infertility: the struggle to conceive
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many couples struggle with infertility and stigma.
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when natalie,* 30, and her husband began trying to have children in the spring of 2019, she assumed it would be easy. after several months of trying to conceive with her husband, natalie’s doctor sent her to a fertility clinic. after several different treatments to try and increase natalie’s and her husband’s odds of becoming pregnant, they decided to pursue in-vitro fertilization (ivf).
infertility refers to an inability to become pregnant after a period of time. definitions vary, but generally not becoming pregnant after one year of trying for women aged 35 and under or after six months older than 35. in canada, roughly 16 per cent of couples trying to conceive experience infertility, a rate that has doubled since the 1980s. this increase can be due to a host of factors, including exposure to harmful chemicals, waiting until later in life to begin having children, stis, etc.
the cost of fertility treatments can also be incredibly high; just one round of ivf can cost $10,000 to $15,000 per cycle in canada. the ontario fertility program covers the cost of artificial insemination (ai), intra-uterine insemination (iui), and one round of ivf. fertility drugs and hormone treatments, which can cost upwards of $5,000 per treatment, are not covered.
natalie spoke to healthing.ca about the ups and downs of fertility treatments, the side effects of pursuing ivf and learning to open up to friends and family about infertility.
*name has been changed
this interview has been edited for length and clarity.
when did you start to receive treatment for infertility?
my husband and i started trying to conceive, i guess, in the spring of 2019. we were trying at home and i sort of naïvely assumed that we’re young, we’re healthy, no health issues, it would be very easy for us. after a couple of months of nothing really happening, i went to my gynecologist told her what was going on. she did a pap and blood work and the full gamut of things that she’s able to do, and everything came back normal. so she gave us some advice on how to keep trying, the days to try at home, the days in my cycle to try, the right ovulation sticks to use and we did that for another couple of months. but still, i didn’t even get pregnant at any point.
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i was having a lot of anxiety about what was going on and i went back to my gynecologist. in ontario, i think if you’re under 35, you have to have been trying for a year before you can be referred to a fertility clinic. if you’re over 35, after six months they can refer you, but she said she could tell i had a lot of anxiety and this stress would probably not help the situation, so she referred me to a fertility clinic after we’d been trying for about six months.
we had our first appointment and they went over our health history and then they gave us a full workup of everything that the fertility clinic can do in terms of blood tests and semen analysis and ultrasounds to kind of check things at different times in my cycle. that took about a month and a half because they had to go through the whole month of my cycle to do some of those tests.
when my husband and i went back to get the results they were not extremely clear. they didn’t say i have unexplained infertility, but they did say that i have something called diminished ovarian reserve which basically means i have less eggs than someone my age should have. i was 30 at the time. the doctor said it wasn’t alarmingly low, it’s definitely a lot higher than some women who have gone on to still have a viable pregnancy through infertility treatment. but that’s kind of what they saw is the issue with why we weren’t able to conceive; everything else is normal with me and my husband.
because my diminished ovarian reserve wasn’t extremely low, they recommended that we do six months of something called a natural conception program. it is really anything but natural; i think that’s just what they call it. we did four rounds of medicated cycles, where they basically put me on hormone pills and then i would go in on certain days of my cycle, they do an ultrasound and blood work to make sure my hormones were all where they needed to be.
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the ultrasound was a transvaginal ultrasound, so they could actually see the ovaries and see that the follicles were growing and make sure that everything looks good. when it looked like i was close to ovulating they would give me a trigger shot, and my husband and i would go and try at home. and then i’d be on hormones through the end of the month just to sort of support a pregnancy if i did get pregnant. but that unfortunately didn’t work for us.
the next step was just a little bit more invasive, but not the ivf stage. we did two months of insemination or iui, which is the same procedure in terms of the medication i was on and the monitoring. instead of us trying at home, they basically just went in and put the sperm as close to the fallopian tubes as they can get it to try to just make it a little bit easier for them to get there and do what they need to do. but unfortunately, that didn’t work for us either.
