This article was originally published in June 2017 and is being republished as Lunchtime Live on Newstalk 106FM cover IVF & Fertility stories.
Making babies the hard way.
There is something shameful and deviant about sitting in a small public toilet in a busy public hospital masturbating. Other people want to use the toilet, you are trying to be as quick and as quiet as possible but you have a job to do and you cant leave the cubicle until it is done.
Welcome to the glamorous world of infertility. I was married a number of years at this stage and my wife was starting to worry that pregnancy wasn’t happening for us. She had established contact with a maternity hospital over her worries. She was given a clean bill of health and now it was my turn and this started with a semen analysis to establish if I had a sufficient sperm count and also to establish the health & motility of these.
I presented at small hatch in in one of Dublin’s maternity hospitals where I was given a container, verified my name, address and DOB and was sent on my way to find a free toilet cubical where I could “produce” a sample.
After the job was done I returned the sample to the hatch where I was told that results would be available within the hour, not to me but to my wife’s gynaecologist. So the next day I rang his office for the results and was told that he couldn’t fit me in for an appointment for at least 3 weeks. This pissed me off greatly as I knew a semen analysis is an “eyeball” count and I wasn’t too keen to hang around for weeks awaiting the result.
I sought the consultant’s number and left a message for him to call me back to put me out of my misery. He called me back and confirmed what I had started to suspect…I had a serious fertility problem. A healthy sperm count was between 50 and 100 million sperm per m/l and mine was only 1 million. Considering that the average intercourse attempts before pregnancy in a healthy couple was 1 in 4 attempts my odds of creating a natural pregnancy were one in 400. Essentially it could take 33 years of monthly attempts for success not 4 months.
And there was worse news to come when we finally did sit and meet with the gynaecologist. Of those 1 million sperm that I did have over 90% were immotile or defective in some way so now my odds had lengthened to a 1 in 4000 chance of pregnancy. Now being fairly certain that we didn’t have over 300 years of monthly sex to create a family it became readily apparent we needed the intervention of fertility specialists. The gynaecologist told us our only option was ICSI a particularly expensive specialist form of IVF. Intracytoplasmic sperm injection is a procedure in which a single sperm is injected directly into an egg.
In that meeting with the gynaecologist I felt numb and totally drop kicked. I had reached the stage in my life where I wanted to become a father. The previous summer I had been on a rocky beach in the West of Ireland with my wife, her sister and two nieces. I remember walking along the beach with my 1 & 3 year old nieces, lifting over rocks to see the creepy crawly creatures under them, the subsequent delight of the kids and had thought “yep I could be a dad” .
As you can imagine my wife was utterly distraught at the news that we could not have children naturally. She is very good with children and had a much stronger instinct and desires for parenthood than me. The gynaecologist said that considering our ages (early thirties) and the severity of my infertility that we had no time to waste and he recommended Clane IVF clinic.
Starting IVF involves a lot of rigmarole. Further medicals, testing & analysis, and also regular tests for STDs such as hepatitis & HIV in order to protect their staff & maintain a quality trail.
And of course during this build up our family and circle of friends are popping out sprogs like there is no tomorrow. When you find out you can’t have children naturally you start to notice every single pregnant woman you pass. Everyone is pregnant except you guys.
I do recall a dinner we went to in a friend’s house where there were 3 couples present. The host couple already had a child and over the course of the dinner the other couple declared “they had an announcement” they were expecting their first child. Obviously they were bursting with pride & happiness and we were very happy for them but immediately I could sense that my wife was distressed but “holding it together”.
After the meal was over and we said our goodbyes my wife broke down as soon as she got inside our car. It is unfortunately a reality for childless couples that other people’s good news can cause them pain. I suppose it invokes a panic that perhaps the IVF will never work and leads to a fear that we would never have “an announcement” of our own.
Eventually we received our prescription for the IVF medication which mainly injectable hormones for my wife. Although I was the one with the fertility problem all the treatment of egg production, egg harvesting and embryo transferral was naturally enough focused on my wife. She carried the can 100% for my infertility.
