Meet the real-life Nina Proudmans

Written by Business Chicks
24 Jun

“My experience and what I’ve gone through has subconsciously influenced me and moulded me into the doctor I am today.”

*This article was first created and published by Business Chicks.

For these three fertility specialists, based out of Melbourne IVF, helping their patients to have “the joyful experience of becoming a parent” is all in a day’s work.

Dr Melissa Cameron

As a medical student, Melissa Cameron had a keen interest in surgery – so she never thought she would study obstetrics and gynaecology and become a fertility specialist. However, when she got a taste for the discipline on her student rounds, she realised it might just be the perfect match for her interests and skills.

“I love the challenge with gynaecology,” she says. “Every patient is a little different, and as a gynaecologist you feel a bit like a detective – asking lots of questions in order to find out what is going on.”

With a balance of time spent in the office with patients, and performing procedures such as endometriosis surgery that can transform a patient’s life, no two days are the same for Melissa. And though she says she loved delivering babies, she no longer practices obstetrics, freeing up her time for gynaecological medicine including IVF.

Most days begin at around 7am with fertility scanning and IVF procedures, then Melissa spends a large part of her day consulting with patients, and some time operating.

Melissa and her partner, an emergency physician, have two children, aged 11 and 8. Their kids were conceived with the help of a sperm donor, who was a long term friend.

“My partner went to University with him and I’ve known him as long as I’ve known her. We spent quite some time discussing all the ramifications of him being a donor, we all had counselling and used the services of a clinic – Melbourne IVF actually! – in order to quarantine his sperm to reduce any risks to us,” she shares.

“Being a doctor, the process was somewhat familiar, but nothing really prepares you for the ups and downs of treatment. We feel super fortunate to have our kids; in fact they are thoroughly sick of me telling them how lucky I am.”

With their busy work schedules and no family support in Victoria, employing a nanny has been a lifesaver for the couple, and Melissa says her hat goes off to families who make it work without any assistance. “I don’t know how people do it without family support, or the ability to pay for help,” she says.

Though she’s not so keen on the business side of things, and finds paperwork a chore, Melissa enjoys the challenge of surgery and considers meeting the babies she helped to bring to live amongst her favourite moments.

For Melissa, the trust that patients place in her is both an honour and a privilege.

“I think we forget how special it is, to be able to help someone make a baby. Having gone through fertility treatment myself, I realise that people are laying their whole lives in front of me. It helps ground me and realise how fortunate we are,” she says.

“It’s important that patients remember they always have the right to seek a second opinion – not just when it comes to fertility medicine, but for all health issues. Surround yourself with the people you need to help you, and don’t be afraid to try someone else if you’re not that happy, as there will be people out there who suit you.”

Dr Kokum Jayasinghe

When falling pregnant didn’t happen as quickly as Kokum expected, she knew she needed fertility treatment. After all, as an obstetrician and gynaecologist in training at the time, she recognised the signs.

“I initially had no ambition to be a fertility specialist, that was far from my dream; I wanted to be a GP,” she shares.

“When I was training I was also trying to start a family, and I realised I needed help. But I was unwilling to share that information with anyone, so I tried to do my treatments when nobody at work would know.”

Fast-forward to today,  Kokum has two beautiful sons, aged 11 and 8. Kokum’s own experiences have influenced the way she practices fertility medicine, as she knows only too well how isolating and challenging it can be. It only took 10 years for her to overcome the stigma attached with infertility and speak about it openly.

“The thing I discovered is, it’s quite hard work! It’s a struggle to go to appointments and fit it all in, especially for people who work full-time and may have a little child already. So I start my practice at 7am, so people can come and see me before they go to work,” she says.

“My experience and what I’ve gone through has subconsciously influenced me and moulded me in to the doctor I am today.”

For Kokum, who won a scholarship to study Medicine in Melbourne Univercity when she was just 19, a typical day begins at around 6.15am. She leaves her sons in her husband’s capable hands so she can get to work; Kokum’s husband, a surgeon, often works evenings or on-call, so the pair have become experts at juggling family and household commitments, with help from the extended family.

