Age at interview: 38
Infertility diagnosis: Yes
Contributing factors to fertility problems: Low egg reserves, in a relationship with a cisgender woman and needing donor sperm, immunological factorsi
Age at diagnosis: 28
Fertility treatments: home insemination with known donor, IUI, IVF, IVF add-ons (prednisolone)i
Background: Tallace works part-time as a research consultant. She and her partner have a 5-year old child and are expecting their second baby. Tallace has Anglo-Italian heritage and lives with her family in a regional town.
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Trying to conceive via home insemination then IUI
I decided I wanted to have children, I think at a relatively young age now, for my peers. I was in my mid-20s.
By the time I actually was in a relationship and trying to conceive, I was 28, and I initially was trying to conceive through donor insemination at home. I was in a relationship with someone who was a trans man, and didn’t produce his own sperm, so we were technically ‘socially infertile’, and so I had a friend who was up for it, and we tracked my cycle, and did about six rounds of home insemination; which was awkward, but free. [laughing] But just didn’t work. I wasn’t totally sure why. At that point, my friend hadn’t had any kind of investigations about his fertility, so we didn’t really know why it wasn’t working, or perhaps we weren’t getting the cycle quite right; and I knew that straight couples wouldn’t be diagnosed as infertile until they had been trying for about 12 months. So I wasn’t too worried at that point.
My partner and I then began the process of IVF. Pretty arduous. That took a little while, as well. We were advised that we needed to do at least two rounds of unsuccessful IUI to be eligible for IVF, and I think that goal there is to tick a box, in terms of your fertility. So if you have unsuccessful IUI, then you’re considered to have a fertility issue. Although, IUI has about the same rates of success as standard, timed intercourse, I think; so again, it’s not a really dramatic thing to have unsuccessful IUI. And I did, I had two unsuccessful IUI attempts. That was pretty frustrating, [to go] through that process, because it was a waste of time, it was a waste of money, it was a waste of emotional energy, for me. I felt like we were forced to do that.
Moving to IVF and being diagnosed with low ovarian reserve
So then we were into the IVF stream, and it was at that point that I was diagnosed as having low egg reserves. There’s a blood test, and that…But I was still pretty young; I was in my late 20s. I think I would have been 29 by this stage, and I had an egg collection cycle. That was…I think now, quite an unusual egg collection cycle. I don’t think they do it anymore this way, but it was a long down- regulation cycle, so I was put on the pill for the first time in my life; I’d never needed to be on the pill before. I’d never been in a relationship where that was a risk. Yeah, so it took about two months altogether. The goal was to turn me off and then switch me back on, with their artificial stimulation.
So they didn’t switch me back on very well, I think; and when I had the egg collection, only one ovary had stimulated and produced eggs, and they collected three eggs from me. That was a very low number, and I knew that because in a sort of barbaric medical way, they had all the women who’d had their eggs collected that day lined up, coming around from the mini general. It was a bit like Gilead. [laughing] Yeah, so we just all came around, and I was in this line of women who’d all had the procedure that morning, and the doctor was coming along the line, writing or telling you how many eggs they’d collected, and I could hear that other women had gotten more like an average of eight. So I knew immediately…I knew that three was a low number, but I could also see that other people that morning had done a lot better. So there wasn’t a clear explanation for that, except that perhaps there’d been a mismatch in terms of my fertility situation and the hormone stimulation cycle that I’d been put on. I think there was an assumption that because I was still relatively young, a lower hormone stimulation would be appropriate; but it didn’t work very well.
Unsuccessful IVF and relationship difficulties
The silver lining for us was that those three eggs were good quality, and all three fertilised and became viable embryos; which is unusual. [laughing] That was a lucky break. I had the embryo transferred fresh, that was unsuccessful. So at that point, I was feeling a bit wrung out from the situation; just was going on and on, and in the meantime my partner had been diagnosed with cancer. So we had a bit on our plate. Then we also ended up breaking up, so that took a couple of years more out of the journey.
Starting over in a new relationship
Yeah, so, I had two frozen embryos at that point, and I wasn’t sure what to do. I was in a new relationship, this time with a woman, and she had known me while I was going through the IVF, so knew that that was on my agenda. But I also just didn’t want to forge ahead without…Yeah, it just seemed all…Anyway, I’m sure this happens to a lot of women; it’s just not the right time, or it’s really hard to know when the right time is.
So, we decided, or I decided, that it was time. I think I would have been 32 when I dragged her to the IVF clinic, where we had to do fresh forms, and counselling, and get her cleared to be the other parent on the paperwork, and my ex had to sign a strangely-named form that was some…it implied that he was releasing his permission for me to be treated as a patient [laughing], which was sort of really weird and archaic language, as if I’m property. Yeah, so I guess I’m just trying to paint a picture of the barriers for IVF, or the challenges of it all. But I guess I was also feeling positive, because I still had two frozen embryos, and I felt like there’d been so much going on that first transfer, that maybe, you know, it just hadn’t been ideal.
