Difficulties conceiving, becoming pregnant, and maintaining a pregnancy during fertility treatment

Megan describes the ‘mind game’ of looking and feeling pregnant because of the fertility medications she took while going through IUI or IVF. After finding out she was not pregnant, getting her period provided a ‘strange release’.

I think the main one for the first IVF cycle, where you are stimulating your body to grow lots and lots of eggs, was the bloating. I caught sight of myself side-on in the mirror, and ended up taking a photo, because I was so astounded at just how bloated my belly was. I still have that photo, and I look like I’m four months pregnant, I think, in that photo. Three or four months pregnant. There’s a definite swelling in my abdomen, which is a strange thing to look at in the mirror, because at that point, you’ve imagined what it will look like, to be pregnant, to feel pregnant; and to look in the mirror and know that you’re not pregnant, and you’re preparing – hopefully – for a pregnancy, if everything goes well… But to see that in the mirror, and to be feeling what you’re feeling, is so strange.

I think that’s the other thing that’s challenging about the medicine that you’re on, particularly in the second half of the cycle, either after insemination or after you’ve had an embryo transferred; is that some of the medicine that you’re taking, some of the hormones that you’re on, do mimic symptoms of early pregnancy. So the fatigue, the nausea, sometimes dizziness and headaches. These are all things that are often mentioned in early pregnancy, and that can be hard when you’re hoping that they’re pregnancy symptoms, but knowing that they’re probably the drugs, and trying not to read too much into it. It becomes a bit of a mind game, I think. And you’re just waiting for that blood test.

The hardest thing is when you find out you’re not pregnant, and it can take a few days for the drugs to leave your system, so it can take three to five days for your period to start, even though you know you’re not pregnant; and that’s a really strange period of adjustment, because mentally and emotionally, you know that you’re not, and you’re dealing with all the effects of that; but physically, your body is not at the point of having a period, of letting go. There’s something strange, at least I’ve found, in that three-to-five-day period, where your body hasn’t physically let go, and it’s a really strange and difficult period, and I have found that the first day of the period is actually a strange release. It’s like your body is now finally catching up to where your head is at. It’s really strange.

When Ingrid was in her early 40s, she and her ex-partner experienced age-related secondary infertility. Ingrid recounts their experience of undergoing IVF without reaching the embryo transfer stage.

So from there, I went through three cycles. So the first, they were able to collect five eggs, so I was quite hopeful, but unfortunately, none of them survived to the transfer date. The second cycle, I did approximately three to four months later. They were only able to collect one egg, even though my fertility specialist thought that she could see approximately three to four. So I went in with one and it was a bit depressing. They kept saying, “Well, it only takes one, maybe.” I thought, “Yeah, well it’s still only one, isn’t it? It has to be a super egg and some super sperm going with it.”

I received a phone call a couple of days later from my specialist and she said, “It looks promising, that one egg,” and this is where some of my subsequent disappointment and just feeling down about the whole process came from, is that one egg was going really well. On day three, I was due to go in for the embryo transfer, and just as I was at the front door at home the phone rang, and the fertility specialist said, “You can’t come in. It didn’t make it. Overnight, it didn’t make it.” So that was quite depressing for me and that’s why I didn’t go into my next cycle straight away.

I had to take some time off. I was just upset. I wasn’t mentally in the right space to go straight into another cycle. Perhaps it would’ve been better if I did, but my specialist did say that sometimes there is some proof that if you go straight from one cycle into the next… Because your body is, I guess, used to the process, it’s used to being triggered, if you like, by the drugs on a monthly basis, and it’s preparing itself, it’s being stimulated. It’s preparing itself for perhaps a pregnancy. Maybe it would’ve been better for me to not wait until I was… Felt like I was mentally capable to go down the IVF path again. Anyway, it is something that I discussed with the fertility specialist and, unfortunately, the third time around, it was disappointing. None of the eggs wanted to cooperate [laughter].

