The Delicacies of Discussing Fertility

 

Asking any couple when they will have a baby is the equivalent to opening Pandora’s box whilst naked with no protective eye wear on – it’s a total no go zone, and extremely dangerous. There is a possibility the couple have been trying for 2 years and are currently saving their pennies for their first round of IVF. There is also a chance they don’t want children and no one should have to justify their personal choices. Years ago, a friend said to me “you and Will should have kids”– little did he know we were 3 weeks post miscarriage and I was still suffering physically; my tears as we walked into the wedding marquee were the reason you don’t ever broach the subject. What I’ve learnt about fertility and trying to conceive is that anxiety levels heighten very, very quickly. I’ve also witnessed the subtle fertility competition that exists; the “trying to conceive” race amongst friends and colleagues– the “we got pregnant without trying” people versus those who have to try a little bit harder. My word of advice – don’t ask about kids, when someone will have kids, when they will “try,” unless they start the conversation – just don’t.

 

When Will and I decided we were ready to start adding to our family I saw my GP, had my blood work done and got told to “give it a crack”. I remember the day I stopped taking the pill – it was a momentous occasion; suddenly we were saying we were ready to take this thing to the next level (little did we really know what the next level really was by the way!).

 

The minute we stopped contraception we wanted to be pregnant. Not tomorrow, not next cycle – today. For years I had been compliant with the pill, freaking out constantly that I was pregnant if I felt a strange niggle or was a day late. I had spent years avoiding, like the plague, the one thing I now desperately desired. To this day I think it’s interesting that we spend years avoiding something then desperately want it; a switch very suddenly flicks! I spend years helping women with contraception as a GP, finding the right option to prevent pregnancy and then suddenly we throw it in the bin, hoping she conceives instantly. Of course, nothing happened the first cycle for us; my poor mother listened as I questioned my ability to conceive. I found myself uttering words like “I’ve never been able to envision myself pregnant, maybe that’s a sign” and “I always knew something would be wrong with me.” My mother gently pointed out that in her day no one worried – people just cracked on. What mum didn’t realise is that everywhere I went I was forced to question my fertility. After 2 months of “trying” I recall driving to work when an IVF centre played their advertisement on the radio, “have you had trouble conceiving? Has it been 3 months?” I felt like the woman was talking directly to me, were they targeting me? And were we having “trouble”? Like a lot of times in my life, my GP hat blew up on my head and ruminating Preeya shone through. The truth was nothing was wrong with me at all – but all the advertising was excellent fodder for my wound-up mind to feed on! I know I am not alone here – patients often come in seeking reassurance after hearing people’s stories of conceiving easily or these same radio ads. Back in the day I’m sure there wasn’t the pressure to be fertile and conceive quickly – people just persisted. Now though every tabloid cover highlights somebody’s fertility issues or struggles with IVF and the radio constantly tells us trying for 3 months is too long – it’s no wonder lots of women start to get anxious before they even attempt to conceive.

 

When you’re desperate to get pregnant you see pregnant women everywhere. When I went to the supermarket it was a pregnant woman who got my park, when I was busting for the toilet at an event it was a pregnant woman who took longer in the cubicle, when I walked down the main street all I saw was prams and babies taking over my footpath. “Did they know how lucky they were?” I kept asking myself. I distinctly recall a patient who came to see me asking for a termination of pregnancy when we were “trying” (FYI I have never had an issue with treating these women as a GP because I am very much of the view a woman has a right to choose on these matters). Suddenly though I was slightly jealous – she didn’t want a baby (and that was her choice) but I was desperate for one; why was the universe torturing me like this?

 

Women (and men) can get very, very anxious about fertility. It is not unusual for a woman in her 20s or 30s to ask me if she should have special fertility testing done because she is keen to get pregnant soon. For most heterosexual couples it’s crack on and see how you go – 92% of couples will conceive within 12 months and 98% within 2 years. There are some women however, we refer early for fertility assistance (this doesn’t always mean IVF, there are lots of other options). This includes women with a history of polycystic ovarian syndrome and irregular cycles, women who have unusual pelvic anatomy, or who have had previous surgery on their pelvis and women who have had recurrent miscarriages. We also refer women over 35 earlier for input from a fertility specialist because we know that the earlier we intervene the more chance there is of a successful pregnancy. For older women we also consider doing a blood test that looks at the ovarian reserve; the test is called anti- Mullerian hormone (AMH). We don’t do this test for everyone and it does incur an out of pocket cost, but for those women who might be older and are concerned about whether or not they have eggs left this test can help plan.

 

With my GP hat on, and for a very practical moment, if you are planning a pregnancy the first step is seeing your GP for blood work to check things like your immunity to rubella and to talk about potential extra testing prior to conceiving (there are now genetic carrier screening tests available for conditions like cystic fibrosis you can do). If you get the green light to “try” then sex every second day in the week before ovulation increases chances of conceiving (days 7 to 14 for women with a 28-day cycle). The husband who says sex 4 times a day is the only way to get pregnant is lying, trust me! I end up telling my patients to relax and not let sex become a chore. When you decide to start a family, suddenly sex isn’t just sex anymore – it has a purpose and lots of couples start to find that very stressful understandably. If after 6 to 12 months (depending on age and other factors) things haven’t been successful then is the time to speak to a fertility specialist and talk through the options, of which there are many!

 

In our case, after 3 months we did get pregnant but sadly, it ended in a miscarriage. Just as we were emotionally recovering in Greece, lazing on beaches, trying every potential gyros combination known to man and contemplating life, Miss S decided to make her entrance. Despite all the insight I now have, if we ever decide to have a second child I can’t say that I won’t get equally stressed and catastrophise!

 

We all have different journeys when it comes to fertility; there is no “right way” when it comes to starting a family. For same sex couples the journey can be even more complex looking for potential donors or surrogates. At the end of the day, if we choose to have children we just want to share the love we already have with another soul– it doesn’t matter how we get there, or how long it takes, and it certainly isn’t a competition.