Читать книгу IVF: An Emotional Companion - Brigid Moss - Страница 9

I couldn’t give my son a sibling

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If conceiving your first child was as simple as putting your Pill in the bin, or was even a happy accident, finding out you can’t get pregnant again can be harder than you’d imagine. Fertility coach, Anya Sizer, says that women often assume they should pull themselves together when they already have one child, and that not having a second or third can be dismissed as less upsetting than having no children at all. The poor relation of primary infertility, if you like.

‘I don’t think there’s much sympathy for women with secondary infertility,’ she says. ‘Maybe you’re at the school gates being a mum, so people assume you should be fine. When that was me, I was very grateful for my first child, but the fact I couldn’t conceive for a second time still made me feel as if I was walking around with a black cloud over my head.’

For a woman who desperately wants that second child, but can’t get or stay pregnant, it can feel as if there is a huge hole in her family. ‘In fact, secondary infertility can be harder to accept than primary infertility,’ says Dr Lee Lim, Consultant in Obstetrics and Gynaecology, Oxford Fertility Unit. ‘And families who really want a sibling for the first child are under extra pressure when they compare themselves to friends who are having their second or third baby.’

There are lots of reasons for not wanting a single-child family: maybe you didn’t like being an only child yourself, or you come from a big family. Sadly, secondary infertility is as common as primary. ‘Of those who had no problems getting pregnant the first time around, around 15 per cent have problems the second time,’ says Dr Lim.

Of course, it’s not officially infertility until you’ve been trying for a year, even if you got pregnant easily the first time. ‘You need to give yourself a year before you label yourself as having a problem,’ says Dr Lim. ‘Often, people who come to see me are anxious, and I need to explain that each month, their chances of pregnancy are only 30 to 35 per cent.’

Secondary infertility is also less likely to be due to underlying physical issues than primary infertility. ‘The family dynamic can change after a first baby, so you may not have intercourse so often,’ says Dr Lim. ‘Or you could have experienced a difficult birth, which can be a very good natural contraceptive, as childbirth is so intimately related to the birth canal. You might not realise that you’re avoiding sex or why. One sign of childbirth trauma is that you may have had a problem in attaching with your baby. A gynaeocologist isn’t always the best person to help you talk about this; a counsellor can be better.’

Having said that, there are often physical reasons for secondary infertility. If you have a new partner, it may be down to his sperm (although that’s not strictly secondary infertility). If you’re still breastfeeding, you may not be ovulating regularly. Another risk is scar tissue in the uterus, which can happen if you have an operation, post-miscarriage. ‘A telltale sign is that your periods have changed after this procedure,’ says Dr Lim. Or it could be that you have or have had an infection that has blocked your tubes. Secondary infertility can also be caused by problems with your previous pregnancy and delivery, including infection, as well as other problems such as endometriosis, PCOS and fibroids.

But the reason that surprises most patients, says Dr Lim, is that a woman may be less fertile because she’s put on weight after having a child. ‘If your body mass index [BMI — a calculation that assesses your weight, taking into account your height] is over 30, it’s much harder to get pregnant.’

Weight is often an issue for women with PCOS, as weight gain is part of the syndrome. ‘Even if we have been able to help a woman with PCOS ovulate the first time around using medication if, by the time she is trying for her second baby, she has put on weight, it gets much harder,’ says Dr Lim.

Finally, there’s the question of age. If, for example, you had your first child at 35, by the time you get round to having your second or third, your fertility will have reduced naturally. ‘It’s not uncommon now for women to try for their second baby at 40 and, at that age, it’s always going to be more difficult to get pregnant,’ says Dr Lim. And, as your fertility is uniquely personal, it could happen earlier too. Abby, who tells her story below, got pregnant easily at 33 but, just two years later, found she couldn’t get pregnant again.

The investigations for secondary infertility are the same as for any infertility, and may include blood tests and scans to check hormone levels and that you’re ovulating properly, an internal examination and tests to check your Fallopian tubes are still working. And your partner will need a sperm test, as both quantity and quality can decline with age.

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It wasn't until Abby, 37, a TV producer and writer from London, started trying for a second baby that she had problems.

I didn’t even have to think about whether having two children was right for John, my husband, and me. I had always envisaged lots of kids running around. It took around seven months for me to get pregnant with Jake, my first baby, when I was 33. I really threw myself into motherhood and loved it so much that I remember thinking, five months in, I really want this again. So when Jake was 14 months, we started trying for a second baby.

