One in six women in Ireland will experience fertility issues. While some can be treated, IVF is often the only route that will lead to a viable pregnancy. We speak to Aoife Corley, fertility expert with ReproMed in Dublin, to mark Infertility Awareness Week.
We all know someone in our close circle of friends who has had difficulties getting pregnant. Fertility issues are so common that one in six women in Ireland will experience them, however very few openly speak about it.
Even less talked about is the process of going through IVF treatment, something midwife manager Aoife Corley from ReproMed says is down to women often feeling like a "failure" for being unable to conceive a baby "naturally".
Here, in conversation with IMAGE, Aoife outlines the signs of infertility that you should know, and what to expect when you choose IVF.
Age isn't just a number
Yes, women are now having healthy babies in their 40s and sometimes 50s. But fertility levels naturally decline in women from the moment we are born, rapidly declining after the age of 35. "Even if you aren't thinking about having a baby, and you think it's a couple of years down the line for you, there are some tests you can have done just to to gauge where you are," says Aoife.
"Nothing is foolproof, but if you have an Anti-Mullerian Hormone (AMH) test on your ovarian reserve, you can test your potential fertility. And that is a number that we would use to guide us on whether a woman should be having treatment immediately, or does she have a year or two years to wait."
Aoife says around 50% of ReproMed patients are aged 35 and older, however she has also had patients "as young as 18, 19 coming in".
Irregular periods can be a sign of something more serious
There is a reason behind most women's irregular cycles, says Aoife. "The most common reason for an irregular cycle would be polycystic ovary syndrome (PCOS), where you have a lot of follicles on your ovaries and your cycles can be really, really long. You could be talking about 60 to 80-day periods for some women with PCOS."
"There can be times where lengthy use of the pill can result in the cycle taking a long time to come back to normal," says Aoife. "If you're on the pill for 10 years and used to having a bleed at the same time every month, and then starting your pill again, that may be masking underlying fertility problems.
"We often find with women in their early to mid-30s who have been on the pill since their late teens or early 20s, after they come off it, their cycles just don't come back. Or they do and they're really irregular. We do investigations and have a look at the hormone level, sometimes it just takes a couple of months to get back in sync.
"And there are some people who come off the pill after 10 years and have a period as normal, a 28-day cycle, tomorrow. It really does vary from woman to woman."
Underlying conditions Aoife is referring to include PCOS.
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How does cancer treatment affect fertility?
"The impact of cancer treatment on fertility depends on what age you were when you had it. Women who have had underlying conditions like cancer are very aware of fertility and we tend to see them coming in a little bit earlier. Someone who may have had treatment as a child or in their teens, we're seeing them [in the clinic] in their late 20s or early 30s for investigations," says Aoife.
Many women will have have embryos frozen prior to IVF treatment if they've had cancer in the past says Aoife. "If you had cancer treatment as a child, sometimes it will affect your ovarian reserve, but sometimes it won't. I've seen it in both ways. It's important to check."
What about a LLETZ treatment?
Many women have a 10-minute procedure on the cervix called a LLETZ treatment -- a large loop excision of the transformation zone -- if a smear test has show abnormal cells or signs of HPV.
"LLETZ generally has no impact on fertility," says Aoife. "It would be more of an impact on pregnancy."
If you've had an extensive LLETZ treatment, your cervix may be compromised. "When you're pregnant your doctor will be keeping an eye on your cervical length with scans and sometimes it does result in you needing to have a surgical stitch just to maintain a pregnancy," says Aoife. "But in terms of fertility, there is no issue."
What about men?
"The biggest factor with men is lifestyle," says Aoife. Unsurprisingly, if a man is overweight, a heavy smoker or drinker, their sperm can be poorer quality than a man who is fit and healthy. "Having said that," says Aoife, "it's not all lifestyle and some of it is genetics. Men can have male fertility issues with regards to sperm motility and progression.
"But generally, with men, if the semen analysis isn't optimal, we do a procedure called ICSI (Intracytoplasmic Sperm Injection)." This is when one sperm is directly injected into the egg in a petri dish. In IVF, the sperm and the egg are left in a petri dish to fertilise on their own.
"Male infertility is definitely easier to treat than female infertility," says Aoife. And the age bracket doesn't apply to men. "Men constantly produce sperm. We as women are born with a finite number of eggs and as we get older that declines. Men reproduce sperm cells every three months right up until death."
How to prepare for IVF
"IVF is a big commitment," says Aoife. "It's a short-term thing, but you're going to be asked to attend appointments at short notice, to tie yourself to certain times to take your medication, you're going to be asked to show up at short notice for procedures sometimes, and women need to be ready for that."
Aoife says if you go into IVF thinking it will have no impact on your everyday life, you will find it difficult. "Mentally, when you start using the hormones and you start injecting yourself you can get heightened PMS-like symptoms. Not everybody gets it, some people will inject and feel on top of the world. But in general, we'll hear symptoms of headaches, tiredness, irritability, and women need to be prepared for those things."
Aoife also advises that if you have a particular busy work period coming up, this is not the month to start IVF treatment.
"With IVF in particular, you're looking at between three and six weeks depending on what protocol you've been prescribed.
"Our most commonly used one in ReproMed is the Antagonist protocol, which is the Short protocol. On this, you start medication right at the beginning of your cycle, usually on day two or three of your period. You have a scan about a week later, then you'd be in and out maybe every day or every second day for about a week. Egg collection will be scheduled at that point. So generally from period to egg collection it'll be about two weeks, and then if the transfer is going ahead, that will be about five days after that."
IVF is an expensive treatment, and many patients can only afford one cycle in their lifetime. Aoife says, "It is expensive and the majority of fertility treatment in Ireland is still privately funded. IVF will cost from €4,500 for once cycle."
At ReproMed, if you are a Vhi member, there is a €1,000 discount on fertility treatment depending on your policy plan. ReproMed also freezes embryos in its Dublin lab if women want to use them at a later date.
Aoife and her team of midwives and nurses are the patient-liaison team that look after all patients at ReproMed. From heterosexual couples to same-sex couples to single women, Aoife and her team immediately see them after their initial consultation with the doctor to go through what has been spoken about, make treatment plans and conduct testing.
"Our main goal is to be a support for patients throughout the treatment cycle, in a 'professional friend' capacity. We need to have a certain amount of rapport but to make sure they're getting the correct information at the correct time," says Aoife.
And the role means Aoife gets to know each patient on a personal level, and feels as if she's on the journey with them. "A lot of people don't talk about it. As a society women are quite open, we'll talk to our friends about most things but for some reason fertility is still taboo. You'd be so surprised how many people are going through it.
"Groups like NISIG, which act as a support service for women going through treatment, are great. At ReproMed we are trying to get a conversation started with people about fertility. It's one in six couples -- it's not a low rate -- it's a huge amount of people."
Patients will see Aoife from the beginning of treatment until they are eight weeks' pregnant. They are then discharged and become a patient of a maternity hospital.
On average, Aoife says IVF treatment has a 30-40% success rate globally. ReproMed however, prides itself on its 50% positive pregnancy test rate as of 2020.
For more information on ReproMed or to book a consultation, visit the website.