Andrea was unable to conceive, even through IVF, due to uterine fibroid disease. She shares how, emotionally, having a hysterectomy was a relief. Later, she and her husband had a child via surrogacy.

I’d say I am super lucky to have a lot of people that are genuinely caring, thoughtful people in my life, and I love the way they were there for me. I’m really, really lucky. I think probably the bigger impact was the fact that because this consumed me for so much, for so long, it just felt like our friendship was not balanced, because there was always something going on in my life about this.

And I think they felt awkward sometimes, about what to do or say, because they had children, and they knew I couldn’t get pregnant. They’d invite me to birthday parties, or baby showers, but equally say, “Don’t worry, we completely understand if you don’t feel comfortable coming.” Again, really lovely, and then I could make that decision based on where I was at, at that particular part of my medical life, but there was just that undertone, that can just change things.

And I also think that it was hard, because of what my condition was, and the likelihood of pregnancy was so kind of low, it was a really heartbreaking space to be sitting in all the time, whereas if I had had a horrible accident, and lost my uterus, or had a horrible disease and lost my uterus, or was born without a uterus, or whatever, you’ve got really clearcut facts. It’s still tragic, it’s still difficult, and I’m not begrudging anyone saying that their experience isn’t as horrible as it would have been, but you have an end point, you have a very clear, definite moment that says, you cannot have children, there you are. Whereas the grey that I faced, trying, and working with such low odds, for so long, was just killing me. It’s why I was so relieved when the hysterectomy happened. I’m like, ‘Finally, my end point,’ you know?

Marika’s first IVF cycle led to an ectopic pregnancy and emergency surgery, and occurred at an already difficult time for her and her partner.

I then had my first cycle of IVF. And that, I can’t remember, it went quite well in terms of, I had number of eggs from that, then a number fertilised. I had my first transfer then was told that was unsuccessful. Then about nine weeks later, I was in the most excruciating pain.

And it was a very difficult time because my father-in-law had just died and we were out shopping to get something to wear to the funeral and I couldn’t walk. I was in so much pain. So my partner went and got the car, drove me to a medical centre because it was on the weekend and that was all that was open. Told the GP there that I’d been trying to fall pregnant and she didn’t touch my stomach, asked very few questions and then prescribed me with some medication and said, “So it sounds like you have a urinary tract infection”. So she gave me this medication, I got home, read the back, it said, ‘Do not take if you’re trying, if you’re pregnant’ or something.

And so anyway, I took this medication and a few days later I was still in so much pain and my husband said, “You have to ring, my GP, our GP, and go and see her”. I got in to see her. She checked everything, but she didn’t think I might be pregnant until after I left. And I was in the car driving back to work and she rang and said, “After you left, I just had a thought and,” because I’d done a urine sample. And she said, “I just thought, I’d check to see if you’re pregnant”. And she said, “You are!”. But she said, “You’re going to have to go and get an ultrasound straight away. I’ve already rung the clinic and you have to go”. So I’ve got to work and then had to say, [laughter] “Sorry, I have to go again”. So then I went to get my ultrasound .

I was pregnant but it was an ectopic pregnancy. So I had to go straight and have emergency surgery. And had my fallopian [uterine] tube removed. And it was very serious and because it hadn’t been treated or picked up when I first went to the GP, it was very high risk. And I was told I was very lucky to have come through. So that was a big shock and not a pleasant time at all. So it was a very complicated time because we were in a stage of grief, especially for my partner, with losing his dad and then dealing with that as well.

Melissa did five rounds of IVF, each time conceiving but then miscarrying at around 6 weeks. She reflects on the emotional impact of her miscarriages and the lack of answers for why they kept happening.