Depending on the day, she could be performing egg pick-ups and embryo transfers at the Royal Women’s Hospital, working with fellows, attending teaching sessions and seeing her private patients.

Sometimes things don’t go to plan: like the morning a few weeks ago when she arrived at her office and the lights didn’t work. With a packed schedule, she had to move forward with her first appointment.

“It was pitch black but we started the examination and I performed her ultrasound in darkness – with ultrasounds the darker the better, actually!” she says.

“The maintenance guy arrived and said, ‘I’ll come back in half an hour’. I said, ‘No, please fix it now!’ We are literally talking about my patients losing their eggs if I am late for theatre, so we couldn’t wait.”

Kokum’s advice for couples who are experiencing challenges when starting a family is direct: “Don’t be shy – start seeking help early. Not all need IVF and there could be more simple ways to help”

Her approach to her patients is as individual as they are, informed by her own IVF journey, she adds. “It’s not my experience that matters, it is her experience and I have a focus in my practice to explore all the non invasive methods to help my patients before considering IVF.  I have the empathy and understanding, as well as the skills and expertise needed to help my patients have the joyful experience of becoming a parent.

If IVF is necessary I am part of the best team in Melbourne dedicated to your success.

 

Dr Raelia Lew

These days, Raelia Lew calls herself a “retired obstetrician”. No longer a real-life Nina Proudman, she’s now a dedicated fertility specialist and reproductive endocrinologist, making her one of just 2 per cent of obstetricians and gynaecologists who have gone on to complete this sub-speciality.

After her alarm gets her out of bed at 6am, she’s getting the kids ready and tag-teaming with her husband to get everyone out the door. Then Raelia drives into the city and it all begins: procedures on her surgery list, before doing an embryo transfer or two for an IVF patient, before a busy afternoon of patient consultations.

Like her colleagues, Raelia has personal experience of IVF – albeit for somewhat different reasons. Before starting a family, Raelia and her husband underwent pre-conception genetic screening, which revealed that they were both carriers of the cystic fibrosis gene.

“My husband and I were very clear that we would not want to continue a pregnancy with a child with cystic fibrosis. He lost his mum when he was 7 to breast cancer, which affected him very profoundly throughout his life, and he didn’t want to lose a child to something like this,” Raelia explains.

“Personally, I felt much more comfortable testing the embryo first rather than having to make a difficult decision if I found out about a diagnosis during pregnancy, though I fully support the rights for a woman or couple or terminate a pregnancy under any circumstances, if she doesn’t want to be pregnant.”

They decided to go down the IVF path to reduce the likelihood that their children would have the condition, and she’s all too aware how lucky they were to require just the one cycle to get enough embryos to have her family.

When it comes to balancing her busy work life with home commitments, Raelia reflects on advice a mentor once gave her: “When you’re juggling a lot of balls, don’t drop the glass ones.” For Raelia, this means blocking off dates during the school holidays to spend quality time with her kids, and making time in her schedule for fun.

Her top tip for hopeful couples is to choose a specialist you have faith in, who will look after you on your journey; finding a specialist you can really connect with should be your top priority.

Raelia also strongly discourages patients from turning to Dr Google for advice or a symptom check, and knows from experience that this can lead to over-investigating and undue stress, a Pandora’s box of sorts.

“Most patients I see with infertility, we can find a solution to their problem,” she says. “But it’s really important to identify issues and proactively manage them, without catastrophising.”

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Post mortem sperm retrieval – a matter of life and death

Further to his interview on Channel 9’s 60 minutes programme, Dr Ben Kroon of Queensland Fertility Group discusses the topic of post mortem sperm retrieval.

Thankfully for the vast majority of people, post mortem sperm retrieval will never become a reality.

It is an extremely complex and challenging area of reproductive medicine, involving retrieval of sperm after a man’s death so that it can be used by his surviving partner.

While new assisted reproductive technologies are allowing more people than ever to fall pregnant and start the family they desire, the law, at times, does not keep pace with these developments.

In Australia, the law does not specifically address the issue of retrieval and use of sperm after a man’s death. So, while a partner may be sure she knows what her partner ‘would have wanted’, without supporting legal documents explicitly stating those wishes, the question of retrieval and use of sperm is not clear.

