Age at interview: 47
Infertility diagnosis: Yes
Contributing factors to fertility problems: Endometriosis, PCOS, thyroid problems, complex hyperplasia
Age at diagnosis: not stated
Fertility treatments: Ovulation induction, IVF, treatment for endometriosis, thyroid problems and complex hyperplasia
Background: Marika works part-time as an academic and lives with her husband and their two school-aged children in a metropolitan city. She is white Australian.
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Trying to conceive and first seeking help
So when I was 30 it was time and my partner and I had discussed, “Yeah, let's start trying”. So I just thought, you know, everything you've heard growing up, you just have sex and next thing you know, you'll be pregnant! [laughter] So that's what we did and then it didn't happen. And I think probably after about eight months, I went and started asking around girlfriends and asked someone to recommend a good GP and someone who was familiar with these sorts of things. So I got a recommendation from a girlfriend, went to see her GP and she was like, “Oh, it’s fine. Don't worry about it. Just keep trying and come back in another year”. So that's what I did. And I didn't really think anything of it.
Being diagnosed with endometriosis and PCOS
And then two years in, I'm like, okay, asked the girlfriends again and said, you know, “This is really isn't happening.” And so another girlfriend recommended her GP and both were female GPs. So I went to see this GP and straight away very early in the conversation, she said, “It sounds like you have endometriosis and I'd like to have a look.” So off I went for an ultrasound and was diagnosed with Stage Four endometriosis and it was everywhere. The size of a grapefruit on my ovaries and my bladder, on my bowel, near my belly button, both ovaries, just everywhere.
So that sort of started further investigations and treatment and looking at alternative options. So then I got referred to a gynaecologist and again, I have a sister-in-law, who's a GP. So I asked her for people she knew and then got a referral and went to see this gynaecologist and then had my first laparoscopy then also found out I had Polycystic Ovary Syndrome.
Ovulation induction, lifestyle changes and starting IVF
So then yes, so I had different hormone things around that time. Then to start trying to fall pregnant, I then took CLOMID [clomiphene citrate] for a while, tried a few different things, started seeing a naturopath. Started having acupuncture, completely changed my diet, cut out alcohol, caffeine, chocolate, dairy, wheat, just started trying everything and anything. Still not happening.
So then we started progressing down the cycle of starting to have the conversations around IVF. By that stage endometriosis was bad, went back for another laparoscopy. Then I think 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.
An undiagnosed ectopic pregnancy
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 sort of, you know, 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, like my GP, our GP, and see her”. I got in to see her. She yeah, 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 and this was still the week where my father-in-law had died. So my partner was staying with his mum. So I was just here. So I went to have the ultrasound.
I was pregnant but it was an ectopic pregnancy. So I had to go straight and have emergency surgery. And had my fallopian 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.
Taking a break from IVF then discovering thyroid problems
So then they didn't know if it was from the IVF cycle that I fell pregnant or if it had, it was a natural pregnancy at that time. So that was that, and so then we had a little break, but we still had a number of fertilised, number of embryos. So we had a little break, but then I went to the doctors again for some other reason. And she said, “Oh, how long have you had that lump?” “Lump? What lump?” And so then I had a lump and so then I had to go and have a biopsy on that. And then they said, “We'll just have to watch and see how that goes”. So then I got sent to see an endocrinologist for that, who then sent me for another biopsy and more tests and it had changed.
So they said that had to come out straight away. So off I went and had my lump removed from my neck. So then I got put on medication for that, which I still take now. So that was that. And then they said, “Well that could have affected your fertility as well,” because of all the hormonal things. So this lump, whatever had happened, was then making my thyroid be overactive and producing too much of that hormone. So then after it was taken out - so I had a partial thyroidectomy. So then I’ve been on thyroxine ever since for that.
Recurrent miscarriages and being diagnosed with complex hyperplasia
So I dealt with that and then came back, ‘Okay, let's do this, we'll go back and have another transfer’, which we did and then we did a few more and still no luck. Then my gynaecologist said what was happening was I was sort of having constant miscarriages. So there was a problem with implantation. So then she said, “Oh, I’d like to have a look in your uterus”. So then they did that and I found out I had what’s called complex hyperplasia.
So complex hyperplasia was, it's a condition where the lining of the uterus is…again, it's like pre-cancerous cells. The cells are atypical and they’re producing too much of whatever they produce. I'm not really good on all the technical medical terms, but anyway, they were a problem. So we had to address that. So yeah, so I had a hysteroscopy for that. So biopsy, D&C, check that. So that came back and then the cells, there was a certain percentage that were abnormal.
