My story: Why you should seek fertility help sooner rather than later

Written by Anonymous
10 Sep

I stopped taking the pill two months before I married my husband.

This article was first published by Fairfax in July 2017.

I stopped taking the pill two months before I married my husband. We’d always talked about having a family and agreed that we wanted to start trying sooner rather than later.

I was 27 and my husband was 31.

Like many women, I assumed the minute I stopped taking the pill I’d fall pregnant. Initially ‘trying’ was fun, both mentally and in practice, and waiting for my period was filled with anticipation – not to mention a whole lot of analysis of every ache and pain.

Days before I was due on, I’d convince myself that my ‘due on’ headaches were worse than normal. I’d tell myself I was feeling a little nauseous and any smell that turned up my nose was another sure sign.

I lost count of the money I spent on pregnancy tests, only to see that repetitive negative line. As the months rolled into two years, I felt deflated and depressed. I felt my body was failing me in the one area it was supposed to succeed.

It was after another negative test that we decided to seek help. The disappointment was becoming too much to bear, and it was clear there was a problem. We needed a resolution and we needed it soon.

As is the norm with all fertility clinics, we initially underwent a series of tests to determine the reason I couldn’t conceive.

Tube blockages, endometriosis and poor sperm count and quality were ruled out. We were categorised as ‘unexplained’ infertility – things just weren’t happening on their own.

We took the doctor’s initial advice and tried insemination. Two rounds of this proved unsuccessful, so we reviewed our plans and proceeded to IVF.

Our first attempt resulted in five viable eggs. One was inseminated and the other four frozen. I was convinced that this would be ‘the one’, and left the clinic with a bounce in my step,

Sadly, it was not to be. This was followed by further heartbreak when the remaining four embryos didn’t survive the thaw. We were back to square one.

Fortunately, the next cycle was successful. On the first attempt I conceived my son, 18 months after starting fertility treatment. I was 31 years old and my husband was 35.

Five years later, my second son was conceived from one of our remaining frozen eggs.

In hindsight, we did leave things too long before we sought help. We were convinced that it would happen, so we should let nature take its course. And we almost felt like we might be viewed as desperate or paranoid if we sought help too soon.

We never considered that time might not be on our side.

Yet, the heartache we went through for so long could have been lessened if we had of sought help sooner. Rather than just worrying unknowingly that something was wrong, we could have got a definitive answer.

We could have educated ourselves earlier on our options and spoken to professionals for advice. In the first instance, it would have relieved our stress. But, more relevantly, it may well have seen our first son born sooner than he was.

Dr David Molloy is the clinical director for Queensland Fertility Group. He says that education about fertility is paramount, and could encourage couples to seek help sooner.

“Fertility issues are very common and about one in eight couples will experience problems getting pregnant in a timely manner,” he says.

“The most common problems are age related infertility and endometriosis. But the newer fertility issues starting to come through relate to ovulation problems, particularly in younger patients because of the obesity epidemic.”

Despite this newer issue in younger age groups, the average age of pregnancy is still 34. For those aged 35 and over, Dr Molloy recommends not waiting too long before seeking help.

“If you’re under 35 you should try for 12 months before seeking help,’ he says. “If you’re over 35, we recommend that you try for six months and then seek advice. Fundamentally, you have 12 chances a year to conceive, but between the ages of 35 and 39 there’s a reduced chance of conceiving, and an even further reduction between 39 to 42. After 42 it’s very hard to conceive, though it’s not impossible.”

Dr Molloy says that getting help sooner rather than later has many benefits.

Initial investigations and testing can provide both answers and reassurance, without committing to expensive or complex treatments. In fact, Dr Molloy notes it could give couples the confidence to keep trying naturally.

However, if like one in 10 couples something substantial is found, fertility treatment can commence sooner. This will save couples experiencing ongoing angst.

“There’s no harm in visiting a fertility specialist, asking lots of questions and undertaking a series of basic tests to determine life supply of eggs and sperm quality,” says Dr Molloy.



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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?

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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.


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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%.

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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.

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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.

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