Inside the fertility clinic: sowing the seeds of love
In the first of our six-part Starting a Family series, Catherine Conroy looks at how, for some, the dream of having children is one that can falter at the first hurdle: fertility
Alison Reede and Neill Carroll pictured with their twin daughters Meghan (left) and Gemma aged 2. Photograph: Aidan Crawley
Lisa Freeman and our son Charlie Gilmour.
Anne McCabe. Photograph: Nick Bradshaw
It is a dull Sunday morning in January and, in a hotel conference room in Dublin, men and women are filling their coffee cups and leaving their coats on. This is an information morning hosted by the SIMs fertility clinic. For the next three hours, a series of professionals and patients will speak on the hows and whys of fertility treatment. Anyone who attends gets a half price follow-up consultation. The room fills up quickly.
Couples sit closely together, whispering to each other when a consultant says something that aligns with their own story. Some women are alone and almost all are taking notes. The couple behind me is discussing cost; the State funding available in other countries. Ireland stands with Lithuania as one of the only European countries that has no such help, although election promises are now being made.
There is plenty of gentle joking to ease the tension. “Some sperm is Usain Bolt, and some is Homer Simpson.” There is a short black-and-white video of sperm mobilising towards an egg set to the Ride of the Valkyries. Dr John Kennedy jokes that the men have been “dragged here” at the behest of the women. They haven’t.
Kennedy speaks carefully, reluctant to give any worrying statistic that might ring for days in the ears of anyone attending. The emphasis is placed on the individual circumstance. It is not always the woman, not always the age. Although he refers to the halcyon days of our 20s, when we were all “young and immortal”.
When it comes to women in their 30s and babies, the media and the medical profession are very worried about us. We are not being realistic, they say. We’ve lost the run of ourselves.
Women generally know that it is more difficult to get pregnant the older we get. Mentioning this article to a friend, she said “Oh God. Please don’t write one of those pieces that says the only real treatment for infertility is a time machine.”
I am sitting in a small room with Dr Eithne Lowe who has been with the Galway Fertility Clinic for 15 years. I tell Lowe about my concerns about media coverage and how I want to write something less alarmist. “So not the truth you mean?” she says, in a gentle mocking tone.
“As I say to everyone who comes in to me, I am going to treat you as an individual, I’m going to work out your individual number [of eggs] and then we’ll see how we go.”
There is no way of knowing with any certainty what your position is until you start trying for a baby. However, when she looks at IVF success rates, “there’s an obvious cut at 38 where you can see it starts to head down”.
“If you’ve no reason for not getting pregnant after 6 months, maybe that’s the time to have a bit of a check just to see what your numbers are.”
There are things people can do to help themselves too and they are the usual obvious – and difficult – things.
“You have to stop smoking. You have to get your weight normal. You have to get your exercise as well as you can.
“Not everyone can get their weight down but you can build up your body muscle. Smoking will bring forward your menopause by about three years. Cigarette smoking damages the eggs.”
And for male smokers? “It’s very hard on the quality of the DNA in the head of the sperm. And if men are heavy smokers it increases your risk of your baby having leukaemia. Men don’t think what they do matters, but it does matter.”
Just as every radio ad about babies is addressed solely to “mums”, matters of fertility are often directed at women alone. However, 30-40 per cent of infertility issues have a male factor, usually low sperm count. The other main causes are endometriosis, polycystic ovaries and “around 30 per cent would be unexplained”.
I ask Lowe if she thinks IVF use will increase drastically in the future. She believes the greater increase will come in the number of people using donor eggs from a younger woman. “Once you hit 43, 44 and you can’t get pregnant on your own, women do egg donation.” The majority of patients travel abroad for the egg donation, often to clinics in Prague and Spain.
“On paper, the cut off age for IVF is 43,” says Lowe, “but in real life I tell them at 42: ‘are you sure you want to do this?’ If they have the money at 46, and don’t mind losing the money for a 2 per cent chance, we’ll do it for you, but for pretty much the same amount of money you can do egg donation for a 60 per cent chance.”
The hardest part of her job is telling people to stop, she says. “People will cling on to every hope, but if you’ve very poor embryos what do you say to people? Part of it is to help them to reach that decision.”
The IVF patients I speak to highlight the importance of researching your clinic. Lowe agrees. “The clinics are very different in their ethos and the way they run things. Price wise, there’s a different pricing structure.”
Galway Fertility Unit is “all-in” with a basic price of about €4,700/€4,800 (per cycle). Lowe says other clinics may have a basic price of €4,500 but they might offer you additional services that will increase your chances as your treatment goes on.
For example, ReproMed Ireland which has fertility clinics in Limerick, Kilkenny and Dublin, quotes €4,500 on its website for IVF, standard treatment. Beacon Care Fertility in Dublin quotes €4,500 for one IVF treatment cycle (including scans, theatre charges, anaesthetic for egg collection and review consultation).