last summer, i think it was in june, we started the process of ivf which was a month of medication that i was on to basically suppress my reproductive system. it’s called downregulation. after that month, i would get my period at the start of my cycle, i would start the shot to do ivf. that process was between 10 and 12 days depending on the cycle, and with my first cycle, they saw lots of follicles, i think there were about 17 and we were told to expect about 12 to 14 eggs at the egg retrieval, which my doctor said would be a really good number. because you lose about 25 to 50 per cent of the eggs at each stage with ivf, with 12 to 14 eggs the hope would be that we’d have maybe three embryos at the end of the entire process.
but i woke up from the retrieval and they unfortunately were only able to get five eggs and one of them just kind of dissolved as they were retrieving it. so, from a numbers perspective, if we wanted to have a second child or even just to kind of have more options, my doctor recommended that we do another round of ivf.
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it was kind of the same process all over again, a month of down regulation, and then 10 to 12 days of the shots. they called me a poor responder to the medication i was on the first round so they adjusted it a little bit and put me on some different shots and hormones. they were actually able to retrieve 12 eggs the second time. going into it, my doctor said to expect about six, so i was very happy with that. and then the whole process from there is just to put the eggs in the first round and the second round together, fertilize them and have them grow out in the lab. so that’s kind of the process that we’re at now.
you went through two rounds of egg retrieval?
yes. it’s not a complete round of ivf because there’s no embryo transfer in there. but two full rounds of the egg retrieval process.
how was that? were there side effects from the hormone shots?
i was terrified to do the shots. i have never liked needles my whole life and i felt the concept of having to give myself up to five or six shots a day was scary. but you do it in your stomach in kind of the fat muscle and they don’t hurt as much as i expected. some of the meds would burn as you were injecting them, so it was a little uncomfortable.
the side effects were pretty intense. you have so many hormones coursing through your body. physically, your body usually just grows one egg a month so to have up to 17, and then with my second round 19 follicles, growing. the fertility clinic likened it to a thing of grapes because they’re getting so large. it’s a lot of bloating and towards the end of the stimulation shot even going for a walk just felt heavy and uncomfortable. my body just didn’t really feel like my body at that point. after the first retrieval i had a really horrible reaction where i gained about six to seven pounds of water weight almost overnight. i was so bloated; it was horrible and that took until my period started about 10 to 12 days later before it went down and was just extremely uncomfortable. even just walking my dog i was struggling around the block.
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it’s a roller coaster of the physical symptoms that kind of come and go and the bruising from the shots. there’s a lot involved with it that you don’t really think about you’re just so focused on the end result, the little day to day things you don’t really think about.
are you waiting to see if there are viable embryos or are you onto another step?
so, we got the results for the embryos. in the first round, three of the four eggs fertilized and in the second round nine of the 12 fertilized. so, they grew the 12 out together in the lab, or in the little incubator, i guess it’s called, and they keep them for about five to six days and they want them to turn into a healthy looking blastocyst. seven of ours made it to day five and six.
if you’re over 35, i think that it’s mandatory at my clinic to send some dna or some portion of the embryo, a little biopsy, off for genetic screening, but we had the choice because we’re under 35. it was just such a lengthy process, we decided we wanted to do everything in our power to make sure that they were healthy embryos. so, we sent them off for testing and that took about three weeks to get the results, and five of the seven were normal. the genetic screening is very basic, it just makes sure it doesn’t have any additions or deletions at the chromosome level. five were considered normal, one of the embryos was considered abnormal, and one of them was unknown. my doctor said there’s a pretty high chance the unknown one is also normal and if it gets to the point that we need to use that we can retest it to confirm.
what is your next step?
we got the results back in november and the next step is to do the embryo transfer. i think it’s a pretty similar prep process, in terms of needing a month to do the downregulation to make sure that your reproductive system is suppressed. and then they’ll kind of do basically what they did for the natural cycles, where they’ll give me some hormone pills to get my uterine lining to the right thickness. and also just have me come in for monitoring as well, to make sure that everything’s looking good before they do that embryo transfer.
