The joys and the sadness of trying to get pregnant

When Will and Joanne De Korte got married in May 2014 they thought they would wait a little while before trying for a baby. But three months later they were ready to give it a go and Will picked up an early pregnancy test in anticipation.

A subsequent negative result was no big deal; it was their first month trying to conceive after all. However, when the months rolled by and nothing was happening, they thought an ovulation kit might help them time things better.

“That was head-wrecking, chasing the ‘happy face’. We got it once in the space of three months,” says Wills (32).

“I don’t know if we were using it right. You don’t think to talk to anyone about it,” says Joanne (37).

Like many of the estimated one in six couples in Ireland who face fertility issues, the De Kortes had never thought this would happen to them. Slowly they were realising that they might have to seek outside help for something they had presumed would happen naturally and privately between just the two of them.

Will, who describes himself as “pragmatic and always looking for an outcome”, was probably ready first to take the next step, while, for Joanne, going to a fertility clinic meant admitting something was wrong.

Fertility clinic

After one year trying to conceive, they went to the GP who referred them to a Dublin clinic. Their first meeting with a doctor “was very straight to the point and quick; it was ‘this, this, this’,” says Will, clicking his fingers. “You will get this done, that done, come back in a couple of months and we will have all the tests done and we will reassess where you are then.”

With all the vagaries of assisted reproduction, nobody knows if it is going to be "okay" or not

The couple found it very “impersonal”. “It is such a tough thing to decide, you want somebody to say ‘it’s going to be okay’,” says Joanne.

However, with all the vagaries of assisted reproduction, nobody knows if it is going to be “okay” or not. And, in hindsight, the De Kortes say they could have done a lot more research before entering this lab-tech-driven branch of medicine, which has a language and a code all of its own.

At that stage, it was still very difficult to tell people about what they were going through, says Will. He found he couldn’t even talk to a colleague who had previously told him about how she had had a baby through in vitro fertilisation (IVF).

Although many people are more open now about assisted reproduction, it is easier to talk about it when it has worked, says Joanne. We hear far less about failed IVF, the strain that puts on relationships and how couples adjust, or not, to the prospect of a childless future together.

Coping

A specialist counsellor in the area of fertility, Kay Duff says part of her job is to help couples who are going through IVF treatments to recognise the heavy load they are carrying and how they might help themselves cope. Even before any of the ups and downs of assisted reproduction, they may be grieving the loss of being able to have a baby in the natural way.

"Usually people are working long hours and trying to do the likes of IVF as if it's almost nothing. But you're having to process this whole thing and you can't process it when you're far too busy," says Duff, who works at the Merrion Clinic and also has a private practice in north Co Dublin.

The extra pressure can lead to difficulties in communication and loss of intimacy

Relationships are challenging anyway and any kind of change or event has an impact, she points out. “Maybe there is a lack of time for the relationship, which is probably okay if you don’t have something as serious as trying to make a baby in a clinic. That extra pressure can lead to difficulties in communication and loss of intimacy.”

They both need to balance a sense of optimism, to get them through the treatments, while at the same time being realistic about the possible outcomes.

She encourages couples to look after their relationship, scheduling dates, making memories and not allowing the process to consume them, which can happen without them realising it.

People go into it believing that if they work hard at it, they will get results. Unfortunately, supreme efforts can go unrewarded “and that’s an awful big slap in the face”, she adds.

When Joanne started to prepare for the first egg collection, her fear that the medication would turn her into a “nightmare” proved unfounded.

“I was grand, wasn’t I?” she says turning to Will with a laugh, as they sit side by side on the sofa in the front room of their home in Swords, Co Dublin.

But Will says it was “very upsetting” watching Joanne having to take the drugs and he tried not to think about how their long-term effects are probably yet to be discovered. “From my perspective I just had to sit back and do nothing. It’s like, ‘I am not adding to this whatsoever’, and you feel disconnected.”

Negative test

Their first embryo transfer was followed by a negative pregnancy test two weeks later. “The moment we found out it hadn’t implanted was the moment we started to put the research in to find out what we were doing and what was meant to happen,” says Will.

Knowing they had enough money for only one more round of IVF, they parted ways with the Dublin clinic. They felt it could not explain the failure and were just offering more of the same.