So off we skipped with our prescription like kids to a sweet shop, we could hardly contain our excitement. My wife required daily injections and I was the injector. Initially we were very giddy and one of our biggest problems was that one or other of us would get into a fit of giggles. It is not very easy to give an injection when one or other of you is shaking like a leaf from laughter. I became very skilled at giving the injections and on more than one occasion managed to give an injection that my wife didn’t even notice.
Part of the treatment involved regular inter-vaginal ultrasound monitoring to observe and monitor the growth of eggs. Normally a woman produces one fertile egg follicle per month alternating ovaries but during IVF the fertility drugs promote Controlled Ovarian Hyper-stimulation whereby a larger number of ripened egg follicles are produced. This is in order to harvest as many eggs as possible so that a number of embryos can be created. This increases your odds of success, IVF is very much numbers game.
I accompanied my wife to the first scan and everything was hunky dory so when some work commitments happened to coincide with the next scheduled scan my wife was happy to travel to the clinic on her own as we just saw the scan as routine and had no reason to fear anything was going amiss. So she headed down to Clane on her own and about an hour later I got a call from my wife who was sobbing uncontrollably at the other end. The nurse performing the scan had ultrasound had inserted the probe and then had gone white, she called the doctor urgently and he went white. It turned out my wife had started Hyper Ovulation Stimulation Syndrome and the cycle had to be stopped immediately.
So there and then our current chances of becoming parents evaporated. Many people will talk about the emotional roller-coaster that is IVF but we never paid much heed. We made a serious mistake and that was we never contemplated failure. We only contemplated success, failure wasn’t even on our mind, so when that failure did come we were totally unprepared. It was like the chair had been kicked out from underneath us.
As mentioned IVF essentially involves Controlled Ovarian Hyper-stimulation but Hyper Ovulation Stimulation Syndrome is a very dangerous condition where the woman reacts “too well” to the fertility drugs and produces too many ovarian follicles and is at risk of essentially an internal overdose of hormones leading to respiratory, cardiac or renal problems and can be fatal.
So getting over this HOSS involved stopping treatment and then careful monitoring to make sure the threat dissipated, we then needed my wife’s regular ovulation cycle to get back on track and as you can imagine this took a number of months. We found Clane IVF clinic to be very professional, very supportive and always felt they had our best interests to the fore and would not rush treatment cycles.
For many patients of IVF, the first cycle really is like the zeroing shots at range practice. It allows the IVF professionals get an idea to the responsiveness to IVF drugs of one woman’s body compared to another’s.
For our second cycle the IVF injection dose was adjusted and we made some significant adjustments to our expectations. This time we only contemplated failure and decided that success would be a bonus. This approach we believed would protect us somewhat from disappointment if the cycle failed again.
This cycle however went well and a date was set for February 2008 for the harvesting procedure. Again this involves an inter-vaginal ultrasound probe just this time with a retractable lance that is able to burst each follicle and extract the egg. At the time the IVF clinic was in a portacabins at Clane General Hospital and there was a small 3 bed-roomed ward next to the theatre which was connected via a hatch to the Embryology laboratory.
So my wife got gowned up and was sedated for the procedure as I waited on my own in the small ward. Eventually my wife was brought back into the ward in a wheelchair, bleeding and with tears running down her face and streaming down her neck. For me this was an extremely low point of my life. I felt extremely guilty because this was my fault, I was infertile not my wife. If I was functional she would not have needed to go through this.
So I’m sitting beside my wife who is upset and confused because of the sedation I’m trying to comfort her and then one of the IVF nurses called in to us to tell us the egg harvesting had been a success and that now it was “my turn”. I was handed a small sample container and had to go into a room I had nicknamed “the milking parlour” to have the most important wank of my life. If you pardon my porn reference this was the “money shot”, I had to produce and my aim had to be impeccable.
Once I provided the sample it was handed over immediately to the embryologist and he went and worked his scientific magic of ICSI. IVF is now a very well understood procedure but many people are a bit horrified when they realise the scientific & medical technology was adapted from the livestock industry.