In most cases, an urgent court order is needed to retrieve sperm. This is a problem because while the judge is coming to a decision, every hour that the sperm lies in the body after death decreases the chance of finding live sperm.

While 24 hours is the accepted time period for successful retrieval, there may still be a small chance up to 36 hours after death.  However, while retrieval might be medically successful, the court may never permit a woman to use the sperm.

I co-authored a paper, published in the Australian and New Zealand Journal of Obstetrics and Gynaecology, in which we surveyed 28 IVF clinics across Australasia to test attitudes towards posthumous sperm retrieval and use.

It appears that directors of IVF units are generally supportive of the practice, given the right circumstances, but that the lack of clear laws makes the response to requests for sperm retrieval very difficult.

Myself, and the papers co-authors, believe that ‘clear, accessible and consistent law in this area would benefit everyone involved, including the medical, legal and societal stakeholders’.

It is not only the law that needs to catch up. In the same way that people discuss organ donation, I believe that couples should discuss post mortem sperm use.

Men should consider and discuss with their partners whether they would want to father a child after their death, bearing in mind that they could not raise the child, and that the child could conceivably be raised by another man.

I need to be clear that I am not suggesting that more people should have their sperm collected and used after their death.

Personally, I wouldn’t want my sperm to be retrieved and used if I died suddenly, and my wife knows this. But, if couples don’t have the discussion and document their wishes, it is seldom clear what one would have wanted if one dies.

Have you considered discussing post mortem sperm retrieval with your partner?

Business Chicks
24 Jun

Children of IVF parents as healthy as those conceived spontaneously

In 2007 a local Melbourne paediatrician approached me curious about whether girls conceived through In-Vitro Fertilisation (IVF) and other Assisted Reproductive Treatments (ART) enter puberty earlier than those conceived spontaneously. With the first babies born through IVF now reaching their mid-30s, this query was my early motivation and the catalyst to initiate a study on the effects of IVF and ART on the health and wellbeing of children conceived through these technologies.

How healthy are IVF children?

This project was the largest of its kind ever attempted, worldwide.

We found that children conceived by IVF grew into healthy, normal adults when compared to children conceived spontaneously.

The collaborative study initially funded by Melbourne IVF prior to a National Health and Medical Research Council (NHMRC) grant involved researchers from Murdoch Children’s Research Institute, Monash IVF, the University of Melbourne and Monash University. Interviewing 656 mothers who used ART and their 547 young adult offspring aged between 18 and 29 years, and compared this to reports from 868 mothers and their 549 young adult offspring who were conceived spontaneously.

Self-report of their health and wellbeing for the first 18 years of life found the ART children had a normal body mass index and similar history of pubertal development to those spontaneously conceived. Educational outcomes, including tertiary admission ranked scores and completion of tertiary education, were also similar.

Were there differences in the health of IVF-conceived children?

Mothers did report a higher rate of hospitalisation, as well as a higher rate of asthma and hay fever in ART children. We found this to be in line with what we already know as a common mild condition in the whole community. The rate is not much higher at 23% of spontaneously conceived children experiencing allergies, compared to 30% of ART children.

These problems are more common in premature babies and we know a higher proportion of ART babies are born prematurely for reasons still largely unknown. Premature births may be because of the age of IVF mothers, as having a baby in your early 40s is generally harder than having a baby in your late 20s or early 30s.

ART parents might take their children to the GP more often and consequently they are diagnosed at a higher rate. We found ourselves speculating if parents of IVF-conceived children are more protective reducing their baby’s exposure to dust and dirt in turn increasing their risk factor for later allergies.

The finding of increased hospitalisations, including in the secondary school years, has not been examined in other studies to date and the reasons for hospitalisation varied, with no consistent set of conditions. Again, we wonder if this is due to parental vigilance.

What will be done to investigate further?

This study fills an important gap in our knowledge about the long term health outcomes of children conceived via IVF and ART. Our results indicate that the perceived physical, mental health, social and environmental quality of life reported by the 547 ART-conceived adults is very similar to that of their non-ART conceived peers.

