventually agreed, barring all superstitions, that we would rather be prepared for the news, particularly if it were to be bad. Our outcome day was 8th August. The day before I was out walking and suddenly had a wave of nausea. I was intending to buy a test anyway and I returned home and decided to do it. I felt a bit guilty that my husband was not home, especially when it was POSITIVE! I couldn’t contain myself, I had to call him and tell him that we were expecting a baby. We were both so happy we couldn’t quite believe it. I did 5 pregnancy tests in total – just to be sure. All the staff at our clinic were thrilled for us and we can never thank them enough.
I had some early bleeding at about 6 weeks accompanied with pain, I was devastated, and we thought we had lost our baby. I was scanned (as practice in IVF) at 7 weeks our scanned showed 2 embryo sacks, which probably explained the early nausea. One was slightly smaller than the other and they were not sure that it would continue. We were referred to the twins’ specialist at our maternity hospital and I was told to have plenty of rest. At 9 weeks, I had more abdominal discomfort and was admitted to the early pregnancy unit. Our scan now showed 1 developing healthy baby and the remnants of the other embryo sack. We felt a little sad and I do sometimes wonder what this baby would have been like, but the news was not unexpected and we were over the moon to see our baby waving at us on the ultrasound scan – it was to be an active one.
After an eventful pregnancy from sickness to symphysis pubis dysfunction, we gave birth to a beautiful, healthy baby girl in April 2002. She is the most precious thing in the world to us and we are so grateful for every day that we spend with her.
We have recently had an unsuccessful attempt at IVF with ICSI in July of this year and we are now awaiting the outcome of another cycle. Our second cycle was very different and much more difficult emotionally and physically than before. I believe that no treatment cycle will ever be the same as another. On a positive note, my family are now always aware of what is happening as I am more comfortable discussing it and they have been much more supportive, particularly my mother an brother.
We desperately want to have another baby and a brother or sister for our daughter but if it is not to be, she will always be much much more than we had ever dreamed of and we cherish her for that.

Since writing this article for the Serono Patients website, we have since been through 2 unsuccessful cycles of ICSI and eventually another successful cycle. Baby James was born in December 2004. read case study - Fertility Treatment for a Second Child.

Good luck to everyone tryng for 1st, 2nd or even 3rd pregnancies.
Sam MacCuish
Cradle Editor