After extensive internet research they chose the IVF Spain clinic in Alicante, an area they knew from holidays. At their first consultation, “We were given so much hope and confidence; they explained absolutely everything to us,” says Will.

There were two rounds of egg collection, the first in September and the second in November, before four embryos – one of which was AA standard they were told – were sent for pre-implantation genetic screening (PGS). This process helps to reduce the risk of miscarriage, by weeding out any non-viable embryos.

I am so sorry, I have very bad news, none of the embryos has passed the PGS testing

The De Kortes were expecting the results early in the new year and, keen to proceed with an embryo transfer soon afterwards, they booked flights and a hotel in Alicante for late January.

In fact the PGS results came earlier and their call from the clinic was scheduled for 3pm on December 23rd last – the 499th day into their IVF journey. Will arranged a conference call as he was still in work but Joanne had gone home.

After exchanging seasonal pleasantries, the doctor got straight to the point: “I am so sorry, I have very bad news, none of the embryos has passed the PGS testing.” The couple hardly heard a word he said after that, about donor eggs being their best option now; the dream was over.

They would have cancelled Christmas if they could, but Will was due to spend it in Limerick with his family, while Joanne would be with hers in Dublin. It wasn't until December 27th that they got to be together on their own, to talk for hours and hours about what they had been through.

Year out

They decided they needed a year out “just to regroup”. At the end of 2017, they will discuss if they want to try again, go for donor eggs or just accept it’s not to be. In the meantime, they have both embarked on a six-month course of a pre-conception nutritional supplement, which they reckon can only make them healthier if nothing else.

With the money gone, another attempt simply isn’t an option right now. But even if somebody walked through the door with €30,000, Will reckons they still wouldn’t want to rush off and do two more rounds.

It was the stopping point for the life we had  and all we've done since then is think about kids

Indeed, once they had got over the shock of the news about the embryos at Christmas, Joanne felt a weight lift and was back to herself. No longer were their lives on hold.

“We have now returned to the relationship we had before we got married,” says Will. “It is like when we got married, it was the stopping point for the life we had beforehand and all we’ve done since then is to think about kids.”

Social media support

Throughout the process, Joanne found conversing with other women in a similar situation through social media very helpful. Knowing there were few outlets like that for men, she encouraged Will to consider writing about it on his then near-dormant blog, The Cook's Belly, which he started in 2010 and where he had chronicled his progression to the final of The Great Irish Bake-Off in 2013.

Will decided to start posting last January about their IVF, to help sort his own thoughts, but he did not anticipate the interest it would attract.

It would be great to have kids, but at the same time I don't think it would break us

“I would never have thought that people needed to hear the male perspective,” he says. “A lot of the time you believe it is a female thing to go through and the guy is there as a support but in lots of way it is the two of you.”

And now they are working on coming to terms with the possibility that it might always be just the two of them.

“I know for a fact if it was just me and Joanne for the rest of our life, and vice versa, we’ll have the best time,” Will says. “It wouldn’t be a bit of our puzzle that’s missing. It would be great to have kids, but at the same time I don’t think it would break us.

“We don’t need a baby to keep me and Joanne,” he adds.

“We are not fixated on it at all,” she agrees.

CASE STUDY: ‘I DON’T THINK MY HUSBAND REALISED HOW BAD IT GOT’

Fiona* (39) knows she and her husband are “incredibly lucky” to have one baby after their first round of IVF was successful. But she has felt consumed by their attempts since to have a second child.

“I am shocked at how much of a failure I feel not being able to provide a sibling,” she says. While her husband “is very kind, a super dad and would love to have another baby”, she thinks he doesn’t share the same sense of urgency. He feels they have a lot on at the moment with a one-year-old and two busy careers.

“As it is my body clock ticking, I seem to take on board most of the guilt and have always been the driver of this journey. I find it really hard to concentrate on anything else.

It is such a private and personal grief and you are expected to still operate in the normal world

“Essentially it is unexplained fertility, with slightly low AMH, but the main issue is age,” she explains. “It took me too long to find the right person.”

Three miscarriages, including one after their second round of IVF, have taken their toll on Fiona and their marriage.

“It is such a private and personal grief and you are expected to still operate in the normal world. I really struggled and feel this put the most pressure on our relationship.