Melissa: A couple of years later I tried many more CLOMID [clomiphene citrate] cycles, before finally succumbing to IVF. I did five rounds. I miscarried each time. And at the end of that year – I was still going to try for one more year – and at the end of that year I was diagnosed with a hyperplasia lining of my uterus, and that pretty much sealed it. My doctor said, “Well there is something we can do to suppress that and you can try again,” but my marriage had fallen apart right at that point. He was leaving me because I wasn’t going to have a baby, he had a plan, he was leaving and so I pretty much decided, ‘Well this is the end of it all now, it’s all over.’

I think the first one was the most disappointing and then the third one was as well. Because there was something a little bit, something felt a bit special about that one, that was my best embryo, it was what they call a blastocyst and that one, that one really hit me very hard for some reason. And the other two, I think the fourth one I was told that the grading of the embryo wasn’t too good, so I had a feeling that may not have lasted. And then the fifth one, I’d kind of reached the point where, ‘Ah it’s just not going to work either.’ I became, I guess, a little bit numb to it.

Interviewer: And so at what stage of pregnancy were you miscarrying?

Melissa: About six weeks actually and that is typical, even if I’d had a couple of times where I did conceive naturally several years before and it was always around the six-week mark.

Interviewer: Once the doctors started to realise that, what kinds of potential explanations were they giving you for that?

Melissa: No explanation given actually and it wasn’t until I did the third cycle of IVF that they did further testing. That was a blood test that involved so many things and that’s where it was picked up that I had these elevated natural killer cells and also an indication of lupus, but no explanation at all as to why I had that problem.

I even tried to query my doctor. I tried to query my doctor later on as to why I might have had that and I even linked an issue with my mother who had a very rare blood disease. And I said, “Is there any way that that could be linked to what I’ve got?”. But, that’s a rare condition and what the natural killer cells within a woman are also not very well researched so I’ve got no chance really of getting an answer, and I’d like one.*

* There is currently no evidence for immunological tests and treatments for infertility. To learn more please visit Immunological tests and treatments for fertility | Human Fertilisation and Embryology Authority (hfea.gov.uk)

Before her first successful IVF pregnancy, Chelsey experienced a ‘devastating’ anembryonic pregnancy (blighted ovum) at seven weeks.

So we finally started having IVF and I found out on my first round of hormone treatment that I’d only produced three or four eggs. I think it was three this time, which was quite devastating when I’d realised that other women who go through this got seven, eight eggs and they were actually able to freeze some embryos. In my case, that was unlikely and whether or not they were actually going to be healthy. So that was quite sad. So my husband decided, because we’d only got the three eggs, not to continue that treatment and to stop it there.

So I continued on the next cycle straight away and we were lucky enough to get four eggs. After the 24 hours we had two embryos, so I went in to get them placed inside, and they – when you were looking at them on the screen, I could see that there was only a couple of cells, so I was very nervous about this. I had a good feeling that maybe we weren’t going to have success again.

So I went and had the blood tests a few days later. I was very careful those couple of days. I didn’t want to do anything just in case I dislodged something. Anyway, it did show up that I was pregnant, and within a couple of days I actually started feeling very ill, very toxic inside, like I was probably equivalent to on chemo, not that I’ve had chemo, but I felt very, very ill and very sick, so I thought things weren’t going right. That was quite isolating again, very devastated really because I thought things aren’t going right, this isn’t a normal feeling of morning sickness that people describe.

At the six-week ultrasound there was signs of a developing baby. I could see the shape of a little jellybean, and the sac, but yet these feelings felt, I was feeling quite ill still and there was no heartbeat, which again was a bit, my heart just dropped. So doctor said, “Let’s scan you again next week.” So I went back in on the seventh week and actually there was still no heartbeat and the formation of what was possibly the baby was no longer there, so I was left – all you could see was the blighted ovum.

So of course, that was very devastating, and I was thinking what could I do more, what could I do better, eat better, relax more, do more, just all these thoughts going around in my head. Again, that took some time to get over emotionally, but I still thought, no, I’m on this rollercoaster now, I need to just keep chugging forward. So even though we went into the next round of IVF, I was still mourning the loss of the previous pregnancy and wondering if this was ever going to happen.