But, month after month, I didn’t get pregnant. I started using ovulation kits and, I admit, became completely obsessed with pregnancy. It was all I wanted and it consumed my thoughts. At any given time, if you’d asked me, I could have told you exactly where I was on my cycle. The two weeks after ovulation were the worst, when I’d constantly be thinking about whether I was pregnant or not. But the signs of being pregnant are the same signs as getting your period — for me, bloating and tender breasts — so every month, it was a mental and emotional nightmare. On the day of my best friend’s wedding I was due to get my period and spent the whole day wondering if I would come on or not. Of course, I did.

Whenever I got my period, I’d have an awful crash. It was as if I was properly, clinically depressed; I would go back to bed for the first and second day and cry for most of the time. I remember coming down for breakfast and sobbing and sobbing in front of John. He was understanding, but he couldn’t really comprehend the heady combination of a bitter disappointment plus a hormonal crash that made me feel so low.

Sex became something that was difficult to deal with as a couple. Exactly when I ovulated began to control our sex life. Scheduled sex is like sitting down to dinner when all the food is ready, but you’re not hungry. We were no longer a normal couple having normal sex, because I was always thinking about the end goal.

Like me, John wanted two children but he would have been absolutely fine to wait a year and see what happened. So why did I get into such a fertility frenzy? There were a few reasons. We seemed to be surrounded by lots of breeding people. Because my friends (in fact, my generation of women, in general) were starting their families slightly later, everyone I knew was having their babies close together, one after the other. Unable to do the same, I saw myself as desperate, and felt that other people were looking at me, pitying me, thinking: poor her, she can’t conceive again.

Also, having got pregnant relatively easily before, I couldn’t understand why it should be taking so long this time. Plus, not only was I thinking about pregnancy all the time, I’d met a few other mums who were having problems the second time too, so I’d begun to talk about it all the time.

Life became all about pregnancy. I was reading different advice on the internet every day, taking handfuls of various supplements, having fresh wheatgrass juice every morning and weekly reflexology and acupuncture sessions. Looking back, it had become a full-time job. I couldn’t stop thinking that there must be something we weren’t doing which could increase our chances.

A year after we started trying, I made an appointment at a fertility clinic for us to get checked out. John’s sperm was a little bit below par, but not too bad. My tubes were clear and my FSH was under 10, but when the doctor did a scan to look at my antral follicle count, to see how many potential follicles I had that month, I only had one or two on each ovary. He told me that my ovaries looked more like those of a woman in her mid-40s, and I was only 37. Then I had an AMH blood test, another way to measure ovarian reserve, and my level was classified as ‘low’ too. That took the stress up a notch. Finding out there was actually something wrong was very emotional. It began to look less and less likely that I’d get pregnant.

As my tubes were open, so — in theory — the sperm could travel to fertilise the egg as in a natural pregnancy, doctors told me I might not need IVF, but was a good candidate for stimulated IUI (where you do hormone injections, the same as IVF, and on the day your eggs are ripe, they insert the sperm into your womb). Injecting the drugs made me feel out of it, not quite on this planet.

Even though I was open with close friends about having treatment, I still felt very alone. And I had to carry on with life as normal, looking after Jake and the house. It was a strain, though, and I remember on one occasion having a huge argument with my mum. I complained to her that Jake was being difficult, and she said it might have been because he was picking up vibes from me. I over-reacted and got really angry, telling her she was out of order.

The first cycle, I over-responded and produced too many eggs. That meant I had to have a horrible procedure called aspiration, where they pop the follicles via a tube that goes into your womb through your cervix. I was awake the whole time, and it was grim. I don’t think I’d realised what I was getting myself into with the stimulated IUI cycles. It was much more medical and full on than I’d expected.

What was amazing though, is how John and I totally came together once we’d started treatment. It became one of the best times of our relationship. He kept telling me it was the right thing to do, and I felt really supported. John never questioned any of the bills either. We were spending so much money, it didn’t seem real — £700 one day, £500 the next. What struck me about fertility treatment is that if it doesn’t work, it feels like a complete waste of money. If it does work, it’s money very well spent. After all, I’d rather have a baby than a new kitchen.

After three IUIs in four months, I started pushing the doctors to recommend IVF because the success rates are so much better than IUI. People say having IUI prepares you for IVF and I think it does; I had got used to the side effects of the drugs, and all the intrusive and personal medical procedures.

The lead-up to IVF was quite an ordeal, even before I started the drugs. I had to have a hysteroscopy; my doctor told me that it’s not certain why, but having this procedure can help to improve the chance of implantation. The doctor also did a dummy run to check my cervix was going to be open enough for transfer by inserting a tube into it and leaving it in for a few hours.