We have a responsibility to continue this research and gather further clinical review in long term follow up of those conceived through IVF and other ART. Further research will evaluate their health status and follow up to determine if there are any important lifelong medical or other legacies of IVF.

What does this mean for those considering IVF?

This study provides reassurance to those requiring IVF that there are no apparent substantial negative long term health and wellbeing effects on young adults compared to those spontaneously conceived.

This study is published in Fertility and Sterility. 

Learn more about IVF in Queensland, Victoria and New South Wales.



 

Business Chicks
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15 years of IVF patients – how have women changed?

The media is increasingly full of stories showcasing the latest 50 year old mum, or the celebrity who has undergone IVF. Even women who have used donor eggs are increasingly more comfortable discussing their medical history.

But, do these sensationalised stories really reflect the changing face of the IVF patient we see every day at our fertility clinic?

At Queensland Fertility Group Toowoomba we decided to assess the reality of these changes. In order to do this we conducted a retrospective study of 1587 women who had undergone IVF between 1998 and 2013 at our clinic in Toowoomba (based in the Darling Downs, west of Brisbane). We know that during this time there has been considerable social change, and we were interested to see how our patients may correspondingly have changed during this 15 year period.

Older women

Studies carried out by the Australian Institute of Health and Welfare informs us that the average age of women receiving treatment using their own eggs or embryos, is 36 years. We know too that over the last 20 years the average age of women giving birth has increased by 7.5%.

What did our study of 1,587 women show? The average age of women undergoing IVF treatment in Toowoomba has significantly increased by 6% - from 33 years in 1998 to 35 years in 2013.  Interestingly, the major shift has been the marked increase in the number of women aged over 39 completing treatment - which 15 years ago was just 3% and by 2013 had grown to 18%.

Rising obesity

The number of overweight and obese Australians has been gradually increasing for the past 30 years across all demographics – from wealthy, metropolitan suburbs to rural and disadvantaged communities.

An Australian Bureau of Statistics Australian Health Survey identified that between 1995 and 2011/12 the average adult woman’s weight had increased by 4kgs. The report likewise stated that in 2011/12 27% of all females aged 18 and over were overweight with a Body Mass Index (BMI) of 25 to 30.

Toowoomba is no exception to this trend. It’s therefore not surprising that the average IVF patient has become heavier. Women undergoing IVF treatment in 1998 at QFG Toowoomba had an average weight of 66kgs, and this had increased up to 77kgs by 2013. More significantly, their BMI (which also takes into account their height) moved from normal at 24 to overweight at 28 in 2013.

Single Women and Same-sex Couples

Shifts have occurred in the structure of families and as a result, we have seen a considerable increase over the past five years in single and same-sex couples accessing donor sperm to start their families.

Looking at the subset of patients where female cause was the sole reason for them having treatment, the proportion of single women and same-sex couples undergoing IVF increased from 2% in 2008 to 22% in 2013.

15 years later

Women attending our fertility clinic in 2013 are significantly older, heavier and have an increased BMI than they did in 1998. However, as women delay child bearing, by choice or circumstance, we need to ensure that there isn’t an unrealistic expectation that medical science can undo the effects of age.

What would you advise?

Unfortunately, we still cannot reverse the aging process, but we can ensure women are given the correct information to help them make informed decisions earlier. For example, the increasing use of the Anti-Mullerian Hormone (AMH) test or as it's more widely known, the egg timer test, can help a Fertility Specialist better assess a woman’s fertility and guide the direction of her fertility treatment.

Many women still remain unaware of the effect of weight on their fertility. We advise weight loss with simple lifestyle changes and, if necessary, dietician support. In addition to boosting a woman’s natural fertility, this can also have a beneficial impact on pregnancy and the health of the child.

This data was presented by Leita Fien, Fertility Nurse, Toowoomba at the 5th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2014) in conjunction with the Fertility Society of Australia Annual Conference held in Brisbane April 4-6, 2014.  Leita would like to acknowledge and thank her co-authors and colleagues Susan Lax, Julie Logan, Jeremy Osborn, and Dr John Esler, Clinical Director QFG Toowoomba.

Business Chicks
24 Jun

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