Trying to conceive and first seeking help
So, we started trying for a family in 2014, a few months after we got married; and I think like most couples, we just assumed it would take a little while, but it will work. I had no health concerns that I was aware of, apart from having slightly low iron; so before we started actively trying, I just went to the doctor and had blood tests, to make sure everything was normal. Then after those came back fine, we just started trying normally. We tried for about a year, with no success, and after a year (which was what the doctor had mentioned) with no success, we went back to the doctor to get things checked. By this time I was having pretty bad periods; but again, didn’t realise that that was anything abnormal. I mentioned this to my doctor, along with various other things that had been happening, and she basically said to me, “I’m going to refer you to an IVF clinic. You need IVF.”
That seemed really abrupt to me; without any kind of further testing, without any acknowledgement that I had been suffering painful, heavy periods. It just seemed like a big leap, to me. So I went and got a second opinion, when we moved house to the other side of the city, and I got a new doctor. She sent me off for a series of other tests, and when the results of them came back all fine, she then referred me to a fertility specialist, and said, “You may end up doing IVF, but there are many, many things before that, and he will take you down that journey, as far as you need to go.”
Being diagnosed with endometriosis and trying ovulation induction
So we went and saw a doctor, a fertility specialist, at the start of 2016, and he ran a more extended battery of blood tests on both myself and my husband. We both also had a couple of other tests as well; checked sperm samples, all that sort of stuff. When everything came back normal, the fact that I was having quite heavy, painful periods still, meant that we then went on to have a laparoscopy. So in March 2016, I went in for my lap, which at that stage was just meant to be exploratory, but while they were there they found stage three endometriosis. So they were able to excise that, which was great; and from that point on, it was sort of treated as, “You had endometriosis, and that’s dealt with now, so everything should be fine.”
So we continued trying as normal, just naturally, for about six months, with no success; at which point we went back to see my fertility specialist, and we then commenced some ovulation induction cycles using CLOMID [clomifene citrate]. We did three of those over the course of around eight months, I think; so, into 2017 now.
Starting ART: IUI and IVF
With no success on any of those, we then moved to IUI, intrauterine insemination; we did two rounds of that. Again, unfortunately with no success, at which point we decided it was time to move up to IVF. So in May of 2018, I did a stimulation cycle, and we got 26 eggs, which was really great. Resulted in eight embryos. Because I had so many eggs, they stopped that cycle, and we ended up freezing all the embryos straight away, because I was at risk of ovarian hyperstimulation syndrome. So, a couple of months later, we tried transferring an embryo; again, no success. So we tried another one in… it would have been late 2018 by that stage, I think. Again, unfortunately, no success. So at that point, my doctor recommended we do an ERA test, an endometrial receptivity assayi, to just check that the timing that we were putting the embryos in was right for my body. So that was in December 2018.
At the same time that they did that ERA test, they also did another laparoscopy for endometriosis, because my pain and my symptoms had started to come back; so two birds, one stone. We got that out of the way, and the results came back that we were putting the embryos in 12 hours too late for my body. So from then on, we started to change my cycle, to adjust it so that we were putting the embryos in the right fertile window for me.
So in 2019, early in the year, we tried for our third transfer, no success; and then we did embryo four and embryo five throughout 2019, and added in a few other things to help things along at that point; because one of the other things that they’d been testing for when I had my ERA and second laparoscopy was just a test for my natural killer cells in the uterus, and mine were elevatedii. So for I think it was embryos four and five, we also added in a couple of other medications which are still considered…not proven to be successful. So we added in CLEXANE [enoxaparin sodium], the blood thinner, and prednisolone, the steroid. The idea is that will reduce the inflammation, and killer cell activity. We also did lipid infusions in each of those cycles as well, which again is supposed to suppress an overactive immune system again, a little bit, I believeii.
No success on either of those, so in January this year, we started our sixth embryo transfer cycle, and when I went in for my first scan, they discovered a lump inside my uterus, which they thought was a polyp; so in March I ended up having another surgery, to remove what turned out to be a fibroid just near my fallopian tube. After recovering from that, we are now in the middle of our sixth embryo transfer cycle. We stopped that cycle to remove the fibroid, and we picked it up again, and now we’re in the middle of that cycle.
Alternatives to IVF
I don’t know about everybody else, but I think at least in our experience of infertility and fertility treatment, there’s various points at which you wonder what’s ahead of you; and I know we’ve jumped ahead a few times and researched what’s involved with adoption, and how surrogacy might work, and international adoption, not just local adoption. Adoption is a bit tricky at the moment, given COVID; particularly international adoption, and international surrogacy, are potentially off the table right now for anyone who was looking at those options, which is hard. That’s something that while it wasn’t on our immediate horizon, it was something that we knew we might have to look at, at some point; and so I think to know that those options may now be limited, at least for the foreseeable future, is a bit hard.
We’re trying not to look beyond the future of where we’re at right now, too far. My focus at the moment is just to try and do these last couple of cycles. Hopefully one of them will work; but if not, then I guess we will probably reset and try for another egg collection with some genetic testing and see if that tells us anything. If the genetic tests come back normal, I guess we will just try a couple more transfers, and then reassess after that. If they’re abnormal, if all of them are abnormal, I don’t know what we’ll do at that point.
In some ways, it would be a relief to have an answer; to finally know why. But at the same time, we may never know why anyway.
You try not to think too far into the future, because it’s a sort of, “cross that bridge when we come to it” moment. I think one thing that has occurred to both of us, now that we’re so far into this process and we’ve tried so many different things, is at what point do you call time and decide to stop. You know, I’ve spoken to the counsellor a little bit about this recently. I’m very aware that the decision to stop will not be an easy one, because to this point, we’ve put all our eggs in this basket; you think that IVF…you know, you know it’s not guaranteed, but you think, and you hope, and you know from the stories of so many people that have succeeded, that this will be your solution. You’ve come this far, but this will be your solution. And I know that it’s not the answer for everybody, but I think the hardest thing will be coming to terms with the fact that it hasn’t worked, and that you may not be a parent of your child.
And look, we can still try surrogacy; again, I know that’s not a guarantee, but I think if the problem is with my uterus, and there is a chance that our embryos will work in a surrogate, then we would absolutely try that, if it was possible. Again, that would be a hard thing to come to terms with, because as a woman, and just as me, I’ve always wanted to be able to carry my own child; but I think on some level, I’d be able to come to terms with the idea of someone else carrying it, if it meant we could have our child. It would be a process I would grieve, I’m sure; but if it still meant that we could have our child, then that would be wonderful.
Contemplating the possibility of not having children
But beyond that, I’m very aware that deciding to stop is not a process that you just grieve once. I think it’s a decision that you will grieve many times throughout your life, because you’re not just not having children, you’re not having grandchildren; and you’re not necessarily in the same way doing first days of school, and last days of school, and all those other milestones that you hoped you will experience, but also that everybody around you is going to be experiencing. That is a repeated loss, I think, that you will grieve many times. But I’m an auntie; I love being an auntie. There will always be children in our life, but…it’s not the same.
