Our Family Is Expanding

Annemarie Eade had her life all planned out. Now 38 and living in Kilbrittain, Co Cork, she and her husband Tony were married in 2009. “Our next step was babies,” she says. “We’d been planning it that way for years and hoped to have a honeymoon baby. Little did we know.”

Things went to plan at first Annemarie discovered she was pregnant while they were on honeymoon in New York.

The couple’s elation didn’t last long. Annemarie started spotting and they rushed to hospital as soon as they arrived back in Ireland. “A scan showed there was nothing in my womb and after taking my bloods, I was sent home to rest from what we thought was a miscarriage,” she says.

The following day, she was called back to have her bloods retested. The initial sample indicated she was still pregnant. “It was confusing,” says Annemarie. “I knew in my heart there was no baby but I wanted to believe a mistake had been made with the scan.”

There was no mistake. She was having an ectopic pregnancy, a rare occurrence that can lead to fertility complications. Annemarie was just beginning what would prove to be a long journey to motherhood.

“About 1% of pregnancies in Ireland are ectopic,” explains fertility specialist Dr John Waterstone, medical director of Waterstone Clinic. “They occur when the fertilised egg implants not in the uterine cavity as it should but somewhere else, usually in the fallopian tube.”

In most cases, the cause is unknown. “They occur in normal fallopian tubes and do not run in families,” says Dr Waterstone.

There are risk factors that can make ectopic pregnancy more likely. Surgery, appendicitis, endometriosis, or pelvic inflammatory disease can damage the fallopian tubes. A previous ectopic pregnancy means there’s slightly higher risk of another. IVF increases the risk and so does using an intra uterine contraceptive device.

Annemarie had none of these risk factors but her baby was growing in one of her fallopian tubes. “Because it was still early in the pregnancy, I didn’t need to have the tube removed,” she says. “I was given an injection and it was all over.”

She and Tony soon started trying to conceive again. But this time, it wasn’t so easy. Months and months passed with no result. After a year of trying, they approached the Waterstone Clinic. There, she was booked in for a routine laparoscopy and dye test. This test checks for blockages in the fallopian tubes. “They inject dye into the tubes and it should go in and come back out again,” says Annemarie. “But with me, the dye wouldn’t go through and it was clear that there was a problem.”

Despite subsequent testing, it never became clear what that problem was. “All we knew was that it was now more likely we’d need IVF to have our babies,” says Annemarie.

Then a surprising thing happened. she got pregnant. However, the pregnancy followed the same pattern as the first: Spotting followed by a diagnosis of ectopic pregnancy.

“My heart broke when they told us to try again and I wondered if I’d be able for a pregnancy failing a third time,” she says. “That was when we decided it might be better to try IVF.”

Women who have had ectopic pregnancies follow the same IVF procedure as women who have not. They take hormonal injections to encourage the growth of multiple eggs. Those eggs are removed and fertilised with sperm and if an embryo is successfully created, it is transferred into the woman’s womb.

IVF worked for Annemarie but she didn’t believe she was pregnant until they had their six-week scan. “I was so used to scans showing nothing and this time there was a blob — our blob.”

The pregnancy passed without incident and the couple’s daughter Madison was born in June 2013. At that stage, they had one embryo in storage and a year or so after Madison was born, they had it transferred. The procedure worked but the six-week scan showed there was nothing in her womb.

“It wasn’t an ectopic; the pregnancy just wasn’t viable,” she says. “It was another low point for us. The years we were trying for babies were all like that: Going from high to low to high to low.”

They started a second cycle of IVF but it wasn’t successful. “I was inconsolable when I got my period that time,” remembers Annemarie.

They tried a third time but by now they were worrying about the cost. Like most health-insurance policies, Annemarie’s provided limited fertility cover. She received a one-off payment of €1,000 for the first cycle.

“I was afraid of what would happen if the third cycle didn’t work,” she says. “I didn’t know if we could afford a fourth.”

She didn’t have to worry as the third cycle succeeded and their son Parker was born in February 2016. “Then we had one of each and we were the luckiest people in the world.”

Looking back, she still doesn’t know why having children was so difficult for her. “I’d always had irregular periods but other than that, nothing was wrong,” she says. “There’s no reason why I should have had ectopic pregnancies.”