Deciding to take a break from IVF and do further research
So, then we had a transfer, and presumably they chose the one that was the second best, and I got my period on time, and had the blood test, which wasn’t a surprise to me, that showed I wasn’t pregnant. I think at that phone call, the doctor asked if I wanted to queue up the third embryo for the next month, and I said, “No, that’s my last chance.” I wasn’t really in a position…I was doing a PhD, I wasn’t really in a position to fund another egg collection cycle, and I really wanted to know why things weren’t working for me. In my family, there is a mythology of being super fertile, so it was pretty shocking to me that it wasn’t working, and…I felt like I was being churned through the IVF system. So I did some reading about unexplained infertility, and something I came across was this concept of an excessive immune response, which is associated with having excessive numbers of natural killer cells in your uterus, which obviously see the embryo as something to be wiped outi. By then, there had been quite a lot of tries. It felt like it had been a lot of tries. And so I asked my fertility specialist to do the test, which is a biopsy, and that came back positive.
Conceiving, pregnancy and birth
So, what that meant was that…The treatment for that is prednisolone, a steroid, to artificially down-regulate your immune responsei. And that’s normally for the first trimester of the pregnancy. So that was what we agreed to do for my final embryo transfer. This was an embryo that had…you know, they’re meant to go two, four, eight, and keep dividing like that; but this little guy had gone two, three, six. [laughing] So it wasn’t the greatest. But with the steroids, it worked. And I had a viable pregnancy. It was pretty surprising, and it was all done in a big rush because they called me after I’d had the biopsy and said, “Oh, we didn’t tell you this before, but there’s a higher rate of success of transfers if you’ve had some kind of abrasion to your uterus.” I think that’s gone out of fashion, but at that time, that was a thing. There were actually some fertility specialists who were just scratching up the inside of women’s uteruses before a transferii. So they told me that I would have the greatest chance if they did the transfer quickly, after that biopsy; and so I said yes.
It wasn’t a great time; it meant that I was going overseas for a conference, and I had a trip planned. So I then had to travel around with morning sickness, which was pretty shit; but on the other hand, thrilling, that I was actually pregnant. So, yeah. So, my son was born. It was a slightly complicated pregnancy; I had gestational diabetes, and then I was diagnosed with placenta praevia, so I had to have a scheduled caesarean; which again, I wonder if that’s related to the biopsy, because they tell me that embryos love to burrow into scar tissue, so I wish I knew where the biopsy had been.
Parenthood and trying for a second baby
Anyway, he came out safe, and then we just enjoyed being parents for four and a half years; at which point I realised that my window was closing, if we wanted to have another child. Which I did. I did, and always have wanted two. And so we returned to the same IVF place, because we wanted to access the same donor, a clinic-recruited donor. They had actually called me when I was probably about five months’ pregnant, and said, “Do you want to have another child?” [laughing] and I was like, “Well, I don’t know.” That’s when they kept aside one go, one straw, for us to try again. So we did come into the second time with a lot of pressure, I think; if the egg collection round wasn’t successful, then we weren’t going to be able to have the same donor, because he hadn’t re-donated, and that was all that was available for us, to have a go with.
Changing fertility specialists
I chose a different fertility specialist this time, because I felt that something that had perhaps been happening with my previous specialist was that she specialised in seeing LGBT clients, and I think that there was an assumption that my social infertility was the issue, and that maybe that had precluded other investigations. Yeah, I just felt like I had had to really drive investigations. So I saw someone else, who was incredibly…I felt like she really knew her stuff, so that was very encouraging; but she was really full-on. I went to the appointment, and said, “I think maybe I’d like to try by December”, and it would have been…I’m not sure, maybe August, then. And she just said, “Well, you’ve been diagnosed with low egg reserves; you shouldn’t wait.” And I was 38, or I was about to be 38. So, she thought that we were fools for even waiting an extra month. So we didn’t; we just rushed right in. I had thought that I should do some kind of super-duper cleanse, and get really healthy; and she just thought that was rubbish, and I was reasonably healthy, and we should just go. Go for it.
Conceiving a second time with IVF
So we did, and she didn’t put me on that down-regulation cycle; it was just a much more standard stimulation cycle. And I was on higher doses than I was for the last one. But still, we got five eggs, and four were mature, so could be fertilised. The other thing that had changed from the first egg collection cycle I’d done was that they had moved to a system of five-day embryos rather than three-day embryos, so my first successful pregnancy was with a three-day frozen embryo, and so this time, before…I think what happened is that two eggs fertilised out of the four viable ones, and by five days, there was just one left. So, that was pretty stressful again, but we didn’t test again to see if I still had the immune response problem, but just as a matter of course I was placed on the…a higher than last time dose of prednisolone, for the first trimesteri. The pregnancy worked. It was amazing, and very hard to believe, for a long time, because I just felt like we’d just gotten there by the skin of our teeth, or something, and I just couldn’t believe that it was actually going to work out okay. But I am 36 weeks pregnant now, so, pretty sure it’s going to be alright. [laughing]
Find out more about Tallace’s experiences in the following short films:
Trying to Conceive and First Seeking Help
Experiences of Fertility Testing
Experiences of Fertility Treatment
Donor Conception and Surrogacy
Experiences of Becoming Parents: Queer Women and Gender Diverse People Presumed Female at Birth
Experiences of Health Practitioners and Health Services
Infertility, Fertility Treatment, and Partner Relationships
Thoughts and Feelings about Infertility and Fertility Treatment
Advice for others Experiencing Infertility and/or Fertility Treatment
Advice for Health Practitioners and Health Services
i 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)
ii There is conflicting evidence for endometrial scratching as a fertility treatment. To learn more please visit Endometrial scratching | Human Fertilisation and Embryology Authority (hfea.gov.uk)