“We would say our average success rate is 55 per cent,” Lowe says.
“When I started it was 18 per cent; 55 per cent is pretty good and what we do when we’re presenting our figures is we divide it into IVF and ICSI (see panel, page 15), so is there a sperm problem, is there not? When there’s a male factor, the success rates are slightly lower than if it’s standard IVF.” Age and lab facilities also have an effect on successful outcomes so it is important that people look closely at success rates. There is no getting away from the issue of age and Lowe says women should be realistic.
“I would be wrong to say wait until you’re 40. I had a 38-year-old who came in to do her AMH [Anti-Mullerian Hormone test – a measure of ovarian reserve] and she said ‘I just want to know what my egg count is like because we’re building a house so I’m not planning a baby for the next two to three years’. I said, ‘41, you are joking?’
“Some of it is the money. I’ve had couples who’ve saved for three years to afford the IVF cycle, from 39 coming back at 42: ‘We’ve got the money, doctor.’ And I can’t say, we won’t do IVF now because you’re too old. You’ve got to get the information. I can’t please everybody so I have to say it the way I see it.”
Lisa Freeman got married in 2006 and started trying to have a baby in 2007, when she was 35 years old. They tried for two years.
“I know they say if it hasn’t worked for you within six months you should seek medical help, but I was nervous we were going to need intervention because I hate people poking and prodding at me.” She cautions others to act quickly, as she believes her delay may have prevented her from having the time to have a second child.
In 2009, Freeman was put on the fertility drug Clomid, which she says was “horrific. I felt like I had gone insane.” She acknowledges that “not everyone has that experience; I know loads of people who thought it was fine.” The next course of action was IUI, “It was so invasive to me which is my biggest problem.”
Freeman had a fear of physical examination that was tantamount to a phobia, something she felt was overlooked by her first clinic.
Between attending the two fertility clinics, Freeman discovered she had endometriosis, “which the first clinic never looked into”, despite her displaying “classic symptoms”. She also had a progesterone deficiency. She went on to have two lots of surgery for her endometriosis.
She was about to turn 39 and was told her best chance now was IVF. “I cried the whole way home in the car. IVF is even more invasive than IUI – I didn’t know if I could handle it”. She also felt guilty “that I was preventing my husband Simon from becoming a dad because I couldn’t deal with the fertility treatment”.
Her consultant suggested sedation for the egg collection and transfer, and valium for scans. She felt listened to. “When people say you need to pick your clinic carefully, I couldn’t reiterate that more.”
Freeman’s son Charlie interrupts us briefly to tell her something. “Our child is an absolute miracle,” she says. “I know everyone says it. It was our first cycle of IVF and we had one embryo.”
The monetary cost was €30,000 in all. “It was never an issue to not be able to afford it, which I can imagine is happening all over the country. Overall the success rates aren’t brilliant. It is a big gamble.”
“I was a honeymoon baby,” says Alison Reede, “and I assumed I’d have one. I come from a very fertile family, sisters, cousins, my mum’s sisters.” Reede got married in 2009 at 35 years old. The honeymoon baby didn’t materialise and after six months, the couple made an appointment with a fertility clinic. Her husband had been treated previously for testicular cancer and it was on her mind, even though “he was treated very quickly with no radiation or chemo”.
“I was 36 at this stage. On the face of it I presented as healthy from a reproductive perspective and general health, I’m not a smoker, I had a regular cycle.”
She describes a period of watching and waiting between tests and appointments, and all the while still trying to conceive naturally. She remembers the red-letter day when they met with the consultant. “There was challenges on both our sides. We both had some factors.”
The consultant told them: “You’ll never conceive naturally”.
“When I heard that, my heart was just racing. And I remember he started listing out adoption and all the other paths to parenthood. And I was thinking, that’s not in my plan.”
She says they were both left traumatised. “From the receptionist through to the doctors, it was just so impersonal and this is a massive life ordeal for people.”
She went to a different clinic, seeking a second opinion. They were received more hopefully so they started with IUI. Reede got pregnant on their third attempt.
They collected a good number of eggs and switched to IVF. “I was like, brilliant, job done.”
She had her first scan in the Rotunda at 12 weeks. She had had a missed miscarriage. It was “soul destroying” so they took two or three months out, but soon Reede wanted to get back to it. I ask her if she considered stopping at any point. “No. I just could not see my life without kids.” She took hope from the fact that she had at least gotten pregnant for the first time.
“At the fourth IVF, I said ‘hold on a second I have to take control here’. I think I’d gone in saying ‘I’m in the right place now, I’m going to put my feet up and they’re going to get me pregnant’ and I had disengaged a little bit. Eventually I thought, ‘no, I have to control this’. I said what other tests can you give me. They said, they’re so expensive. And I said, take money out of it, what would you give me?”
Reede availed of tests called “Chicago Bloods” [A test that looks at whether or not the body is hostile to embryos, so named as they were traditionally carried out in a Chicago medical facility ]. “They have to go off to America, hence the cost.