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how are you feeling gearing up to have this done?
hopeful but also, you know, i’ve been so hopeful each round that i’m kind of also trying not to get my hopes up. i’m trying to be realistic knowing that the first one might not work, we might need to wait till we do the second one. so i’m just sort of preparing myself in that sense.
how are you coping with the roller coaster of being hopeful in one stage and then it not working out?
it was really hard for me at the beginning. my husband and i didn’t really tell anyone, family or friends, when we first went to the fertility clinic and kind of did all of those tests in the beginning. i don’t really know why we didn’t at that time, i don’t know if it was just because i was dealing with the disappointment of the cycles and not really knowing what was to come.
it was probably february or march of last year that we started telling more of our friends and family what we were going through and the point that we were at, and a lot of people that we talked to said that they struggled or it took them a little bit longer, or that they knew someone that was also going through the same thing.
when i started talking to people about it more, i started feeling a lot more comfortable about what we were going through. the stigma of it, we don’t really talk about it very much. so when i did start talking to people about it, i was like ‘oh my gosh, there’s so many more people that are experiencing this.’ we’re all kind of in the same boat where we have so many questions and there aren’t always answers.
you can’t always go to your doctor and your nurse with the 15 questions popping up in your mind every day, so you’re googling things and trying to find resources. having people to talk to you about it really helps. especially because a lot of what was going on had to be done to my body, the procedures and the medication.
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my husband was extremely supportive, but it is not his body, he doesn’t know what the bloating feels like or everything. so to talk to friends or friends of friends that had experienced it really helps as well. emotionally, it was hard when i wasn’t opening up to people but then once i did, i felt a lot better about it and a bit more hopeful. i think it just kind of made it allowed me to have more of a support system than just my husband and i together
many women say they felt ashamed when they had trouble becoming pregnant, even though this isn’t anyone’s fault. did you ever experience that?
i did a little bit. i kind of went down a bit of a path where, i was like between my husband and i, i’m the reason why we can’t get pregnant. it’s because of me that we’re going through this and it’s costing us so much money. the financial costs really stressed me out. i kind of went down that path a little bit, but my husband never made me feel like that. he was incredibly supportive.
there were several times where i didn’t know what to do because this is so expensive. and he was like, “well, we want to exhaust all our options. this is what we have to do, we’ll figure it out.” but that was definitely a struggle for me at one point, but i was able to get over it very quickly, which i think was a good thing. and i think the reason that i was able to not feel ashamed and that there was a stigma was once i started talking about it a little bit more.
was there anyone who you’ve talked to who doesn’t understand or didn’t quite get what you were going through?
i’ve had a few people that have said, ‘why don’t you just consider adoption?’ and while that is definitely 100 per cent on the table for my husband and i, we haven’t talked about it in significant detail. but when that was brought up, i wasn’t quite at that stage yet. sometimes the way it was positioned by certain people is that it’s so easy to adopt, but it is definitely not an easy thing to do. there’s a lot involved in that as well. i think some people just didn’t quite understand what we were going through, but also that there aren’t very easy other options that we could just go run to. so that was a bit of a struggle, i would say.
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i also remember feeling kind of frustrated or upset when i heard that. but then also thinking maybe these people just don’t know the process and it’s not meant in a negative way. it’s just kind of meant as a way to sort of help, they wanted to make sure that we were happy and they know we want to have a child. they were just trying to give us solutions or help us find that. but when i was kind of in my lowest point after that first egg retrieval to hear that, knowing we were going into another (round) with this, it was a little bit difficult to hear, because we just weren’t at that stage yet.
it is such a struggle. it really is a roller coaster of emotions. every cycle you go into it with so much hope and then you get your period and you’re so disappointed and there’s so many highs and lows to it. it kind of consumes you, your whole life starts to revolve around your cycle and the different stages of your cycle. but there’s definitely really exciting points. i remember calling my husband with the update of how many of our embryos made it and i was crying, but happy crying. it really is a roller coaster of emotions.
having that support system with family and your partner is just so important to get through it because i definitely had some very low points where i was really struggling with it. you definitely do become a lot closer to the people who are there and supporting you through this.
what it feels like is a regular series that explores the experience of being diagnosed, treated and living with a health challenge. have a story to tell? email info@healthing.ca.
emma jones is a multimedia editor with healthing. you can reach her at emjones@postmedia.com or on twitter @jonesyjourn
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