www.ectopicireland.ie

FACT FILE

• Ectopic pregnancy is a life-threatening condition affecting approximately 1% of pregnancies.
• Ectopic means out of place and an ectopic pregnancy is one which implants outside of the uterus. 95% of ectopic pregnancies occur in the fallopian tube but it is possible to have an ectopic pregnancy in the ovaries, cervix or abdomen.
• The symptoms of ectopic pregnancy are just the same as for regular pregnancies. It is not until the foetus begins to grow that symptoms begin to occur.
• Symptoms can include abdominal pain, vaginal bleeding, pain or diarrhoea during a bowel movement, pain when passing urine, nausea and feeling light headed or faint. If not treated the ectopic pregnancy can rupture and cause severe bleeding which can be fatal.
• An ectopic pregnancy cannot be saved. Treatment options depend on the size and age of the pregnancy. If there is any risk of rupture it must be removed.
• In some cases, the pregnancy does not progress and it may be possible to manage without surgery. In other cases, the surgeon may perform keyhole surgery under general anaesthetic to remove the pregnancy. If the tube is damaged or if there is significant bleeding, the tube may have to be removed too.
• If the ectopic pregnancy is not diagnosed early or if the woman presents with severe symptoms, open abdominal surgery may be necessary. In this case, it is unlikely the tube will be saved.
• In some other cases, a drug called methotrexate is given in injection form to treat the ectopic pregnancy.
• If your fallopian tube and/or ovary is removed, your fertility may be affected. The majority of women who have one tube left are pregnant again within 18 months of trying. Those that aren’t can try fertility treatments such as IUI. However, if both tubes are removed or if there are complications, IVF may be the only option.
• Women who have had previous ectopic pregnancies are at higher risk of having another. Therefore they should have an early pregnancy scan, at five or six weeks’ gestation. Once the pregnancy is established, no special care is required for mother and baby. The pregnancy should progress the same as any other.

Link:http://www.irishexaminer.com/lifestyle/healthandlife/parenting/against-the-odds-life-after-ectopic-pregnancy-457222.html

Name: Rebecca O’Callaghan

Lives: Ballincollig

Job title: Fertility nurse specialist at Waterstone Clinic, Cork.

Salary bracket: I’m very lucky in that I love what I do and it pays the bills.

Education background: I attended both primary and secondary schools locally in Ballincollig, and completed my Junior and Leaving Certificates there also. I went on to study a BSc (Hons) in General Nursing at University College Cork. My core hospital group, where I did most of my work placements, was Cork University Hospital.

Hobbies: My hobbies include going to the gym, socialising with friends, shopping, beauty and reading when I get the time.

Describe your job in five words: Challenging, interesting, satisfying, educational and rewarding.

Describe yourself in five words: Motivated, friendly, chatty, hard-working, and soft.

Personality needed for this kind of work? I think with all walks of nursing there is a specific type of personality needed to cater to the job. You need to be professional and vigilant, and constantly thinking about the next potential step for a patient. You have to not only be aware of the medical side of things, but the emotional side of things too when it comes to fertility. You need to be straight in the decisions you make, but caring and kind in how you make and deliver them. You also need good communication skills, not only with your patients, but also with your fellow colleagues for care to run smoothly. You need to love what you do.

How long are you doing this job? Two years.

How did you get this job? I always knew I wanted to be a nurse. When I completed my CAO in school, I included General Nursing in every county possible. Luckily, I achieved enough points to study here in Cork as I am a major home bird!

I began the four-year General Nursing course in University College Cork in September, 2010. For the first three years, study was divided between lectures and practicals in the college and work placements in all different hospitals and fields of nursing. This gives you a great insight early on into which area of nursing might suit you best. You get to experience working on both surgical and medical wards in various hospitals and the emergency department, theatre, intensive care and specialised areas too.

You also get the chance to experience midwifery, psychiatric nursing, intellectual disability and public health nursing. My personal interests mainly revolved around emergency nursing, and surgical/theatre nursing. I worked on an orthopaedic and plastics surgical ward in Cork University Hospital prior to coming to Waterstone Clinic — two very different areas!

When I heard about a job going in the fertility field, the whole aspect really appealed to me and, being a spontaneous person, I went for it and was lucky enough to get it. I’ve loved every minute there so far. It shows that even if you think you have found the job for you, there are many other possible opportunities out there too.

Do you need particular qualifications or experience? Some nurses in Waterstone Clinic are qualified in Midwifery, some General Nursing, and others in both.

Describe a day at work: Your day can start at different times, depending on what you are rostered for that day. We run a full theatre and recovery for patients having fertility procedures such as egg collections, embryo transfers, IUIs, aspirations, and testicular biopsies as part of fertility treatments such as in vitro fertilisation, intrauterine insemination, ovulation induction, frozen embryo transfer cycles, donor egg cycles, etc.

Every day, one or two doctors hold a clinic for patients to come in to meet them, whether it be for a first consultation or review consultation, and a nurse will always assist a doctor with these.

We have a full-time nurse in the office taking patients’ calls and queries all day. We also have nurses doing their own consultations with patients, taking bloods, and doing drug demonstrations.

Every day, there are nurses also seeing people through scan appointments. We also have nurses working in more specialised fields, such as egg donation, sperm donation and PGD.

How many hours do you work a week? 40.

What do you wear to work? A comfy pair of navy scrubs.

