Age at interview: 39
Infertility diagnosis: Yes (secondary infertility)
Contributing factors to fertility problems: endometriosis and adenomyosis
Age at diagnosis: 32
Fertility treatments: ovulation induction, surgery for endometriosis, IVF, pre-implantation genetic testing (PGT)
Background: Kate works part-time as a teacher. She lives with her husband and two school-aged children in a metropolitan city and is Australian.
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Trying to conceive and first seeking help
When my husband and I got married, that was 2012. I came off the pill just before we got married because we knew we wanted to start a family pretty soon after. So we started trying straight away and I also started tracking my cycle and things like that. But we were having no luck. So months were going by and nothing was happening. As time went on I started to suspect that maybe I might have a little bit of endometriosis, just based on some of my symptoms. There was not much prior to that to give me that indication but I guess the pill kind of masks those sort of things.
So as time went on I thought, ‘I'm not going to waste time,’ because I was - let me think I think I was 31 when we got married. So being in my 30s I knew time was precious. So went to see a hormone specialist who ran some tests and nothing major came up. Low progesterone I think came up but nothing that was really indicating why we were having trouble. Checked out my husband, everything came back fine there. So eventually he referred us on to a fertility specialist. So we started working with a fertility specialist.
The thing I've learnt about fertility is it's a really long process. So you've got - investigations take a long time right. So you know a couple of months’ worth of blood tests. You might change a different medication, a couple more months of blood tests. So once we saw the fertility specialist he decided we would try CLOMID [clomifene citrate] and see how we went. And we still weren't getting any results. No pregnancies at all. So then eventually he said, “It's time to do a laparoscopy and investigate what's going on.”
And by this point I had started to suspect endometriosis. So we went on the wait list. I think I only had to wait about three months - three or four months. And then had the surgery. I remember waking up from the anaesthetic and saying to the nurse straight away, "Do I have endometriosis?" And she said, "Yeah you do." She said, "It was all over your bowel and your bladder."
But they had told me that often a laparoscopy was enough to increase pregnancy chances. So then after that we started trying straight away again.
And then when I met again with the fertility specialist, by this point we had been trying for about 18 months. And I'd probably hit my limit and I said to him, "I want to move straight to IVF." I'd met with one of the doctors at the hospital for the post-operative check-up and she had suggested that given that I'd had a diagnosis of endometriosis I needed to act really quickly. Her advice was, "This grows like a weed so you need to jump straight to IVF. Don't stuff around."
So I went back to the fertility specialist, said, "All right let's move ahead, let's start the IVF process.” So of course more waiting. We began that process, more investigations. You know you've got to do couples counselling. All sorts of things are involved in getting that process started.
Becoming pregnant with the help of ovulation induction
Then I was due to start injecting - you start injecting day one of your cycle, so my cycle was due that week. But it didn't come. And then the fertility nurse rang me on, it must have been the Friday - my period should have come by the Wednesday and it hadn't and I just assumed it was stress-related. And then she said to me, "Can you just do a home pregnancy test? Just to check." Which I thought was ridiculous because by that point I'd done so many home pregnancy tests. And it was positive, which was just the shock of our lives.
So in the end we didn't need the IVF but back then - so that would have been 2014 - no it was 2013. Back then you didn't get a refund on the medication because we were about to start injecting, so by that point we were out of pocket about four grand. I know regulations have changed on that now.
So anyway we were happy, right? It didn't matter. So we were happy just to not worry about the money at the time. And then had my son. So no complications with the pregnancy. Everything went to plan.
And then when he was 12 months old we thought, ‘We'll try again straight away.’ We knew that we couldn't muck around. Went back to the specialist. He put me straight on CLOMID [clomifene citrate] and I fell pregnant a second time, which was amazing after 18 months of trying for the first. So that was fantastic. Again no complications with that pregnancy but both pregnancies did require the use of CLOMID [clomifene citrate].
Trying for a third child while grappling with endometriosis
Then when my second child was a little bit older than 12 months, maybe about 14, 16 months, we thought we'd start trying for third. And we've been trying ever since. So no luck in that sense. After having the two boys I did notice a dramatic increase in my endometriosis symptoms.
The first surgery I had was diagnostic so there wasn't much that they did to remove it. But I did notice after the pregnancies that I was having pretty severe pain and symptoms. So eventually we decided we'd take CLOMID [clomifene citrate] again and I think we did five rounds of CLOMID [clomifene citrate]. Still no pregnancy. Went back to the fertility specialist. We thought we'd try ovulation induction [gonadotrophins via injection]. We did three rounds of that. Still no pregnancy.
Went and had a procedure done - I can't think what it was called but where they flush your tubes. Which they do as part of the surgery but this was just, you know, not under anaesthetic or anything like that. So I had my tubes flushed again but they were clear as they have been all along. Still no pregnancy.
Then I went and met with an endometriosis specialist because by this point the symptoms were affecting my ability to function daily. So we then decided we'd do another round of surgery but this time we would do excision surgery and aim to remove as much of the endometriosis as we could. We did a specialised ultrasound to check for something called Deep Infiltrating Endometriosis and it showed that I have a nodule inside my bowel.
So that's been problematic because that requires a different type of surgery. It requires a bowel resection. So anyway we made the decision to go ahead with excision surgery. That was in March of last year, so March of 2019. And that was great, it was a much more intensive surgery. Bit of a longer recovery. Had a couple of nights in hospital, that sort of stuff. But got great relief of symptoms. I felt like I'd got my life back really.
So then after that - once I'd recovered from that surgery - we started trying again. And by that point we'd been reassured that there was nothing that was showing up as to why I wouldn't be able to get pregnant. So kept trying. Still nothing. Went back to see the fertility specialist. Did another couple of rounds of ovulation induction. Still nothing. Then we decided, December last year - so December 2019 we decided we'd give IVF a go now that I'd had the excision surgery we thought that was our best shot.
IVF and thoughts about the endpoint of fertility treatment
So we began that process in December. And so far we've done - so egg collection went really well. We managed to collect 22 eggs and I think it was 19 of those that were - 18 or 19 of those were mature. We had about ten or 12 - I can't remember the exact numbers now - that fertilised. And we had - it might have been about seven I think that made it to five day old embryos. We sent a couple of those away for genetic testing. We sent three away. Two came back normal, one was abnormal so that was destroyed. And so far I've had three embryo transfers and all have been unsuccessful.
I've got one more frozen embryo to go and then that's probably about it. Trying to figure out whether or not we would proceed with another simulated cycle. Probably not, it's getting very expensive. Very time-consuming and I'm starting to feel like - well I'm 39 now, we started this when I was 36. So three years we've been trying to conceive the third child. And I think it might be just about time to get on with life. Which is easier said than done. But yeah I think that could be it.
Yeah so that's the fertility journey so far that we just haven't quite - it's been a bit of a struggle all along. Yeah.
You just assume if you've been able to have two that you can have another. I mean age is working against us now but you know three years ago I was 36 technically - and you know the tests of my egg reserve that was very high. It was higher than average for my age. We have no trouble getting eggs or creating embryos but we can't get them to stick.
Find out more about Kate’s experiences in the following short films:
Experiences of Fertility Treatment
Pre-implantation Genetic Testing and Fetility Preservation
Experiences of Complementary and Alternative Medicines and Therapies and Lifestyle Changes
Infertility and Fertility Treatment: Seeking Information and SupportThoughts and Feelings about Infertility and Fertility Treatment
Advice for Family and Friends of Someone Experiencing Infertility and Fertility Treatment