Taking a break from IVF to manage complex hyperplasia
So then we had to monitor that and then it became more complicated because the hormones and the treatment for IVF stimulate the problem of complex hyperplasia.
So at each stage it was always having to weigh up and manage the offset of, ‘If I do this, it will help that, but then it causes complications with all my other conditions,’ which are starting to emerge, well had already been there, but unbeknown to me. I didn't know. So then it was decided I would have a break and have a MIRENA [Levonorgestrel] put in, which would help manage the hyperplasia and then help that to all settle down and then have another hysteroscopy and then get everything cleaned up and laparoscopy, clean everything out and come back and have another try.
Resuming IVF, a successful pregnancy, and trying for a second baby
So we did that and we were just going backwards and forwards doing that for a few years. So that was probably four years in of that and then probably I think it's on the seventh transfer I had, I had a successful pregnancy. But then that came with complications as well. So I was bleeding up until 14 weeks. So there was a lot of monitoring involved in that. Then by about 14 weeks that settled down and then I went on to have a successful pregnancy and my first son, which was very exciting and yeah, sort of, so that was, yeah, the rollercoaster sort of came and we hopped off for a little while and got into new roller coaster, parenting.
So - oh actually no, my first child was on my second cycle.
Yeah. I think I must've done my second collection after we learned about all the other problems, cleaned everything up, did a new cycle and I think I had two embryos left by this stage. Yeah. So I had one, had my first son, and all I had then was one left. [laughter] It was like deciding when to do that last one - because of everything we'd been through and by that stage and all the complications and the hormonal things and what they were doing to me and our relationship, my relationship, we just can't do it again.
We've got one left and then we have to put an end to that, that part of medical intervention. So we waited nearly three years and then said, then we were ready. And so again, during that time was – had another laparoscopy, another hysteroscopy, had a MIRENA [Levonorgestrel] in and then went back and [sighs] had the last transfer. Everything just worked and I had my beautiful second son and we closed that chapter.
Managing complex hyperplasia after having children
But then I guess the management of all those issues has continued and continues to this day. Now that my youngest son is eight years old, with having to make decisions around, because the discussion, when I first found out I had the complex hyperplasia, having a hysterectomy got put on the table. And then it was said to me since I'm still trying and want to, that we would continue and then at the point of when I’d finished coming to the end of that, then we would have the discussion about when to have the hysterectomy.
So I saw the – when did I last see my gynaecologist? It would have been June last year. And I said, yeah, “I've come, I'm this age now, I just don't see the point. I would rather just manage the risk and continue to have regular biopsies”. So that's where I'm at now. So I have the MIRENA [Levonorgestrel] in and I have six monthly blood tests and annual biopsies. And so that may change three years in, I’m like, ‘Okay I don’t want to do this’. So I’ll have the hysterectomy or I’ll be in menopause. Who knows? So we just continued and rather just do a…because when I had the lump in my thyroid and I was in it, I felt like I didn't get to make decisions. It just, I was just told, “Your cells have changed, your cancer risk has gone up because they're already abnormal cells and we have to take it out.”
And so I just went along and the same with laparoscopies, I found the momentum of everything tied in with the emotion of wanting the outcome of having children was so enmeshed that the decision making process was just, I looked back and it was just a blur. I just look at other decisions I make in my life and go, yeah, I mean, of course I thought it through, it just yeah, not in the way I think through other decisions. It was just, I was all into everything and just, yeah. Even though I was having to weigh up that this would cause this, and then that would cause this, it was yeah, very…I don't think I really was aware or took on the complexity of it at that point in time. It was just – I was so focused on, I just embodied wanting to be a mother – it was so strong. [laughter] It was just like, yeah, if you said you're going to take out this part of my body – “Yeah. Take that part out. Take it out!” I look back now and go, yeah, it was quite a lot. A lot of surgical interventions. Yeah, a lot of interventions, a lot of invasive interventions.
So, yeah, so that's it in a nutshell.
Find out more about Marika’s experiences in the following short films:
Wanting to Become a Parent
Donor Conception and Surrogacy
Experiences of Health Practitioners and Health Services
Infertility and Fertility Treatment: Seeking Information and Support
Difficulties Conceiving, Becoming Pregnant, and Maintaining a Pregnancy during Fertility Treatment
Infertility, Fertility Treatment, and Partner Relationships
Infertility, Fertility Treatment, and Work
Thoughts and Feelings about Infertility and Fertility Treatment