Is your industry male or female dominated? There are more females than males staff wise. Our nursing, reception and admin teams are mainly female. However, we do have three male fertility consultants, two male embryologists and one male andrologist.

Does this affect you in any particular way? Not at all. The whole team is amazing.

Is your job stressful? How? Rate it on a scale of 1-10: I think any job in nursing will always have some level of stress attached, especially when so much of other people’s lives depend on you. There are some days that can hit a 10 and others that are more relaxed. I think once you love what you’re doing, it’s all worth it.

Do you work with others or on your own? I work within a large group of people made up of lots of different teams and each person is as important as the next.

When do you plan to retire or give up working? When I’m 65! A long way to go yet.

Best bits: Knowing that every day you go to work, you get to help somebody. Also, receiving photos of beautiful babies a few months down the line from when patients have attended the clinic is an amazing feeling.

Worst bits: Unfortunately, fertility treatment does not hold 100% success rates so seeing people struggle is heart-wrenching.

Advice to those who want your job? Prepare to work hard. However, the happy endings will make it worth it.

Waterstone Clinic is Ireland’s largest independent fertility specialists and has a state-of- the- art national centre of excellence at Lotamore House in Cork.

An insight on Gene Editing technology and its moral and ethical implications with David Mc Connell, Gerard Casey, Pat Clarke and John Waterstone.

Sarah Carey from Newstalk speaks with Dr John Waterstone about his views on gene editing, PGD at our clinic and the issue of state funding and legal aspects attached to Preimplantation Genetic Diagnosis.

Listen to the interview here:

http://www.newstalk.com/player/embed.php?mediaType=podcast&id=201201%27

Unfortunately, some couples experience unexpected obstacles along their journey when trying for a baby. We chatted to Mary McAuliffe, Head of Clinical Service at Waterstone Clinic,which has just opened a state-of-the-art national fertility centre of excellence at Lotamore House in Cork, and asked for her insights into what you can do when things don’t go quite to plan.

Most couples start out assuming the path to parenthood will be pretty straight forward, and can be thrown off course when pregnancy doesn’t happen as quickly as expected. From excitement and anticipation, to frustration and upset, there is no denying it can be an emotional rollercoaster if waiting for that positive test takes too long.

And while a lot of couples are definitely becoming more proactive regarding their fertility, going for fertility assessments before trying to conceive; others can be uncertain about how long to wait before seeking help and advice.

“The female partner’s age is one of the main factors influencing her chances of conception, McAuliffe explains. “Ideally, if the woman is over 35, investigations should be started after six months of trying. If she’s younger, seek help after trying to conceive for 12 to 18 months.”

It is a fact aht as many as one in five couples will have a delay in becoming pregnant, so getting help early is key.

“In these situations, I would advise taking a two-pronged approach – making contact with a clinic and, at the same time, trying to boost your fertility. There are many things a couple – both the male and female – can do to increase their chances of having a baby, such as quitting smoking, reducing alcohol intake to healthy limits or stopping it all together, and eating a well varied and healthy diet.”

McAuliffe also points out that both parts should aim to get plenty of exercise, maintain a healthy BMI and take a good quality vitamin supplement and folic acid.

“Couples should also be aware of their own past medical history, and it is helpful if the female partner is aware of her mother’s history, such as early menopause. Ask yourself, have you experienced changes in cycle pattern, or have a history of endometriosis or PCOS? Does your partner have a history of testicular injury, undescended testis or testicular mumps or any other condition that you may suspect has had a negative effect on fertility?”

In such cases, McAuliffe suggests seeking help early regardless of age. It is helpful too to keep a menstrual cycle calendar, tracking your cycle length.”

“It is helpful too to keep a menstrual cycle calendar, tracking your cycle length.”

Anohter tip she shares is to have the reassurance that the clinic you attend is offering you the best chance of having a baby.

“It is always good to make contact by phone with the clinic beforehand, as you get a good feel for the team by asking some questions or chatting through some of the areas you are concerned about. The patient liaison team will talk you through a series of blood tests and investigations that are helpful when attending an initial consultation. These investigations will help in diagnosis”

At the Waterfod Clinic consultations are available within two weeks, and the more information the couple have at these visits, the more that can be achieved.

“Some couples may feel that if they attend a fertility centre, it will always progress onto treatment. That’s not always the case, McAuliffe explains. “That initial consultation is about offering an assessment, information and honest advice.”

For many, she points out, this visit will provide reassurance that all is well and to continue trying, while also providing the opportunity to build a plan and timeline for them to return if needed.

“If a couple are advised to consider treatment, we encourage them to take an information pack home, take time to talk over it together, and call if they would like to discuss the treatment further. This usually leads to further questions, which can be answered by phone, or some couples will pop back for further information session.”

https://www.herfamily.ie/pregnancy/ask-expert-steps-take-facing-fertility-concerns-269398