“We’d taken loans out at this stage and we’d two good jobs – I took money out of the credit union. We weren’t going on holidays. You’re not living your life. I wasn’t going out anymore, socially, no interest. I was just focused. I tried to avoid any social events I could because you’re afraid someone’s going to say they’re pregnant and I don’t know how I’m going to react.”
The consultant advised trying a hormone drug called DHEA to boost the quality of her eggs. But her fifth IVF cycle didn’t work. “I said to my husband, we’ll do one more round but I can’t physically do it any more. I cannot physically or mentally do it any longer. I’d kind of made my peace.”
The last round was successful. “I was pregnant on my 40th birthday.” Reede and her husband have twin girls now, Gemma and Meghan. “Two heartbeats. I can tell you, the tears that day,” she says.
With all she has experienced, she decided to help other women in a similar situation and now works as a life and fertility coach. “It’s a mind-body holistic approach. So that’s what I do now, I support women on a one-to-one basis.”
She believes the mental health element is underestimated. She talks about mental fitness: “stamina, agility, adaptability. You never know when you start out how long this IVF journey is going to be. You have to learn to walk hand-in-hand with it rather than see it as the enemy and something you have to conquer.”
Anne McCabe married in 1996 at the age of 26. Having come off the pill for a few months, there was no sign of her natural cycle returning. Doctors reassured her; she was still very young, but a year went by. She asked to be referred to the Rotunda Hospital for investigations. “They were quite reluctant because of my age. They encouraged me to go back on the pill but I wanted my own body to kick in, everything natural. I kept pushing for investigation.”
She was eventually advised to begin IVF. She got pregnant on her first attempt. “I was overjoyed, ecstatic.” Then, at her six-week scan, she found out she was miscarrying. “It was heartbreaking.”
She had a second IVF treatment and an embryo transfer. Both failed. “I put myself through a third attempt at IVF. I was bruised and emotionally and physically drained. I knew I wouldn’t get pregnant because my body wasn’t able for it.”
By chance, she was watching The Late Late Show with Pat Kenny (“that’ll show you how long ago it was”) who was speaking with a fertility consultant. Her mother rang and said, “I think you should ring this doctor.”
The consulant was Dr Phil Boyle. She immediately felt a rapport. “I’m after finding someone who understands what I’m going through. I explained my symptoms. I had no periods, I was failing to ovulate. He said, ‘I think I can help’. And to hear those words. Because I was told IVF was my last attempt at having a baby.”
Boyle had trained in the US and was familiar with McCabe’s condition straight away: hypothalamic amenorrhea.
“Finding someone who was interested in finding out the problem rather than bypassing it was just amazing. And I said to my husband, ‘Right. We’re packing our bags and we’re going to the US to have all these tests done.”
Within months she had a confirmed diagnosis, which she says was a massive relief. “I had to wear a pump which mimicked the hypothalamus and contained the drug that I needed (GnRH)... And I had to wear it 24/7.”
Her natural cycle started again and she wore the pump for three months. “Once my period stopped, it didn’t even register with me that I was pregnant because I couldn’t believe it, because it was just ‘no, it can’t be’. I didn’t want to do the test I was so scared. Josh was born on my 30th birthday. The best present I have ever received.” McCabe has had two successive pregnancies, using the same procedure again.
It is quite difficult to get men to speak openly about their involvement in the fertility treatment but Fred Rainert is a gregarious character at ease with speaking about his personal life.
He married Orla in 2004. “We met late in life,” he says. He was 37. “It does make a difference when you meet later in life and get married late.” They conceived on their honeymoon but then miscarried early on. They began IVF after about a year.
“It’s horrendous to see the changes that your partner goes through on a physical level because of the hormones that are injected and what that does to the body. The bruises she was incurring from the injections, they didn’t go away because it was nonstop for months.” Rainert hated telling his wife the results of negative pregnancy tests. “I’m the one who looks at my wife in the bedroom who just breaks down crying. And that’s what I don’t like dealing with, imparting that pain.”
The couple did eight IVF cycles before having a child, Leo. They had stopped some time before but had two frozen embryos for five years. His wife said she couldn’t let them go. The couple had been through the adoption process in Russia, which had fallen through. Then they started the fostering process. His wife was determined. But he remained sceptical about the embryo transfer.
“I didn’t appreciate the odds against us. But with her desire to go ahead and her need not to destroy the two embryos, and from that we have Leo our son so I can’t knock it. The clinic was right.”
Leo was born in November 2014 and the couple recently received more good news, “Orla is pregnant again.”
Rainert advises men in a similar position to “keep your mouth shut. Keep your ears and eyes open. Be as supportive as anything. When it works, it pays dividends.”
“The whole process has cost me €56,000,” he adds. “And you can put that in big bold writing.”
Starting a Family: Pregnancy will appear in the Saturday Magazine on March 19th