Having found the IUIs so traumatic, when it came to IVF I really tried to prepare for it, to get revved up mentally and physically. I was scared (mainly, that it wouldn’t work), but I tried to put a lot of positive energy into every procedure. I’d read a lot about whether the mind can make a difference to fertility. Even though I didn’t wholly believe it, I thought, there’s no harm in being positive. But I was up or down with every piece of good or bad news. Every day was a roller-coaster on IVF, not only because it’s so important to get right, but because the drugs were making me spaced out too.

John was more positive. He saw IVF as a solution and he wasn’t scared of it. Although he thought it might take more than one go, he also believed there was no reason why the clinic couldn’t help us. He was determined to persist with treatment until we got what we wanted.

At my first scan, they only saw six follicles developing, and the doctor in charge of me said that ideally they’d like to see more. He said I was a ‘slow responder’, explaining that it was as though my ovaries were deaf, and needed more drugs to ‘hear’ the message. This was a real blow. The doctor immediately maximised my drug dosage, but not only was I disheartened, I was now terrified it wouldn’t work. Afterwards, I spoke to a friend of mine who’d done IVF and had got pregnant, and she’d only had three eggs harvested; that made me feel better, and three eggs became my benchmark.

Every day, I did what the doctors said without questioning it. It’s quite invasive and personal, to give someone else the task of getting you pregnant, and it all felt quite mechanical — like being on a conveyor belt — but I trusted that the doctors were doing the best they could for us.

On the day that snow brought the whole of London to a standstill, and a friend had her operation for a brain aneurysm cancelled, the fertility clinic was open, having picked up key staff around London with a helicopter.

I forced myself to view the side effects of the drugs — fuzzy thinking, tiredness — as positive, proof that something was happening. I had some bloating and my ovaries felt strange, but I told myself it was all good. By the second or third scan, things weren’t looking quite so dire, as I’d gone up to eight follicles. Having the egg-collection operation was quite surreal, especially being with all the other women in the ward before and afterwards. It was odd to be sharing such a crucial moment in our lives with strangers. But it was also quite exciting. We all wished each other good luck.

When I came round from the anaesthetic, the doctor told us that every single follicle had yielded an egg — that meant we had eight, which was amazing. From then on, it became like a dream IVF cycle. Every day, the embryologist would telephone me and say positive things about the embryos. In the end, every single one of them lasted five days and went to blastocyst.

Before transfer, there was some debate about whether we should have one or two embryos put back. The embryologist was pushing for one, as the embryos were such good quality, but the doctor said we could have two. Faced with that decision in a more rational state, I’d have gone for one; as John pointed out, we already had one child, and having twins wouldn’t have been practical. But at the time, I’d got myself into such a state about not being able to have a baby that I was completely up for a multiple pregnancy. I didn’t even consider the medical issues for me or any babies, such as that a twin pregnancy has a higher risk of miscarriage and complications. I just desperately wanted a child or even children.

In the end, I did have two embryos put back in. One was top grade, and the other was almost as good. Transfer was horrible: I got really cold because they told me to drink what felt like gallons of water, there was no heating on and I was only wearing a flimsy gown. John did his best to keep me calm and warm.

People say the two-week wait is the hardest part, and it is. Suddenly, from doing injections, having scans, taking phone calls, you’re on your own and there’s no contact with the clinic. For the first three days, I stayed in bed while Jake was at nursery. One day, I’d think I was feeling pregnancy symptoms, then the next day, I wouldn’t. It was like all those months when I’d hoped I was pregnant, but much more loaded.

The night before the pregnancy test, I couldn’t sleep. I got up at 6 a.m. and did it in the bathroom. It was positive. I couldn’t quite take it in. I went in and got into bed with John and woke him up and we hugged. It wasn’t until I went into the clinic later that day that it really sank in.

I went to the six-week scan convinced it was twins. But there was only one heartbeat. It was a shock — I’d thought it would be all or nothing. The staff at the clinic and John were really delighted, but I kept thinking: what happened to the other one? It’s strange, as I had a sense of loss, and even though I know it’s better to have one baby at a time, I still think about the other possible baby to this day, whenever I look at beautiful Edie, who’s now six months old.

The embryos turned out to be such good quality that we’ve got six blastocyst embryos on ice. I’m very grateful to have Jake and Edie, but I don’t know if I’m up for having a third child yet — or ever. We haven’t decided what we’ll do with the embryos; maybe we’ll donate them to medical research.

Q: HAD YOU HEARD OF SECONDARY INFERTILITY BEFORE IT HAPPENED TO YOU?

