biological children I wanted. I wanted a mini
Nick running around, not to have to think about
using somebody else’s sperm.’
Polycystic ovaries stopped me ovulating
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The symptoms of PCOS all directly attack your femininity: facial hair, spots, weight gain. But the worst one of all is lack of periods and the resulting infertility,’ says Theresa Cheung, co-author of the book PCOS and Your Fertility, who herself underwent medical treatment to conceive her two children. ‘Getting pregnant felt like something I should have been able to do as a woman. It seemed so easy for other people. But I had to accept that it wasn’t going to happen for me naturally, that I needed medical help,’ she says.
As the most common hormonal disorder for women, affecting up to 10 per cent, PCOS (polycystic ovary syndrome) is a major cause of fertility problems. As you may know, with PCOS it’s not that you’re not producing eggs, it’s that you don’t actually ovulate, which leaves your ovaries filled with follicles that have failed to launch — the so-called ‘cysts’. ‘The hormonal environment in the ovaries isn’t conducive to ovulation,’ explains Mr Tarek El-Toukhy, Consultant and ‘
Honorary Lecturer in Reproductive Medicine and Surgery at Guy’s and St Thomas’ Hospital NHS Foundation Trust.
It’s now generally agreed that lifestyle is key for controlling PCOS symptoms, and healthy living can help to regulate your cycle. ‘Weight loss, if the patient is overweight, and exercise can both decrease the intensity of polycystic ovaries, and we see a lot of success just by doing this,’ says Mr El-Toukhy. Theresa agrees: ‘My symptoms — including a lack of periods — come back if I’m not taking care of myself by eating badly or not exercising enough.’
If you have PCOS, you’ll probably have had months, possibly years, of medical treatment by the time you reach an IVF clinic, usually starting with a drug treatment: one to induce ovulation, such as clomiphene (Clomid), and/or metformin, a drug used to treat diabetes. If this doesn’t work, the next line of attack is often an operation called ovarian drilling (this is exactly as it sounds). ‘We don’t know precisely how this operation works, but it could be related to the release of chemical substances within the tissue of the ovary, contributing to changes in the local hormonal environment and stimulating ovulation,’ says Mr El-Toukhy. Next comes IUI (intrauterine insemination — where sperm is put into the uterus around the time of ovulation), using the same ovary-stimulating drugs as IVF and, finally, IVF (although a lot of women choose to go straight from Clomid to IVF).
• • • • • • • • •
Amanda, 35, a public relations director from London, only found out she had PCOS when she came off the Pill. When ovulation-inducing drugs didn't work, she started IVF.
I had no idea that I had polycystic ovaries until my weight ballooned when I stopped taking the Pill. I went from a size 10/12 to a size 16 in a matter of months. I’d been on the Pill since I was 17, when I first got together with Adam. By my late 20s, I wasn’t happy that I’d been taking it for so long and Adam and I were about to get married, so I came off it.
Around six months after the wedding, I decided to see a doctor and get myself checked out because of the weight I’d gained and the fact that my periods had become so irregular too. That’s when I was diagnosed with PCOS.
At the time, we weren’t trying to get pregnant, but we weren’t being too careful either. For contraception, we were simply avoiding sex on the days I assumed I was ovulating. Once I was diagnosed with PCOS, it turned out that my actual cycle was so irregular, I’d been avoiding the wrong days. So, in theory, I should have got pregnant and we had, in a way, been trying for eight months with no success.
I started to use an ovulation kit, but it didn’t really work because I had such an erratic cycle. When I was monitored to see how often I was ovulating, there was no rhythm or reason to my cycle: sometimes I’d ovulate every two months, sometimes every four. Because I was ovulating so rarely, I realised we only really had around four chances a year to get pregnant. So when I was prescribed clomiphene (Clomid), a drug to make me ovulate, I was quite optimistic — you hear a lot of miracle stories about Clomid.
The first month I took it, scans showed I didn’t ovulate. So the next month, the consultant doubled my dose. You do hear bad things about Clomid too, how it can give you mood swings, but luckily I wasn’t affected. This time I did respond and, amazingly, I got pregnant.
A couple of weeks later, on my birthday, I suddenly felt very hormonal, and found myself crying for no reason. I tentatively put it down to being pregnant. Later that day, we went out for a family lunch. I felt some cramping then, during the meal, I started bleeding. When we’d finished eating, I told everyone we were going shopping but, in fact, Adam and I went to the hospital.
There, the nurse asked me to do a urine sample for a pregnancy test, then told me I was no longer pregnant. I came home and cried all night, devastated.
With my sister’s first baby due, my parents flew off to Hong Kong to visit her the next day, while I went back to my gynaecologist for a check-up. Just as I’d parked outside his surgery in Harley Street, my phone rang. It was my brother-in-law, calling from Hong Kong, to tell me I had a nephew. That hurt. I was genuinely happy for my sister and him but, at the same time, I felt sad and a real sense of loss for Adam and me.
The gynaecologist said that if I wanted, I could carry on with Clomid in my next cycle without a break. With hindsight, I can see I should have taken a couple of months to get over what had happened, both physically and emotionally. I felt sad for a long time. What did help was telling myself that there was a reason the pregnancy hadn’t continued, that the baby most likely wasn’t chromosomally right.
Ideally, you’re only supposed to take Clomid for six months, but I ended up on it for eight. I didn’t want to give up. I thought it was supposed to be a miracle drug, so I couldn’t understand why it wasn’t working for me. I was ovulating, but not getting pregnant. And I desperately wanted to know why. It was so frustrating.
I was referred to another private consultant, who took me off Clomid and put me on a drug called metformin. This helps to control blood-sugar levels, which can be high in PCOS, and can regulate your cycle so you start ovulating. She explained that it would take a couple of months to work, and if metformin alone didn’t make me ovulate, I could combine it with Clomid. If I didn’t get pregnant, she explained, the next step would be IUI.
As someone who’s extremely organised and used to being in control, those months of waiting for the metformin to work were hard for me. I kept thinking: friends are getting pregnant with their second babies and I’m struggling to fall pregnant with my first. And I was conscious that I’d be even older if and when I had a second child. The pregnancy I’d lost was still very much on my mind, and it was coming up to the due date. It felt like time was running away and there was nothing I could do about it. The one positive sign was that the metformin was helping me lose weight.
Two cycles of metformin and Clomid together didn’t get me pregnant, so we started IUI. That ramped up the stress levels. We were spending nearly £1000 a cycle and I was trying to fit in all the appointments with work, taking cabs to the clinic in lunch breaks because I was so busy.
The actual procedure itself wasn’t fun either. The sperm transfer had to be done with a full bladder, and waiting for my turn was very uncomfortable. I know being stressed probably didn’t stop the IUI from working, but it certainly didn’t make it very pleasurable. Every time IUI didn’t work, we booked in for another round. Looking back, I can see we should have stopped after two or three times but we were advised to keep going. It was like groundhog day: every month, I’d find myself back at the clinic. Finally, Adam and I decided our fifth IUI would be our last, and it was time for IVF.
I was referred to Guy’s and St Thomas’. We had all the standard tests and we were surprised to hear that Adam’s sperm count had dropped, never previously a problem. The embryologists