Karl:
One in six couples is infertile so it is a huge problem, but until recently infertility has been a taboo subject. Irish society is geared towards the designer family and there is an attitude that you are not a complete man unless you have fathered children. It's a kind of machoism. There is a lot of ignorance out there about infertility. I've had men say to me in the pub, "send her down to me and I'll show you how it's done". That attitude is prevalent.
I'm often home at lunchtime, when I might answer three or four calls from people - men and women - who need information on infertility. There is such a great need for knowledge.
I have felt sad, but never depressed about our situation. My attitude is to concentrate on my work and to live for the moment, which is possible only because Martina and I talk about everything and share our feelings. When we had IVF the first time, we had our tears over the fact that it didn't work, and we moved on. They tell you the IVF success rate is just 30 per cent, but you think of yourself as being one of the 30 per cent who will end up with a baby, not one of the 70 per cent who will not.
Basically, I feel I'm a spectator and Martina is doing all the work. I have been there to offer support - and to offer the donations when needed, of course. We have always been at each other's side through our IVF attempts, and that mutual support has helped both of us. This is a thing people have to do as a couple - you can't leave it to one person.
Martina:
`THOUGH we have been unsuccessful with our treatment, the experience has brought us closer together. I was 22 years old and we were married one year when we decided to start a family. All of my family were having babies - there were four children born within 11 months. We tried for a year with no luck. Meanwhile, I was having pains in my sides, which I was ignoring, which is a common story. I saw a gynaecologist and had a laparoscopy (internal examination of the abdomen by use of a laparoscope passed through a small incision in the abdominal wall). I was told I had polycystic ovaries, a condition where the ovaries cannot release eggs because the ovaries are covered in cysts. It was a complete surprise.
Because I was so young I lived in a fairy-tale world where I thought that the doctors could fix everything, no problem. We wanted three children - a boy and a girl and a boy - and we had names picked out for them. We still have the names picked out. Next I had a wedge resection, which they explained as being like peeling an orange. The outside lining of the ovary is peeled away and this should give you a window of six-to-nine months when the ovary works properly. For some reason it did not work. Instead, I was one of the unfortunate ones who develop adhesions as a result of the surgery. I have serious longterm effects: I cannot lift heavy things, I can't turn suddenly, stand up suddenly or bend over without intense pain. It is debilitating.
When I was 25 years old, my GP said: "Would you think of having a hysterectomy?" I thought this was an outrageous suggestion, as Karl and I felt there were more conservative ways of treating my problem. At this stage, we were unaware of IVF treatment and in hindsight, I am glad I held on to my womb.
Within the next five years, I had an operation to separate the adhesions, then a second wedge-resection and then a laparascopy that turned into a full-scale laparatomy because I began bleeding internally. At several stages during this five years, I was prescribed Clomid, a drug which kick-starts the ovaries into producing eggs, and was told to have intercourse at ovulation. That is when relationships can get very, very tough. If you don't talk and really work it out between you, you could fall apart.
THE process of going through the second IVF treatment last November was very draining as I got an infection and had to take antibiotics. I didn't feel very well, but didn't think it would affect my chances of becoming pregnant. After embryo transfer, I didn't feel great and spent a lot of time in bed. I don't think it was the IVF treatment that made me ill, it was that I was unwell. When the IVF failed, I must admit I felt relieved as I could take care of myself and build myself up. Naturally, I was upset and sad. Karl and I sat down and spoke about it and Karl said he could not bear for me to go through it again because I had been so unwell. We had decided at the outset to give ourselves two attempts at IVF treatment anyway. Accepting that they had not worked was a very sad period of our lives. We have decided our next step will be to explore the prospect of adoption. The books are closed on Irish adoptions so we are starting to look at foreign adoption. There is a four-year waiting list just to be assessed in the Southern Health Board region, but I am 31 and still relatively young.
According to our survey in the NISIG, most couples are 32-36 when they discover they are infertile. Some of infertile couples felt some GPs and gynaecologists were not very sensitive towards their needs. A lot of misinformation was given to some infertile couples - for example: that IVF costs £20,000; and that the process takes eight months: both are untrue. The average price of IVF ranges from £1,200 to £2,400 a cycle. The process from starting the nasal sniffer (which regulates hormones) to embryo replacement, is approximately five to six weeks.
Our survey found that 60 per cent of our members had GPs who, correctly, organised a semen analysis prior to investigating the female (about 40 per cent of infertility cases have to do with poor sperm quality). But unfortunately, 15.4 per cent of females were prescribed Clomid and it was later diagnosed that found their fallopian tubes were not patent, so any eggs released could not have been fertilised anyway. Some GPs told their patients, "relax, you're young yet". And 40 per cent of NISIG members felt their GPs were slow to refer them to a consultant.
Of those surveyed, 80 per cent were unhappy to attend clinics alongside antenatal patients where, in some cases, videos illustrating breast-feeding were being shown while infertile couples sat in the waiting-room. This experience was very distressing.
NISIG feels it would be more appropriate for infertile couples to attend the gynaecology clinics, rather than the obstetric clinics, because in some areas the obstetrician may be too busy with obstetrics to give sufficient time to infertile couples. For those of us in the Munster area, there is no choice but to travel to Galway, Dublin or Kildare for specialist infertility treatment. This may involve at least five trips to your clinic in each cycle and staying in that area for four to five days towards the end of the cycle. We would welcome the setting up of an assisted conception unit in the Southern Health Board region.
NISIG feels that after a year of attending their GP or gynaecologist without becoming pregnant, couples should be referred to an infertility specialist. Any female over 35 should be referred within six months. A lot of the initial investigations can be carried out by the gynaecologist, such as hormonal analysis, semen analysis and X-ray examination of the uterus and tubes. NISIG was established in Cork in 1996 so that infertile couples can meet and share their experiences and help each other. Not all couples choose to take the IVF route and this must be respected. NISIG holds regular meetings throughout Ireland and the telephone helpline is available all day. Speaking with other infertile couples helps ease the pain and the feelings of isolation.
In conversation with Kathryn Holmquist.
The National Infertility Support and Information Group will hold a seminar for infertile couples, GPs and the general public on April 24th, 1999, at 1.30 p.m. at the Killeshin Hotel, Portlaoise. A panel of nine guest speakers will cover all aspects of the infertility experience, from getting started with initial investigations through embryology and counselling to adoption. The cost will be £30 for individuals; £40 for couples (free to members of the NISIG).