I knew some people struggled with miscarriage, but I assumed that if you’d had one child and wanted a second within a couple of years, you’d be fi ne. I didn’t really listen to talk about declining fertility; I thought it alarmist when I heard doctors saying that after the age of 35 your fertility ‘falls off a cliff’. Certainly, I will tell my children what happened to me, so they can make up their minds about when to try for their own family.

Q: WHAT’S YOUR ADVICE TO SOMEONE WHO’S STRUGGLING TO CONCEIVE AFTER HAVING A CHILD?

People say, ‘Oh, you have a child, you should be grateful.’ And yes, you are so grateful, but you are also devastated to think that might be it. It’s important to acknowledge what you’re going through; I think the frustration and disappointment must be every bit as acute as not being able to conceive the first time. If you already have a child, you know what you’re missing. And your idea of a family is being torn to shreds.

You have to keep plugging away with trying, giving yourself breaks from treatment when you need to, as it’s very intense. Most importantly, keep the faith. My husband helped me with this. And now we have a daughter, we are just so delighted and grateful, with her, for ourselves and for Jake. IVF made the experience of her so much more special – a reward for all our hard work.

Q: WHAT’S YOUR ADVICE TO SOMEONE WHO’S CONSIDERING HAVING IVF FOR SECONDARY INFERTILITY?

Don’t be scared of it. It’s perceived in society as a much bigger deal than it really is. When you’ve got to the point that you need IVF, you’ve done a lot of the hard work by having all the fertility tests and maybe IUI. You’ve already been sad and had to deal with a lot of uncertainty. Before I had IVF, I had the attitude that it was high-tech and unnatural, but it’s really not that bad. The best way to think about it is simply that IVF gives you a better chance.

Q: WHAT PRACTICAL THINGS HELPED YOU TO GET THROUGH IVF?

Much as I hated having the IUI cycles before IVF, they gave me an opportunity to learn what not to do during IVF. I tried to live as normal a life as possible during IUI – for example, I was in the pub all afternoon on my birthday, when I should have been resting. But when it came to IVF, I focused on it completely and didn’t let anything get in the way.

Also, at first I tried every complementary therapy going, but, by the time I got to doing IVF, I knew what was working for me – acupuncture. I tried to be really healthy but not obsessed, so, very occasionally, I’d have a small glass of wine. I also tried to stay calm.

Q: IS IT A GOOD THING TO TALK TO FRIENDS ABOUT WHAT YOU’RE GOING THROUGH?

I found it was a release to let people know what we were doing. That said, at some points it’s better to get on with things yourself and not talk about them so much. Sometimes, with other women who are also trying to get pregnant, it can become destructive, as you end up comparing yourself to them. I had one friend who I confi ded in, who was going through the same thing, and who was incredibly supportive.

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There’s not nearly so much written about secondary infertility as primary. Fertilityzone.co.uk have a dedicated secondary infertility section on their forum and reading the posts shows how difficult it can be. One mum says, ‘I am so glad to have my son, he is my life and I wouldn’t want to be without him, but I can’t get rid of this agonising pain in my heart. I want another baby I so desperately want my son to have a sibling.’ Fertility Friends (fertilityfriends.co.uk) also has a very busy thread on their forum for secondary infertility.

In their explanation of secondary infertility, the National Infertility Association in the US, Resolve (resolve.org), describe all the aspects in a very perceptive way: ‘It’s a cruel irony that the more positively parents feel about parenting, the more painful is their experience of secondary infertility’ (www.resolve.org/diagnosis-management/infertilitydiagnosis/secondary-infertility.html). They also bring up the issue of how wanting another child and having treatment can affect the child you already have.

Lynda, 42, blogs at http://tryingfornumbertwo.blogspot. com/ about almost five years spent trying for a sibling for her daughter, who she conceived after only three months. She is appealingly honest: ‘It seems so unfair that for most of my daughter’s life I have been grieving for an unborn child. I really feel that my grief has overshadowed the joy of having my beautiful daughter.’ Kathy Benson, now mother to Sean and Abby, went through four years of secondary infertility and documents her journey in her blog, chicagobenson. blogspot.com. ‘I especially had a hard time’, she writes, ‘when friends and family members would announce their pregnancies publicly at social gatherings.’ She also makes the point that women with secondary infertility tend to be surrounded by reminders that they can’t conceive because they are so often around children and other mothers. The book she found most useful was Conquering Infertility: Dr. Alice Domar’s Mind/Body Guide to Enhancing Fertility and Coping With Infertility (Penguin Books).

On the practical side, Infertility Network UK has a factsheet on secondary infertility, available at infertilitynetworkuk.com. Sadly, if you already have a child, it’s very unlikely that fertility treatment such as IVF or ICSI will be NHS-funded.