So I believe that 18 eggs were harvested and treated with ICSI. This resulted in 15 successfully fertilised eggs. We opted for a service that matured the zygotes a bit longer in the lab. While this was more expensive it also improved the odds of success when transferred.
I think it was 2 weeks later that we went back for the eggs to be transferred. To improve the chances of success Clane transferred 2 zygotes in what is a relatively straightforward procedure and then it was a waiting game for 2 weeks until the first blood test.
Those 2 weeks are a time of huge anticipation. Do you cheat and try a home pregnancy test or do you wait until the official, higher accuracy, blood pregnancy test. So we waited until the official test and you have to then wait for a phone call from the lab to give you the good or bad news. Like I said we had dampened down expectations but it was till nerve racking.
When the news came it was positive, we were going to be parents. Naturally we were overjoyed and we kicked into “nesting mode” and what turned out to be an uneventful and normal pregnancy.
Sean, our first child, was born in October 2009 and when I first set eyes on him I became very emotional. Tears came out of nowhere as I sobbed uncontrollably looking at this helpless little bundle swaddled in a hospital blanket, blinking and yawning and wondering where he was.
We still had some frozen embryos and so a year or so later we decided to try for another cycle. This time we chose to transfer only a single embryo as a year or so into being parents neither of us fancied the thoughts of being parents of twins. But again, we made the mistake of not contemplating failure, again we thought everything would work like it did the previous time. So cycle 3 was a failure but as well as that all along the different phases of harvesting, fertilisation, transfer, freezing and thawing there was an attrition rate and so after cycle 3 we only had 2 fertilised zygotes left.
Again, after a failed cycle my wife needed a number of months for her menstrual cycle to get back to normal before we could go for the 4th cycle attempt. We took the decision to transfer our last 2 remaining embryos taking the chance on twins rather than the expense of a further cycle. Like in the case of our first pregnancy only one embryo took and in May 2012 our second son Ciaran was born.
Both boys are now in school with one in Junior Infants and the other in First Class of our local Educate Together. Both are healthy fun loving kind kids with a love of the outdoors and both have a curious mind and 99% of the time they are a pure joy to raise. The thought always fascinates me as to how would their personalities be different if they had been transferred in the opposite order. Technically they are twins being conceived on the same day but just born over 2 years apart.
IVF was an expensive undertaking and we spent many tens of thousands of euro. I am conscious of many of my Irish Army Air Corps colleagues with fertility difficulties remain childless because either the IVF technology was not mature enough at the time to deal with their level of infertility or because they simply could not afford the cost of the procedure.
I have no doubt that my fertility trouble stemmed from my working environment in the Irish Army Air Corps at Casement Aerodrome, Baldonnel. The working conditions were horrendous, we had no chemical training whatsoever, we were issued with no PPE whatsoever and the buildings that housed the chemicals I worked with were asbestos clad brick sheds built by the British in 1915-1918 and were unfit for purpose as they had utterly inadequate ventilation.
Chemicals we worked with in Baldonnel were exceptionally dangerous and were listed as Carcinogens, Mutagens and Teratogens and a number of chemicals in daily use were reproductive toxins and warned of harm to fertility as well as the capacity to cause heritable genetic harm.
My wife and I are definitely one of the luckier couples from Baldonnel, many couples have not been able to have children and will move into an old age that will be lonelier as a result. It is one thing if you don’t want a family but to want a family and be denied it because your employer didn’t give a damn about Health & Safety is galling.
Worse still I believe are the serving and former personnel who have managed to have children but whose children have suffered serious physical & mental disabilities due to their parents unprotected chemical exposure during their service in the Irish Army Air Corps. Many of these chemicals have the capacity not only to harm sperm, eggs and the developing child but also to harm the male & female reproductive organs increasing the chance of disabled children long after leaving the service.
Infertility is common and on the increase but the levels of infertility or fertility difficulties experienced by male personnel in the most chemically contaminated workshops in Baldonnel appears anecdotally to be as high as 50%.
This is another health effect of the chemical Health & Safety failings that needs full investigation by competent medical & scientific bodies.