“I was consumed by the pain and basically just indulged in it, whereas my husband wanted a relief from it and to do other things. It wasn’t as big a deal for him and he just wanted to move on.”

Under pressure

They went to two sessions of counselling together and he said he was fine after those, so they stopped. But she felt huge pressure when pregnant after the most recent IVF and was struggling returning to work with a new baby.

“I felt that I really wasn’t getting the support I needed.” With the subsequent miscarriage and the effect of hormones, she was “struggling to function and see how to go on”, she says. “However, my husband was calmer about the whole thing and I don’t think he realised how bad it got.”

Fiona has tried lots of different things to help her cope: individual counsellor, couples counselling, acupuncture, fertility coach, GP, consultant and reading other stories online. Her mother and sister were hugely supportive too.

You start this emotional and expensive journey full of hope

While she would love to say that being open and talking about it with her husband enabled her to come to terms with the situation, “what actually helped was my finding other supports and ways to move on. It is a really painful journey on which, unfortunately, it seems if you want to succeed, you have to keep moving.”

To other couples just starting out on the road of assisted reproduction, her advice is to be open with each other and talk.

“You start this emotional and expensive journey full of hope,” she says. “However, it is probably worth talking upfront about what are the possibilities and limits you are willing to take. Taking regular breaks together and trying not to let it consume you is also advisable.”

*Name has been changed.

CASE STUDY: ‘I FELT GUILTY FOR NOT PROVIDING MY HUSBAND WITH CHILDREN’

Too many people think IVF is an easy fix, says Brenda*, and she counts herself and her husband among them.

When they got married in June 2012, they started trying for children straight away. Almost five years and many treatments later, she is carrying twins conceived using donor eggs.

The couple’s fertility problems were rooted in the fact Brenda was found to have had stage-four endometriosis. Because she likes to have a plan and also felt it was “her” problem, she was the driver in addressing the difficulties.

“From very early on, one of the biggest stresses was my husband’s apparent lack of interest in the issue,” she says. At a stage when timed sexual intercourse was crucial, “he was either out or too tired from work”. As the process wore on the main stress became lack of communication between them.

Neither of us turned to each other and checked to see how we were doing emotionally

“I felt guilty for not providing my husband with children. Guilty that due to my body we were spending our first few years of marriage with doctors and clinics, instead of having children and getting on with life.”

They limped from one decision to the next and “while we spoke about it, we didn’t ever talk about anything other than the facts”, she recalls. “Neither of us turned to each other and checked to see how we were doing emotionally.”

They have each gone through very rough patches, both having moments of doubt. All the while, they pretended to family and friends that everything was great.

“I think we started pretending in front of each other too. We were living together but there was little or no intimacy, which is slightly ironic given we were trying for a baby.” They were lucky, she says, that they didn’t have the additional stress of money issues for what is a hugely expensive process.

I was feeling more and more lost, and my husband was slightly oblivious

After one of many setbacks, they decided to go for couples counselling; Brenda was the reluctant one “but my husband was insistent”. She describes it as the best decision they have made since they got married.

“We were surviving but each argument was getting worse and I was feeling more and more lost, and my husband was slightly oblivious. We didn’t solve any great problems there but we were able to hear each other for the first time.

While he did want a family, he didn't want it at the cost of our relationship

“My husband finally heard my real anxiety was that he would trade me in for someone who could provide a family. I had said it before and he dismissed it but he had never reassured me he wouldn’t, because he didn’t realise I needed to hear that. He got to tell me that while he did want a family, he didn’t want it at the cost of our relationship.”

They finally had a conversation, too, about the reality of not having children. They realised that “yes, we would be sad, but that we loved one another and that would be enough”.

After those sessions, “I can’t say everything was amazing,” says Brenda candidly. They still had arguments but not with the same venom.

“We went from bad weeks to bad days, which were so much easier to acknowledge and move past, once we started talking about things.”

Infertility is a lonely and tough road, she adds, and couples starting out on it need to remember that they do have someone to hold their hand – their partner.

“You have chosen to have children with your partner for a reason and that is something you need to remind yourself of in your dark days.”

*Name has been changed.

[ swayman@irishtimes.com ]